Sequential combined hormone replacement therapy (HRT) is a medicine that contains the hormones oestrogen and progestogen. It's used to treat menopause symptoms.
Menopause is when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier. It affects anyone who has periods.
As you reach the menopause your ovaries gradually begin to produce less oestrogen and progestogen. This can cause symptoms such as hot flushes, mood swings and vaginal dryness.
Taking HRT can help these symptoms and help prevent other conditions such as weakening of the bones (osteoporosis), which is common after the menopause.
A doctor will usually recommend sequential combined HRT if you have menopause symptoms but you're still having periods, or your last period was less than 12 months ago.
Sequential combined HRT involves taking oestrogen every day and taking progestogen for 10 to 14 days of each 28-day cycle. You'll usually have withdrawal bleeding at the end of each course of progestogen.
This is different to continuous combined HRT, where you take both oestrogen and progestogen every day with no monthly bleeding. Continuous combined HRT is usually prescribed after you have not had a period for 1 year or more.
You'll need to take combined HRT if you still have a womb. This is because taking oestrogen on its own can thicken the womb lining, which slightly increases the risk of womb cancer. Taking progestogen together with oestrogen reduces the risk.
Sequential combined HRT is only available on prescription. It comes as tablets or skin patches.
Brands include Elleste Duet, Clinorette, Femoston, Novofem, Tridesta and Trisequens tablets, and Evorel Sequi and FemSeven Sequi patches.
Important: HRT shortages
Currently there are supply shortages of some types of HRT. If the medicine you've been prescribed is not available, a pharmacist or doctor will be able to advise you about using a different brand or type of HRT that is suitable for you.
Key facts
- Your medicine will contain 2 or 3 different types of tablet or patch. You'll take the oestrogen part of your medicine every day and take your progestogen for 10 to 14 days of each 28-day cycle.
- HRT can take up to 3 months to work fully to improve your symptoms.
- Common side effects include headaches, breast tenderness, feeling sick and irregular vaginal bleeding, but these usually improve in the first few months of starting treatment.
- If you feel that the HRT you're taking is not helping your symptoms, talk to a doctor. It can take time to find the right type and dose to suit you.
- It's common to take sequential combined HRT for 2 to 5 years, and then try stopping to see if your menopause symptoms have improved. Your doctor may suggest swapping to continuous combined HRT after 1 to 2 years when the risk of irregular bleeding will be reduced.
- It's important to see your doctor at least once a year for a check-up and to review whether you need to keep taking HRT.