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[ScottishCatLady]

I have been doing brilliantly for a couple of years on these patches, life changing in fact as I was virtually bed bound with early onset symptoms due to being AuDHD for a few years prior.

I am now back to struggling again with chronic fatigue, horrible anxiety, some night sweats and just plain old inability to get going. It's crushing if I'm honest and I want to nip it in the bud as things are falling apart quite rapidly.

I am wondering what my options are now as I don't think there's an increased dosing option on Sequi? I do also have a horrible fatigue week every cycle but I don't think I can do continuous yet due to my age?

I'm going to make an appointment with my GP who is fantastic so I'm not worried about that, just want to go in with some knowledge of my options. (I do also have testosterone, when I remember to apply it...).

Thank you all!

[bombsh3ll]

At 43 you could be on a combined oral contraceptive pill continuously with no bleeding, no hormonal ups and downs and a much more generous dose of estrogen.

I take Zoely and I love it. I'm 45.

If you want to stick with menopause treatment your options are to use two of the combined patches (NHS often reluctant to fund this) as the evorel sequi/conti only contain 50mcg estradiol which is a low dose, or to switch to a higher strength estradiol patch with a different progestogen.

Some progestin options are bleed free including the IUS or oral desogestrel 150mcg, slynd or provera. Of these only the IUS and provera are licenced for MHT so access on the NHS may be restricted.

Micronised progesterone is also a popular option, metabolically slightly more favourable but won't get rid of periods if you are still having them.

No reason you can't go on continuous MHT before menopause, sequential if still menstruating is a guideline not the law, and bleed pattern should not trump overall wellbeing if continuous suits someone better.

[ScottishCatLady]

Thank you. I was on the pill most of my adult life and came off it to actually symptom check when I realised I might be peri so it definitely does not work for me. It did relieve night sweats (as that's what popped up immediately after coming off) but everything else was dreadful. Sequi changed my life within weeks.

Good to know I can try continuous, when I was trying to figure out if I could everything said absolutely not and it didn't really make sense to me so I'm glad it could be an option.

[bombsh3ll]

Absolutely there is no safety issue with using continuous.

It just may not stop your periods.

Whether you tell your GP you are still having periods and want continuous is up to you depending on how knowledgeable they are. Some who lack confidence will stick rigidly to guidelines recommending sequential, without any understanding of the physiology.

Therefore it may behoove you to say your periods have stopped.

However the fact you are on testosterone suggests they may have been to a menopause seminar or two, so just read the room.

[sheila99]

Imo conti is not a good option if you aren't meno. It's unlikely to stop your periods and then you get into the 'unexpected bleeding' problem with the associated unnecessary intrusive procedures. Utro is body identical and so safer than the synthetics. If you want to be bleed free a mirena is your best option. It isn't unusual to need a higher dose of oestrogen as your own production deceased.

[ScottishCatLady]

It's not so much the bleed, as annoying as that is, it's the way the hormone fluctuations eff me up due to the interaction with my autism and ADHD. I won't be doing a Mirena.

[bombsh3ll]

The thing is if you are bleeding at the moment and then you go onto conti for reasons related to wellbeing rather than prioritising bleed pattern as the be all an end all, and you continue bleeding, you haven't lost anything. This is neither "unexplained" nor "postmenopausal bleeding" and should not be treated as such by an experienced provider.

Menstrual irregularity is a hallmark symptom of perimenopause, occurring in untreated women and those on hormone therapy alike.

In fact the group with the most problematic bleeding is typically those on sequential MHT, trying to synchronise it with an increasingly unpredictable natural cycle. These women often end up having their own period AND the withdrawal bleed.

Treatment should always be individualised and sometimes this means someone using continuous because it keeps them more stable eg with moods, migraine, endometriosis etc. Conversely there are postmenopausal women who fare better with sequential, perhaps because they don't tolerate the progestogen well and appreciate a break from it, accepting that this may involve having withdrawal bleeds and a marginally higher risk of hyperplasia (but more favourable breast and cardiometabolic outcomes).