Sequential combined HRT tablets and patches

NHS information about the sequential HRT, including what it's used for, who can take it, how to take it and side effects.

This information is about sequential HRT. There is separate information about combined HRT.

What sequential HRT is for

During menopause, your body makes less of a hormone called oestrogen. This can cause symptoms.

Sequential HRT (hormone replacement therapy) is a type of HRT. It comes as oestrogen on its own and oestrogen combined with another hormone called progestogen (the medicine form of progesterone).

The oestrogen in sequential HRT works by replacing the oestrogen you've lost. If you still have a womb (you have not had a hysterectomy to remove it), increasing your oestrogen can thicken your womb lining and sometimes cause side effects. Including progestogen in the medicine can help prevent some of these side effects.

Sequential HRT is used to help ease menopause symptoms such as:

• hot flushes and night sweats
• vaginal dryness, itching or pain
• mood changes
• sleep problems

It can also help prevent weaking of the bones (osteoporosis), which is common after the menopause.

It is usually prescribed if you're at the start of menopause (perimenopause) and still have periods, or your last period was less than 12 months ago. If your last period was more than 1 year ago, you may be prescribed continuous combined HRT.

How to use sequential HRT

Sequential HRT comes as tablets and patches.

Your GP should discuss the risks and benefits with you before you start using HRT.

When you use sequential HRT:

• you'll use an oestrogen-only medicine for part of the month and a combined progestogen and oestrogen medicine for the rest of the month
• you'll usually have something like a period (withdrawal bleeding) during the times when you're not taking progestogen
• talk to a doctor if your symptoms are not getting better – it can take time to find the right type and dose to suit you

Always follow your doctor's advice. There are also many different brands of combined HRT, so instructions may be different.  Follow the information that comes with your medicine.

Find out more about when to take HRT.

How to use different types of sequential HRT

Side effects of sequential HRT

Like all medicines, sequential HRT can cause side effects, although not everyone gets them.

Common side effects

Common side effects of sequential HRT include:

• headaches
• breast pain or tenderness
• skin irritation where you stick the patch
• vaginal bleeding
• sleep problems
• mood swings

Sequential HRT will not usually affect your ability to drive, ride a bike or use machinery.

More about side effects

These are not all the side effects of sequential HRT.

For a full list, see the leaflet that comes with your medicine or search for your medicine leaflet on the electronic medicines compendium website.

Read 'does hormone replacement therapy (HRT) cause cancer?' on the Cancer Research UK website.

You can report any side effects you get on the Yellow Card website

Who can and cannot use sequential HRT

Most adults going through menopause can use sequential HRT.

But it's not suitable for everyone. For example, it may not be suitable if:

• you've had an allergic reaction or other serious side effect from HRT
• you've ever had breast cancer, are having tests for breast cancer or are high risk due to family history
• you have an oestrogen-dependent cancer
• you have thickening of the womb lining (endometrial hyperplasia), fibroids or endometriosis
• you have angina or recently had a heart attack
• you have vaginal bleeding with no known cause
• you've ever had a blood clot (thrombosis), are at risk of blood clots, or pulmonary embolism

Before taking sequential HRT, tell your doctor if you have any medical conditions.

Breastfeeding and sequential HRT

Tell your doctor if you're breastfeeding. Sequential HRT is not recommended if you're breastfeeding.

Pregnancy and sequential HRT

If you're trying to get pregnant or you become pregnant while using sequential HRT, stop using it and talk to your GP. Sequential HRT is not recommended during pregnancy.

Using sequential HRT with other medicines, food and drink

There are some medicines, remedies and supplements that may not mix well with sequential HRT.

This includes:

• medicines for epilepsy, such as phenytoin or carbamazepine
• some antibiotics, such as rifampicin
• medicines for HIV, such as tenofovir or ritonavir
• herbal remedies that contain St John's wort

Before using sequential HRT, tell your doctor if you're taking any other medicines, herbal remedies, vitamins or supplements.

Food, drink and alcohol with sequential HRT

You can eat and drink as normal while taking sequential HRT.

Find out more about your medicine

To find out more you can:

• check the leaflet that comes with it
• search for your medicine leaflet on the electronic medicines compendium website
• check the NHSBA website for more information on pre-paying for your HRT prescriptions
• speak to a pharmacist or a doctor for advice