Continuous Combined Oral HRT
Continuous combined oral HRT tablets contain both oestrogen and progestogen, taken together every day.
This provides continuous protection for the womb lining and usually results in no monthly bleed.
They are prescribed for women who still have a uterus and are postmenopausal.
How is continuous combined oral HRT used?
- Daily tablets: Both oestrogen and progestogen are taken together every day.
- Provides continuous womb protection without a monthly cycle.
- Common NHS brands include Elleste Duet Conti®, Femoston® Conti, Premique® Low Dose.
Benefits
- No monthly bleed: Periods usually stop, which many women find preferable.
- Convenient regimen: Simple daily tablet containing both hormones.
- Effective symptom relief: Proven to reduce hot flushes, night sweats, mood changes, and vaginal dryness【NHS】.
- Widely available: Easy to prescribe and adjust doses.
Potential Drawbacks
- Side effects: Breast tenderness, headaches, bloating, or mood changes may occur.
- Blood clot risk (VTE): Oral oestrogen increases the risk of blood clots compared to transdermal options like patches or gels【NHS】.
- Liver metabolism: Tablets are processed by the liver, which may not suit women with liver disease or digestive issues.
- Breast cancer risk: As with all combined HRT, there is a small increase in risk with long‑term use, which rises with duration.
When should continuous combined oral HRT be used?
- Postmenopause: Usually recommended for women who are at least 12 months past their last natural period.
- Perimenopause:
- Not usually the first choice, as bleeding patterns are still irregular.
- Can cause unpredictable bleeding or spotting if started too early.
- Sequential combined HRT is generally preferred during perimenopause.
- Continuous combined tablets may be considered in late perimenopause if periods have stopped for around a year, or if a woman strongly prefers to avoid monthly bleeding and understands the likelihood of irregular bleeding at first.
Who might benefit from continuous combined oral HRT?
- Women who are postmenopausal and want a simple, bleed‑free regimen.
- Those who prefer a daily tablet rather than patches or gels.
- Women without clotting risk factors or liver disease.
- Anyone seeking effective relief of menopause symptoms in a familiar tablet form.
Key Safety Message
If you have a uterus and are prescribed HRT, you must remain on progestogen alongside oestrogen.
Continuous combined oral HRT provides both hormones every day, offering womb protection and usually stopping monthly bleeding. It is best suited for women who are postmenopausal, but may be used in late perimenopause with careful monitoring.
Always seek medical advice before starting or changing your HRT.
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