If more than one year has passed since your last period, you probably need to take hormone therapy continuously. Stella’s clinical advisor Dr Lucy Wilkinson explains how this works and why it’s important.
What is hormone replacement therapy (HRT)?
As the name suggests, HRT is a kind of medication that replaces the hormones your body no longer produces during perimenopause and postmenopause.
You can take HRT as pills, patches, gels and vaginal preparations. HRT is the most effective treatment available for menopause symptoms, although it is not suitable for everyone. Your own doctor will be able to advise you on the best options for you personally. Alternatively, you can take Stella’s free online assessment to see which treatment options are suitable for you. If you decide to go ahead with HRT from Stella, you will have access to online doctor’s appointments with menopause specialists as part of your plan.
Read here for more about the stages of menopause.
What is continuous hormone replacement therapy?
If you are over 45 and you haven’t had a bleed for at least one year, you have probably had your last period. This means that you have passed menopause and are now postmenopausal.
If this is the case, and you decide that HRT is right for you, you will need to take continuous HRT. This means that your prescription contains the same amount of hormones every day.
It can sometimes be tricky to decide if you have been through menopause – for example, if you have a medical condition that means you don’t have periods, or if you take medication which stops them. If you aren’t sure, speak to your doctor. They will be able to advise you where you are in your menopause journey, and which type of HRT is best for you.
Start your free online menopause assessment to see if HRT is right for you
Are there different types of continuous HRT?
Two types of hormone are used for HRT: oestrogen and progesterone. You will need to take oestrogen every day to control your menopause symptoms.
If you do not have a womb (for example, if you have had a hysterectomy), you can take oestrogen-only HRT continuously with no other hormones.
However, if you still have your womb, you need to take both oestrogen and progesterone. This is because progesterone protects the womb’s lining from the effects of oestrogen. If taken alone, oestrogen can cause abnormal thickening and even cancer. Progesterone provides effective protection against this and removes the risk.
Therefore, if you still have your womb and you are postmenopausal, you need continuous combined HRT containing both oestrogen and progesterone every day.
Continuous combined HRT is available as patches or pills.
Read more about different types of HRT.
Will I have periods when using continuous HRT?
No. You should not have periods when using continuous HRT. If you do, speak to your doctor. They may advise switching to sequential HRT.
It is also important to note that irregular bleeding can be a common side effect in the first weeks and months of an HRT prescription. This can take up to six months to settle.
If this happens to you, keep a note of when the bleeding happens and let your doctor know. This is especially important if you still have bleeding after the six-month mark as there could be something else going on.
In general, you should always see your doctor if you have any bleeding after the menopause (including bleeding after sex). This is known as postmenopausal bleeding, and needs checking out urgently. In most cases this is due to a common and benign problem like fibroids or genitourinary syndrome of menopause, but it can sometimes be a sign of cervical or endometrial cancer.
Read more about the risks and benefits of HRT.
How do HRT needs change with age?
Your HRT needs will change as you go through menopause.
It’s common to need to adjust your dose of HRT as time passes. You may find that you need more or less oestrogen to control your symptoms. This is normal and reflects the continued change in your body’s own oestrogen levels as you progress through menopause.
When you reach menopause itself (meaning that you’ve gone a year or more without a period), your HRT needs are likely to change again. If you have been taking HRT cyclically, your doctor is likely to recommend switching to continuous HRT at this point.
This switch will generally happen after 2-5 years on cyclical HRT, or when you’re over the age of 54. It can be tricky to decide when you have reached menopause if you don’t have regular periods, but your doctor can advise you when it is time to switch.
Final word
Continuous HRT is a highly effective treatment for menopause symptoms, and it’s prescribed when it’s been more than a year since your last period. If you think this type of HRT would be a good fit for you, speak to your own doctor or one of the Stella clinicians if you’re getting your HRT from us.
Find out more about menopause on our blog or in our symptoms library.
nhs.uk. n.d. Hormone Replacement Therapy (HRT). [online] Available at: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/.
Hillard, T., Abernathy, K., Hamoda, H., Shaw, I., Everett, M., Ayres, J. and Currie, H., 2017. Management Of The Menopause. 6th ed. British Menopause Society.
Thebms.org.uk. n.d. HRT-Guide. [online] Available at: https://thebms.org.uk/wp-content/uploads/2016/04/HRT-Guide-160516.pdf [Accessed 16 March 2020].
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