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[Cassie]

I read an article that said if one is over a certain age and has been on sequi hrt for more than 5 yrs it is advised to take a continuous no bleed hrt. I am not keen on that and was wondering if there is any medical reason to switch over to conti, after a certain age, apart from the fact that its a bit of a nuisance to be having bleeds in your late 60s or even into your 70s but am sure that there are ladies on this group who still get bleeds in their 60s? Any idea the reason behind the theory that its safer to use conti in later years?

[Cassie]

Hurdity, you may have some insight here, I seem to think you had a post about this previously? Would be good to know the reasoning behind the theory of continous hrt after a certain age? 

[sheila99]

I haven't seen any medical evidence to back this up. Isn't it that they assume you won't want a bleed if you're meno? Hurdity is on long cycle sequi so presumably doesn't think it's harmful.

[applejack]

I asked my doctor this very question as a result of my post meno bleeding, and said I would prefer to go sequi even though it's inconvenient to have a bleed and she said it's not what they're advised to recommend.

I have no idea why though. She just said it was in line with the advice they were given

[Cassie]

Exactly, Applejack, I read it on some med forum, cannot remember where, would really like to know what the reasoning is, dont want to be doing myself an injustice but would like to know if its a proven fact.

[applejack]

For what it's worth I've booked an appointment with a private doctor next week who specialises in women's health/menopause and I'm going to ask her this exact question.

I'll report back if she answers it!

[pepperminty]

Hi, I found the below,

Forms of hormone replacement that give continuous progestogen with the oestrogen have been developed to avoid bleeding altogether. This method is called ‘continuous combined HRT’ and is thought to reduce the risk of endometrial cancer even more so than sequential HRT. If you have had at least a year without periods and are thought to be postmenopausal, continuous combined HRT can be used.

 I think it has to do with the increase risk of cancer types. But that said it is more risky drnking and smoking and being over weight  etc. So it is about weighing up the risks and benefits.

PeppermintyXX

[applejack]

This is pretty much what the doc told me this morning.  I asked about this specifically and she said that yes, whilst it it sounds counter intuitive, conti is more protective of the endometrium post menopause

[Cassie]

Thankyou Applejack did she specify why though? And from what age?

[applejack]

Sadly we didn't get enough time to go through it in detail but that will come once my biopsy results arrive - hopefully if the results aren't bad news I'll need to have a proper discussion about what to do next re HRT and this is one of the issues I need resolved.

Results are apparantly ready, but not posted yet.  Expect they'll be landing on the doorstep in the next couple of days.

YIKES!

[sheila99]

Are there any studies to back this up or is it an educated guess?

[Hurdity]

Long time ago I read up on this so have in my head that evidence shows that the risk of endometrial cancer is slightly greater with sequi HRT than conti HRT  ie progesterone taken on a cycle or all the time. However we are talking about RELATIVE risk rather than ABSOLUTE risk which remains low provided that you maintain the right balance between oestrogen and progesterone, even on a sequi cycle. You need to get to know your womb and what it can take and I presume you will know this now after many years on HRT ie you will know whatrs normal for you.

So no it's not an age thing. Most docs put women onto conti HRT once they are post-menopausal or at age 54 if they were peri when they started and have been on HRT for some time.

As sheila says most women do not want to bleed and yes I am now late 60's and still on cyclical HRT (course of progesterone every 6 weeks or so) as sheila also said! Of course I hate it (hacving the damn bleed) and would rather not but even more I would hate to be taking progesterone continuously though many women do not mind this at all. In my case it's not heavy and so I know my womb is protected. Now and again I've had scans for one reason or another nad has always been OK. I have a small fibroid which I assume is not getting bigger (has been measured twice and wasn't).

Always best to go by the licensed dose (of progestogen - if taking them separately) but this can be tweaked after consultation with your doc and as you bcome post-meno and you know how your womb behaves. All persistent or troubling abnormal bleeding should be referred to doc just to be on the safe side.

Have you got a link to the article Cassie?

Hurdity x

[Cassie]

I dont have the link Hurdity, it was whilst browsing. I only use half a pump to one pump at most and  I am really hoping the 100mg of Utro is doing the trick for 12 days I use it also every 6 weeks. I would hate to have to take it daily.

[laszla]

I too have read the studies that determined slightly greater endo cancer risk on sequi but as I am looking into this dilemma (54 I've been advised to go on continuous), confusingly I've also read on Prof Studd's site that continuous progesterone "may be the harmful factor in the causation of cardiovascular disease."
I for one am more worried about cardio risks than cancer, both parents and grandparents all having had ticky hearts but no cancer in the family. And I hate taking progesterone, I agree with you Hurdity that even the nuisance of a bleed is preferable to constant progesterone. I believe scans aren't available on the NHS and I imagine one needs to regularly check it if staying on sequi.

[Cassie]

Would love to get a professionals opinion & advice on this.