Sequential (Cyclical) Oral Combined HRT
Sequential (also called cyclical) oral combined HRT is a type of hormone replacement therapy that contains both oestrogen and progestogen. It is designed for women who still have a uterus and are in the perimenopause or early menopause. The regimen mimics the natural menstrual cycle and usually results in a monthly withdrawal bleed.
How is sequential oral combined HRT used?
- Daily tablets: Oestrogen is taken every day.
- Progestogen added part of the month: Usually for 10–14 days, depending on the brand.
- This pattern mimics the natural cycle and triggers a monthly bleed.
- Common NHS brands include Elleste Duet® and Femoston® 1/10 or 2/10.
Benefits
- Womb protection: Progestogen prevents the womb lining from thickening, reducing the risk of endometrial cancer.
- Cycle mimicry: Provides a monthly bleed, which some women find reassuring in the early years of menopause.
- Effective symptom relief: Proven to reduce hot flushes, night sweats, mood changes, and vaginal dryness【NHS】.
- Simple daily regimen: Easy to take and widely available.
Potential Drawbacks
- Monthly bleeding: Withdrawal bleed occurs, which some women may find inconvenient.
- 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.
Who might benefit from sequential oral combined HRT?
- Women who are perimenopausal or in the early years after menopause.
- Those who prefer a monthly bleed to mimic their natural cycle.
- Women who want a simple daily tablet option.
- Those without clotting risk factors or liver disease.
Key Safety Message
If you have a uterus and are prescribed HRT, you must remain on progestogen alongside oestrogen. Sequential oral combined HRT provides both hormones in a cyclical pattern, offering womb protection while mimicking a natural cycle. It is best suited for women in perimenopause or early menopause. Always discuss with your GP before starting or changing your HRT.
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