Sequential or Continuous Combined HRT: What Changes in the Routine?

Two combined HRT prescriptions can have different monthly schedules. Confirm which one yours follows.

Compare the schedules

Regimen	Usual timing	Bleeding pattern
Sequential, also called cyclical	Estrogen every day; progestogen for part of each monthly cycle.	A withdrawal bleed usually follows the progestogen course.
Continuous combined	Estrogen and progestogen every day.	The aim is no scheduled monthly bleeding. Early irregular bleeding can occur.

The cited guidance describes sequential treatment as commonly used while periods continue or within a year of the last period. Continuous combined treatment is commonly used after a year without periods. Your history and prescribed product determine the plan.¹²

Ask for the dates for your prescription

The guidance describes 10 to 14 progestogen days in a 28-day sequential cycle. Have the prescriber identify the exact dates and tablets or patches for your medicine. If the schedule is unclear, ask the pharmacist to go through the packaging with you.¹

Write those instructions somewhere you can check them when the prescription is refilled.

Discuss bleeding changes

With continuous combined HRT, irregular bleeding can occur in the first few months. Heavy bleeding or unexpected bleeding after six months needs a doctor’s review. Changes after you have been taking HRT for more than a few months also need discussion. These timeframes are not a reason to delay calling with a concern.²

For sequential treatment, ask what bleeding to expect and which changes should be assessed.

My Body Changed. Now What? lists a symptom diary and Visit Brief in its toolkit. They can organize symptoms, bleeding notes and questions for your HRT review. See the book.