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[violetbat]

I started HRT 5 years ago when I was 51 and still having periods.
Since then have been on a sequi regime using gel initially and now everol 100 and utrogestan.
I have always hated the utrogestan- even taking it vaginally it would cause horrible acne , bloating and pain pretty much the entire time.
In this time no gp has asked for a review.
Fast forward to last month. I asked the gp if I could switch to norithisterone as I know I can tolerate that better.

She reluctantly agreed and prescribed me the three tablet one- this of course is not available anywhere so I had to go back and be given the 5 mg tablet which I can cut in half and use as sequi until the lower dose becomes available.

Anyhow I questioned whether she was trying to put me on a Conti regime with the lower dose tablets. She was and referred me to sections of the BMS which said that after 5 years women should ideally use a conti regime as they get better endro protection.
She didn’t at any point discuss this with me before hand.

The thought of having to take progesterone everyday scares me.

 I always feel crap on it. The 2 weeks break I get on sequi is a blessed relief.

Can any wise people on her advise as to whether this is the best way to go though?
Many thanks🙂

[Taz2]

No you don't have to change. Others on here are still on sequi in their sixties. I swapped back at 57 as I hated the progesterone full time too. I've had a hysterectomy since due to prolapse so only use oestrogen.

Just a thought violetbat but if you like norethisterone could you change to patches as Evorel sequi contains this?

Taz x

[violetbat]

Thanks taz. The dr suggested this but it would mean 2 patches and hence double the itching as I am on everol 100. Although I have been wondering whether I should cut back and see what happens?🤷🏻‍♀️

[sheila99]

I have the same problem. They told me there's a slightly increased risk of endometrial cancer with sequi. I use long cycle (6 week sequi) with utro. Can you let me know how you get on with norethisterone? I got on with it in evorel patches but had to change as i became allergic to the glue. At the time gp wouldn't prescribe it so I've been on utro which wipes me out.

[violetbat]

I have the same problem. They told me there's a slightly increased risk of endometrial cancer with sequi. I use long cycle (6 week sequi) with utro. Can you let me know how you get on with norethisterone? I got on with it in evorel patches but had to change as i became allergic to the glue. At the time gp wouldn't prescribe it so I've been on utro which wipes me out.

I had to put up a bit of a fight to swap. I will update. I bloody hated having to shove those tablets up my vagina. A tinny half tablet feels so much more do able!

[Donna69]

I have had so much trouble swapping did exactly the same to me I was happy on sequi but 5yrs on gp changed me to conti and I felt dreadful and then bled for 7 weeks.I have come off hrt all together now as they refused to put me back on sequi.Turns out at 54 I am still peri and get the odd period so by what I have read I should still be on sequi they really need to review the guidelines and stop pressuming everyone is menopausal by 54

[Ana21]

I was postmenopausal when I started hormone therapy, so I started on continual MHT.  I was plagued by unscheduled bleeding for several years.  My old doctor was a firm believer in postmeno = continual.  My new meno doctor switched me to sequential to see if it would control the bleeding.  It does.  I'm almost 60 and I was switched to sequential two months ago.  It's about what works for your body.  I have a very thin endometrium and the continuous progesterone was causing bleeding.  By the time I saw my new doctor, I was spotting 21 days per month on average.  MHT has to be tailored to individual needs.

[Donna69]

It’s a minefield getting hrt I was so happy on sequi it just worked for me I don’t get on with progesterone so just having it the last few days was ideal.no one will let me go back on it so came off hrt all together and now my life is a mess of anxiety,hot sweats months with no periods the periods that go on for weeks.Does anyone know if I was to go private a gynaecologist be a better help in the minefield of hrt?

[Ana21]

Hi Donna69

I wasn't officially postmeno until just before my 55th birthday.  I'm so sorry you felt you had no option but to stop taking MHT altogether.  You need to start looking for a new doctor.  I'm in Canada, so things may be different here, but there can be long waiting lists to attend the clinic/doctor of your choice.  It took me 18 months.  It was worth the wait.

[Penguin]

It’s a minefield getting hrt I was so happy on sequi it just worked for me I don’t get on with progesterone so just having it the last few days was ideal.no one will let me go back on it so came off hrt all together and now my life is a mess of anxiety,hot sweats months with no periods the periods that go on for weeks.Does anyone know if I was to go private a gynaecologist be a better help in the minefield of hrt?

