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[SueRoe]

I use Femseven Sequi and feel much better during the combi phase with progesterone than during the oestrogen-only phase. So, does anyone know if it would be unwise to use the combi patches throughout the month without a break from one month to the next? It seems to me that this would be safe because the combi patches deliver 10 micrograms progesterone per 24 hours, much less than the progesterone-only contraceptive pill which delivers 30 micrograms per 24 hours and that is considered safe even for women who smoke. It's less than a year since my last "natural" period so according to advice I should use a 2 phase HRT. But why? It's not necessary to have a bleed is it?? I've read the info on this website but I can't find the answer to this. Toodlepip.   

[honeybun]

It is said you should not be on a conti HRT until you are about 54. I was on sequi for two years until I was about 52. I then had spotting during the month and my GP moved me to Evorel conti.
I wad really unsure so emailed Dr Currie who said it was fine.
Some women struggle with progesterone....I am not one of them.

If you are happier on the combined patch then ask your GP. You really can't just use half a box of HRT a month. You would be renewing your prescription far too often.


Honeyb
x

[SueRoe]

Thanks honeybun, I understood it to be that you shouldn't be on conti until you are 54 or haven't had a natural period for a year - but you can't tell that if you're on HRT can you? I think I'll try using the combi patches for a month and see how I feel then speak to my GP as you advise. I don't know about the effect of combi on womb lining - presumably it can't build up so no bleed or slight bleed... (zippety do dah!)

[honeybun]

Strangely enough lots of women have a lot of spotting and light bleeds on a conti patch.
Took me a good few months to settle and for the bleeding to stop.

At least if it happens you will know what's happening.


Honeyb
x

[Suzyq]

I use progesterone everyday at 49 and not fully menopausal! It makes me feel much better - I am terrible on estrogen only - anxious and panicky! I don't think there's any problem with either method at any age - it is purely what works for you!!!

[Dana]

If you were using the combined sequi patches every day of the month, instead of just half the month, the overall prog dose might be too high. Using that dose for 2 weeks is meant to initiate a bleed, but if you were to be on a conti HRT the daily prog dose would usually be lower. I know you are only doing it as an experiment, but just be aware of that.

I think it's very much up to your doctor, and you as an individual case, as to whether you are on the conti or the sequi type. When I first started having my meno symptoms at 51 my doctor put me straight on to a conti HRT, and I had only been 6 months without a period. I then went off HRT at the age of 52 for about 4 months, and I never got a bleed during that time. I'm now 55, so I can only assume that I've been post meno for around 3 years, but I don't really know that for sure.

[Taz2]

Although it's tempting to use the one that makes you feel better I would be really wary of this without first having the docs advice. The risk of endometrial cancer is real. Also, lots of us know the inconvenience of being over 50 and finding that our womb lining is too thick which then triggers a whole list of scans and appointments - under NHS guidelines - often leading to hysteroscopy in order to give the all clear.

As you are 52 I really think that your GP would be sympathetic to you using the conti HRT. I believe that Honeyb's doc was agreeable for her to start before 54 but just check it out first.

How are you getting on with FemSeven? I see you recently changed from Evorel. Have you had a bleed and was it heavy or light?

Taz x

[honeybun]

I agree with Taz about the pitfalls of self medicating.

Just a question though. Is the dose of conti patches not the same if you see what I mean. ie....the second half of the sequi (combined oestrogen and progesterone) as the conti for the month. Ok that's,as clear as mud but I can't think how else to put it 


Honeyb
x

[Limpy]

I think Taz & HB are right re self medicating.

I think I see what you are getting at HB
Is it - with Evorel sequi the patches for the second half are actually the same conti patches which are used in Evorel Conti - all the time ?

[SueRoe]

There's a table available at MIMS.co.uk about the types of HRT and the doses they achieve. I've just been checking and those who've expressed concern about the dose of progesterone are correct - Femseven sequi dose is 10 micrograms per day and Femseven conti dose is 7 micrograms per day according to those figures. Thanks for that, I'll see my GP. 
Taz2 you asked about the change from Evorel to Femseven - I find Femseven much better for me in the +progesterone phase ie mood more stable, sleep better, just spotting and no cramping. Plus the patches seem to gather far less fluff than Evorel and don't leave a gluey square on my tum. Thanks for your advice ladies. x

[Hurdity]

The point about using sequential HRT while you are peri-menopausal is that your own cycle is still fluctuating and there is likely to be unpredictable spotting and bleeding. Yes Freda conti HRT works to prevent a bleed (eventually when you are post-menopausal) because the progestogens interfere with the oestrogen receptors in the uterus lining and work to prevent growth and build-up - which is why the dose needs to be right for the amount of oestrogen being taken.

