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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 be given estrogens alone - Oestrogen Hormone Therpay. If you haven't had a hysterectomy, estrogen will be combined with a progestogen. The type of HRT recommended for you will also depend on your risk factors, preferences, symptoms and if you are still having periods. For a better recap, have a look at our Hormone Replacement Therapy - explained article.

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 simply postmenopausal. If you want to take HRT for menopause symptoms, you need to take it continously. This means 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 (uterus). 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. If you are curious as to why, have a read of our Progesterone Hormone Therapy article.

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 this over the first six months. It should settle down. Sometimes you may need to adjust your prescription if you feel this is needed. If your bleeding persists for more than six months then 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. nhs.uk. n.d. Hormone Replacement Therapy (HRT). [online]
    Available at: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/.

  2. 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.

  3. 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].