You could contact a few private menopause clinics and question them re their policy before booking the appointment. For example, I called Prof Studd's clinic to check they still allowed utrogestan for shorter periods with scans and was told they didn't anymore, so I didn't end up booking in with them as it would have been a waste of money. If you just ask a general question when you phone re allowing women to do x at y age then they should be open re their policy on that.

[Hurdity]

As per the other answers. No need to transfer to conti HRT if progestogens taken continuously do not suit you. I'm probably one of the oldest on here still taking cyclical HRT. I'm 70. OK it's horrible having to have a withdrawal bleed, but there is no choice if I want to stay on HRT as I still have a womb, and love the times when I am on oestrogen only!

Hurdity x

[Ana21]

Endometrial cancer rates have been on the rise for some time.  I recently read:  "Over the last decade, the incidence and mortality rate of endometrial cancer have increased disproportionately compared with other cancers.  In some communities, endometrial cancer is already more common than breast cancer and leads to the death of more women than lung cancer."  You see a similar trend globally.  In some countries, it's the only gynaecological cancer that showed mortality rates increasing.  I read a statistic stating that, globally, the rise in endometrial cancer diagnoses is projected to continue; estimates suggest another increase of over 50% by 2040.

So I'm not surprised that Professor Studd's clinic has changed their policy.  That's the direction things are heading. 

[Penguin]

Endometrial cancer rates have been on the rise for some time.  I recently read:  "Over the last decade, the incidence and mortality rate of endometrial cancer have increased disproportionately compared with other cancers.  In some communities, endometrial cancer is already more common than breast cancer and leads to the death of more women than lung cancer."  You see a similar trend globally.  In some countries, it's the only gynaecological cancer that showed mortality rates increasing.  I read a statistic stating that, globally, the rise in endometrial cancer diagnoses is projected to continue; estimates suggest another increase of over 50% by 2040.

So I'm not surprised that Professor Studd's clinic has changed their policy.  That's the direction things are heading.

That's quite worrying. What is the cause, do you think? Is progesterone every day more protective against endometrial cancer just because it keeps lining thing? Can that not be achieved as readily on a sequi regime? Prior to perimenopause women wouldn't generally have high levels of progesterone throughout their whole cycle so I guess I'm just trying to understand what is sufficient to manage the risk.

[Ana21]

Hi Penguin!

I didn't want to cause worry.  Endometrial cancer rates have been rising for decades.  You had mentioned Professor Studd's clinic and I thought this might explain the change in policy at his clinic and elsewhere, as well as the general behaviour of doctors regarding hormone therapy.

More than 80% of endometrial cancers are estrogen related, so factors that affect estrogen exposure may largely explain the increase.  Key influences are high and rising rates of obesity, which can increase levels of estrogen, diabetes, and the shift in reproductive trends, such as delaying childbirth until later in life and having fewer children.  For example, in North America, it's estimated that increasing rates of obesity account for nearly half of all cases.

Other hormonal risk factors include beginning menstruation at an early age, later menopause, not having children, estrogen-only MHT for women who still have a uterus.  Use of oral contraceptives appears to protect against endometrial cancer.

Based on the posts, the women on this forum are receiving excellent care and screening.  Many women do not.

[Penguin]

Hi Penguin!

I didn't want to cause worry.  Endometrial cancer rates have been rising for decades.  You had mentioned Professor Studd's clinic and I thought this might explain the change in policy at his clinic and elsewhere, as well as the general behaviour of doctors regarding hormone therapy.

More than 80% of endometrial cancers are estrogen related, so factors that affect estrogen exposure may largely explain the increase.  Key influences are high and rising rates of obesity, which can increase levels of estrogen, diabetes, and the shift in reproductive trends, such as delaying childbirth until later in life and having fewer children.  For example, in North America, it's estimated that increasing rates of obesity account for nearly half of all cases.

Other hormonal risk factors include beginning menstruation at an early age, later menopause, not having children, estrogen-only MHT for women who still have a uterus.  Use of oral contraceptives appears to protect against endometrial cancer.

Based on the posts, the women on this forum are receiving excellent care and screening.  Many women do not.

Thanks, that all makes sense. I guess the estrogen risk is more when it is unopposed then as lining isn't shed sufficiently.