Continuous HRT vs Sequential HRT: Which Type Is Right for You?
Continuous HRT vs sequential HRT compared. Learn the difference between combined and cyclical hormone therapy, when each is used, and how to choose with your doctor.
The Two Main Types of Combined HRT
If you still have a uterus, you need both estrogen and a progestogen when taking HRT. The progestogen protects the uterine lining from the stimulating effects of estrogen. How the progestogen is taken determines whether your regimen is sequential or continuous. The choice between the two largely depends on where you are in your perimenopause and menopause journey.
Sequential HRT Explained
In sequential, also called cyclical, HRT you take estrogen every day and add progestogen for a set number of days each month, typically 12 to 14 days. When the progestogen phase ends, you usually have a withdrawal bleed, similar to a light period. Sequential HRT is generally recommended for women who are still having periods or who have had their last period within the past 12 months. It mimics the natural hormonal pattern more closely and tends to be better tolerated in the earlier stages of the transition when the body is still used to cycling.
Continuous HRT Explained
In continuous combined HRT, both estrogen and progestogen are taken every day without a break. There is no planned bleed, though breakthrough spotting can occur in the early months while the body adjusts. Continuous HRT is generally recommended for women who are postmenopausal, meaning they have not had a period for at least 12 months. Starting it too early in perimenopause often leads to unpredictable spotting and is not usually recommended.
Key Differences at a Glance
Sequential HRT suits perimenopausal women and produces a monthly bleed. Continuous HRT suits postmenopausal women and aims to be bleed-free. The underlying hormones can be the same in both; the difference is in the dosing schedule. Both approaches effectively manage hot flashes, sleep disruption, mood changes, and bone density loss. Neither is inherently superior in terms of effectiveness.
What If You Are Not Sure Where You Are in the Transition?
Perimenopause can last anywhere from a few years to over a decade. Many women are uncertain whether they have reached menopause. If you are under 50 and have irregular periods, sequential HRT is almost always the starting recommendation. If you are over 50 and periods have been absent for over a year, continuous HRT becomes an option. Your doctor will guide this based on your age, symptoms, and cycle history.
Making the Decision Together
The right type of HRT is a clinical decision made with your doctor, informed by your symptom history and where you are in the transition. Tracking your cycle patterns and symptom severity before your appointment makes that conversation much more productive. PeriPlan lets you log symptoms over time so you can bring clear, detailed information rather than relying on memory. Revisiting the type of HRT you are on is reasonable as your circumstances change.
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