Women's Health

Sequential (cyclical) regime

For women who are still having regular periods or are within 12 months of their last period. This causes a monthly withdrawal bleed

You should not continue sequential HRT beyond 5 years or beyond age 54, due to an increased risk of endometrial cancer.

Continuous (no-bleed) regime

For women who have not had a period for 12 months or are aged 54 or over. This provides steady hormone levels and usually no bleeding.

At our Practice, we have made the decision not to prescribe testosterone as part of HRT.

At present, testosterone is not a licensed medicine for women in the UK. The available products are designed for men, which makes finding the correct dose for women difficult and increases the risk of side effects. Safe prescribing also requires regular blood monitoring and specialist review, and we do not currently have the systems in place to support this safely within the Practice.

Our clinicians are happy to discuss testosterone with you as part of your menopause or HRT review, including the potential benefits and risks. If you wish to explore this treatment, prescriptions can be arranged through a menopause specialist or obtained privately.

The British Menopause Society (BMS) have recently updated their recommendations for progesterone dosage in women using higher doses of oestrogen as part of their HRT.

High dose oestrogen is defined as:

• 100mcg patch
• 4 pumps of oestrogel
• 3mg Sandrena
• 6 sprays Lenzetto
• 4mg oral estradiol

As you may recall from when you started HRT, whenever we give oestrogen to women with a uterus (womb) it is very important that we give them progesterone alongside it. If we were to give oestrogen without progesterone the lining of the womb (endometrium) can thicken and over time this can lead to endometrial cancer. The progesterone protects the endometrium from this risk.

In view of these new guidelines, if you are taking a high dose eostrogen, you have four options going forward:

Reduce your oestrogen dose

1. Increase your progesterone dose as above – accepting that we don’t know if there is an increased risk of breast cancer associated with this regime
2. Continue on your current regime – accepting that there may be an increased risk of endometrial cancer associated with this regime. If you choose this option it is very important that you report any vaginal bleeding (if your periods have stopped) or change to your bleeding pattern (if you are still having periods)
3. Consider having a Mirena coil as the progesterone part of your HRT regime – this is a great option as it provides excellent protection against endometrial cancer on all doses of HRT and has little or no increased risk of breast cancer. Once the coil has been fitted it works for 5 years before needing to be changed. It also provides contraception if you need it. After the first couple of months most women will have no bleeding at all with a Mirena. DWe can fit Mirena coils at the practice or this can be done at a sexual health clinic.

You should contact your GP if you experience:

• Any vaginal bleeding more than 12 months after your last period
• Changes to your bleeding pattern (heavier, more frequent, or prolonged bleeding)

If you are using, or planning to start, a weight-loss injection and are on HRT it is important to let your GP know.

These medicines can slow down how your stomach absorbs other medications, including HRT tablets. This may mean your HRT does not work as expected, particularly the progesterone part if taken orally, which protects the womb lining and reduces the risk of endometrial thickening and cancer.

To keep your HRT safe and effective, your GP may:

• Review your current HRT medication
• Recommend changing to a non-oral form of HRT (for example, a skin patch, gel, spray, vaginal preparation, or intra-uterine system like the Mirena® coil)
• Adjust your HRT dose temporarily when you start or change your weight-loss injection

HRT does NOT provide contraception! Remember to ask about this if you still need to be protected.

If you are of child-bearing age, you should use reliable contraception while on weight-loss injections, as these medicines are not safe during pregnancy.

Because HRT guidance evolves as new research emerges, it’s important to have regular reviews:

• 3 months after starting or changing your HRT
• Then annually thereafter

At these reviews, we will check your symptoms, dose, and any side effects to ensure your treatment remains safe and effective. Sometimes we will send a questionnaire and if you are getting on well you may not need to speak to a GP. Please respond to requests for HRT reviews.