Hormne combinations and single-drug formats: continuous combined hrt

HORMNE COMBINATIONS AND SINGLE-DRUG FORMATS: CONTINUOUS COMBINED HRT
A second common oestrogen—progestogen combination involves taking both hormones every day. This is described as continuous combined HRT. Individual doses of progestogen are lower than when the progestogen is taken for ten to fourteen days a month, but the total monthly intake is similar. If progestogen gives you side effects like those of premenstrual syndrome (such as irritability and breast tenderness) you may find this hormone format helpful. About 80 to 90 per cent of users of this continuous combined HRT no longer experience withdrawal bleeds after an interval of six to twelve months. However, irregular bleeding may occur for the first few months, and women with fibroids may have irregular bleeding that is difficult to control without surgery. There is some research to suggest that continuous combined HRT may have a less stimulatory effect on breast cells and breast cancer than combined cyclical therapy or oestrogen alone.
Freda, whose principal reason for being on HRT was control of severe hot flushes, was pleased with the effect on her bleeding patterns of swapping from one HRT routine to another. Her experience of cyclical progestogen therapy was unacceptable. 'I was still having moderate to heavy with-
drawal bleeds sixteen months after I started and I felt these were more of a nuisance than the hot flushes. My doctor then suggested I try continuous combined HRT and, after three months of intermittent spotting and seven months of withdrawal bleeds, I no longer had any bleeding and felt well.'
As with combined cyclical therapy, women on continuous combined HRT who do not have withdrawal bleeds are considered to be at no higher risk of endometrial cancer than women who bleed, and should continue with progestogen as recommended by their doctor.
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Hormonal

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