Sequential vs Continuous

In a combined HRT regime, the decision to prescribe a sequential or a continuous progestogen depends on an individual's bleed pattern (not age).

SEQUENTIAL REGIMES

• Sequential combined HRT is sometimes called cyclical combined HRT.
• If periods are ongoing or have been present within the last 12 months, a progestogen should be prescribed sequentially.
• This means the oestrogen is taken daily, and a progestogen is taken for (usually) half of the month.
• A progestogen is required for at least the same duration as that produced during the luteal phase of the monthly cycle, which is 12–14 days.
• This should give a once monthly predictable bleed that begins towards the end of the progestogen phase or during the break from progestogen. It is not a concern if there are no withdrawal bleeds.

CONTINUOUS REGIMES

• Where periods have been absent for >12 months, including in women who are amenorrhoeic taking the minipill, a progestogen for HRT should be prescribed continuously.
• This means oestrogen is taken daily and the progestogen taken daily too.
• This is a no bleed regime, although continuous combined HRT commonly produces irregular bleeding or spotting in the first 4–6 months of treatment as a side effect. This should be investigated if bleeding persists beyond 4-6 months.