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[Louise Jay]

Hello I am 54 and have been taking Femoston 2/10 for several years and it has made my peri symptoms manageable. A couple months ago I returned to GP for a review and had blood test to check levels and all normal although I know these are not reliable. Recently I have been experiencing bloating and mood swings have returned but manageable and also nausea.
I have two questions please if anyone can help
I have read some information stating that as women get older they may need less estrogen could I maybe experiencing side effects of too much this and need to actually reduce my dose.
and
Should I be going on continuous HRT at 54 I am on sequential so having a monthly bleed. 
Many thanks for any thoughts or advice

[bombsh3ll]

This should be an individual personal choice.

However many prescribers stick rigidly to blanket one-size-fits-all guidelines and will insist that you change to continuous after 55.

There is no good evidence that older women achieve the same outcomes (quality of life, bone density etc) on lower estrogen doses, however there is a mentality among many clinicians that estrogen needs to be wrestled from the patient like a narcotic, and older women frequently find their prescription arbitrarily and unilaterally slashed.

Femoston doesn't come in 2mg continuous, so to achieve the same estrogen dose you would either have to take two 1/10mg tablets or separate estrogen and progestogen.

[sheila99]

At 54 you can choose conti or sequi as you won't know if you're meno or not. If you use conti when you still have a cycle you'll still bleed which is liable to lead to intrusive investigations for 'unexplained bleeding'. I'm not at all convinced you need less as you get older, I've only ever needed more as my own production dwindled and every time I try reduce my symptoms return. But some women stop hrt and don't have symptoms. As your mood swings have returned I think you need more oestrogen not less. Bloating can also be an oestrogen deficiency symptom but of course there are other causes too so you may want to get it checked out.

[Mary G]

If you get on well with Femoston you could change to a separate oestrogen (oral or transdermal) and Duphaston (dydrogesterone) if you want to use a similar dose on a continuous combined basis.

Re needing a lower dose of HRT with age, I hoped I could get away with one pump of Oestrogel now that I'm 64 and very post menopause but I'm afraid it was a fail.  My migraine auras returned and my gynecologist said I had vaginal dryness so now I'm back up to two pumps of Oestrogel every day.

If anything, you probably need slightly more oestrogen when you get older.