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[jaymay]

Hi,

I’ve been on evorel sequi hrt patches for about 14 years. I’m 56 this year. I had some bloods done recently (sex hormones, thyroid vitamins and bloods) suggest I’m definitely post meno now. My ostrogen level was good and my testosterone was at the top of the range(not on testosterone treatment)

I have tried evorel conti patches twice in the past to try and get away from having withdrawal bleeds and it gave me bad low back pain and dragging period type pains.

I had scans done each time and everything was fine. The pain and bloating went as soon as I removed the patch. It was unbearable. My withdrawal bleeds have always been at the right time and no bleeding in between.

I also tried oestrogen patch and separate utrogestan in the past which gave me massive heartburn. I just couldn’t cope at all. I don’t want to take anything vaginally as I am on vagifem and everything V.A is stable so don’t want to change anything. I definitely do not want a mirena coil either as I don’t want something that can’t be stopped or removed easily if there are issues. Also I have problems with getting my smear done and have to go to the colp clinic at local hospital to get them done because of issues with position of cervix and V.A.

I just recently tried conti patch again and had the same problem as before. I stopped the hrt completely for a week and all the pain (as before) went, but I had palpitations and started again with the return of hot flushes.

Ive gone back onto my evorel sequi patches and pain and palps have gone. I think I am perhaps sensitive to progesterones.

My only questions are please:

1)Can I stay on evorel sequi patch indefinitely?

2)The way I read the info in the patient info leaflet it seems to say that it is used for osteoporosis in post meno women?  which seems to suggest that its ok to use post-meno? I might have got the wrong end of the stick and read it wrong though.

Thanks

[sheila99]

I stayed on sequi til 64 because I couldn't find a progestogen that agreed with me. They told me there's a slightly higher risk of endometrial cancer this way but they agreed to it. How long before you get side effects? It seems a bit odd that you're OK on the combined patch for a sequi regime but not when you use the same patch for conti.
I spent a long time not wanting a mirena for the same reasons as you but I had one 2 months ago and it's been great.

[jaymay]

Thanks, Sheila.

The issues happen quite quickly. I waited for the end of my sequi and withdrawl bleed and then started the conti. I was fine for about ten days or so and then the back pain and period type dragging pain started. I took the patch off and the pain went away in a couple of days. I then restarted with half a patch but same thing happened. I just wondered if the progesterone built-up after a while and if when I’m on the sequi the levels increase and drop so the side effects not so noticeable….I just don’t know.

I do get period-type pain with my withdrawal bleed on sequi but it goes away again when I’m back on the oestrogen only patches.

[bombsh3ll]

If you feel well on sequi but not on continuous then you should be afforded the autonomy to choose to continue sequi and accept the small theoretical increased risk of endometrial hyperplasia.

Guidelines recommend menopause hormone therapy prescribing is individualised and based on shared decision making, however some GP's particularly if they lack confidence or experience, tend to stick rigidly to arbitrary age based cut-offs for switching to continuous.

Many do not even understand the rationale behind this, it's a computer-says-no situation.

It is also worth noting that whilst endometrial risk is slightly increased if sequential HRT is used long term, other outcomes such as breast, cardiovascular, thrombotic etc and possibly cognitive appear to be more favourable with sequential vs continuous.

[jaymay]

Thank you so much for your reply.