Some women are not progesterone intolerant and during fertile menstruation ( rather than HRT induced withdrawal bleed) only felt rough during the few days immediately prior to the period rather than for the whole two weeks. This type of pmt is the same as such women feel on HRT just after stopping the progesterone phase and just before the period - so now on the oestrogen only phase. It is thought to be caused by the physiological changes caused by the sudden fall in progesterone and can lead to headaches, tension and irritability. Once the progesterone has cleared from the system and the physiological changes reversed, most women feel much better.

Unfortunately with HRT the hormone changes in the menstrual cycle are not replicated. - it is just 2 weeks of oestrogen and then 2 weeks of both hormones - and often the progestogen is synthetic which can make the problem worse. Therefore the time that women feel well on the oestrogen is very short.

This leads women to believe that oestrogen only is making them feel rough, but this is not the case. During the natural/fertile menstrual cycle once the period has started most women feel at their best for perhaps a couple of weeks until either the progesterone reaches its peak - or during the withdrawal ( when pmt is experienced).

For those who are able to opt for a longer cycle - it is easy to recognise this, and the length of time on oestrogen only is greater - so it is possible to feel really good for much longer, without the progesterone being in the system.

Freda I think you fall into this category - you can tolerate the progesterone but experience normal pmt before your bleed during the progesterone withdrawal phase.

As has been mentioned Evorel is different from Femseven because the progestogen dose for Evorel conti is the same as the combi patches on the Evorel sequi preparation ie both are Evorel conti.

Personally I would not want to take progesterone all the time because of possible interference with the beneficial effect of oestrogen (ie interference with oestrogen receptors), and as far as I recall the cancer risks in the study on which all the risk info is based, were higher on progestogens than oestrogen alone. This study is limited though.

All this being said I can see why anyone would want to adopt a regime that makes them feel the best they possibly can!

Bit of a ramble!

Hurdity x

Later edit to correct typos - I always read my posts through, but usually to see if what I've written makes sense and sounds fair but try to correct typos too - some of them get away 'cos it takes ages to write the posts anyway and then mealtime is calling (or something else!)

[Taz2]

A ramble maybe Hurdity but an informative one!!

Taz x 

[SueRoe]

Thanks for all the info Hurdity.

[maggiesinc]

The point about using sequential HRT while you are peri-menopausal is that your own cycle is still fluctuating and there is likely to be unpredictable spotting and bleeding. Yes Freda conti HRT works to prevent a bleed (eventually when you are post-menopausal) because the progestogens interfere with the oestrogen receptors in the uterus lining and work to prevent growth and build-up - which is why the dose needs to be right for the amount of oestrogen being taken.

Some women are not progesterone intolerant and during fertile menstruation ( rather than HRT induced withdrawal bleed) only felt rough during the few days immediately prior to the period rather than for the whole two weeks. This type of pmt is the same as such women feel on HRT just after stopping the progesterone phase and just before the period - so now on the oestrogen only phase. It is thought to be caused by the physiological changes caused by the sudden fall in progesterone and can lead to headaches, tension and irritability. Once the progesterone has cleared from the system and the physiological changes reversed, most women feel much better.

Unfortunately with HRT the hormone changes in the menstrual cycle are not replicated. - it is just 2 weeks of oestrogen and then 2 weeks of both hormones - and often the progestogen is synthetic which can make the problem worse. Therefore the time that women feel well on the oestrogen is very short.

This leads women to believe that oestrogen only is making them feel rough, but this is not the case. During the natural/fertile menstrual cycle once the period has started most women feel at their best for perhaps a couple of weeks until either the progesterone reaches its peak - or during the withdrawal ( when pmt is experienced).

For those who are able to opt for a longer cycle - it is easy to recognise this, and the length of time on oestrogen only is greater - so it is possible to feel really good for much longer, without the progesterone being in the system.

Freda I think you fall into this category - you can tolerate the progesterone but experience normal pmt before your bleed during the progesterone withdrawal phase.

As has been mentioned Evorel is different from Femseven because the progestogen dose for Evorel conti is the same as the combi patches on the Evorel sequi preparation ie both are Evorel conti.

Personally I would not want to take progesterone all the time because of possible interference with the beneficial effect of oestrogen (ie interference with oestrogen receptors), and as far as I recall the cancer risks in the study on which all the risk info is based, were higher on progestogens than oestrogen alone. This study is limited though.

All this being said I can see why anyone would want to adopt a regime that makes them feel the best they possibly can!

Bit of a ramble!

Hurdity x

Later edit to correct typos - I always read my posts through, but usually to see if what I've written makes sense and sounds fair but try to correct typos too - some of them get away 'cos it takes ages to write the posts anyway and then mealtime is calling (or something else!)