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Hormone Replacement Therapy after your periods have stopped

Women who are more than one year past their last period need to take hormone therapy continuously. This article explains what that means, and why it is important.

Recap - what is hormone replacement therapy (HRT)?

HRT is when you take a form of medication to replace your body's natural hormones. This is because our female hormones - oestrogen and progesterone - drop during perimenopause and menopause.

All forms of HRT contain a type of oestrogen. If you've had a hysterectomy in the past, you'll need estrogens alone. If you haven't had a hysterectomy, you'll need both an estrogen and a progestogen. The type of HRT recommended for you will depend on your risk factors, preferences, symptoms and whether you're still having periods.

What is continuous hormone replacement therapy?

If your periods stop for more than one year between the age of 45 and 60, and there's no medical reason for this, you're postmenopausal. If you want to take HRT for menopause symptoms, you need to take it continously. This taking small doses of oestrogen and progestogens (if needed) daily without any breaks.

Are there different types of continuous HRT?

Continuous combined HRT is usually recommended for women who are postmenopausal with a womb. This means you'll take both oestrogen and progestogens each day. The specific form and dose of HRT will depend on your unique needs.

For women without a womb you'll need continuous oestrogen-only HRT.

Will I have periods when using continuous HRT?

No - but when you are first adjusting to HRT you may experience a bit of irregular bleeding. You should track and track this over the first six months. It should settle down, and sometimes adjustments your prescription will needed. If your bleeding persists for more than six months you should consult your GP or a gynaecologist.

On the point of irregular bleeding - remember that it's very important to have routine screenings for cervical cancer. This means having a cervical smear every 3-5 years on the NHS.

How do HRT needs change with age?

As you progress through menopause (one year without periods) your HRT needs will change. If you start HRT before your last period you'll need to move from taking hormones cyclically to taking them continuously after menopause. This switch will generally happen after 2-5 years on cyclical HRT, or when you are above the age of 54.

References:

1 National Health Services Website (2018). *Types - Hormone Replacement Therapy * Retrieved 16 March 2020 from [https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/types/].

2 Hillard T., et al. (2017). Management of the menopause. 6th edn. British Menopause Society. UK.

3 British Menopause Society (2016). HRT Guide. Retrieved 16 March 2020 from [https://thebms.org.uk/wp-content/uploads/2016/04/HRT-Guide-160516.pdf].