Seq vs cont: When to switch

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After a minimum of 1 year of sequential HRT, women who wish to avoid a monthly withdrawal bleed may attempt a switch to a continuous combined regimen which aims to be ‘bleed free’.
The timing of the switch from a sequential to continuous combined HRT should be considered in relation to the frequency of prior bleeds.
Women who had shorter durations of amenorrhoea before starting HRT are likely to need to continue on sequential regimes for longer.
The absence of bleeding whilst taking a sequential regimen reflects an atrophic endometrium.

If a sequential regime has been used for 5 years or more, consider switching to a continuous regime. This is because long-term use of sequential combined HRT for more than 5 years may be associated with a small increase in risk of endometrial hyperplasia and endometrial cancer.

NOTE:

Clinical evidence has demonstrated that continuous combined HRT provides more effective endometrial protection than sequential HRT.

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