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Continuous Hormone Therapy – Effects & Risks

Continuous hormone therapy is a form of hormone replacement therapy in which oestrogen and progestogen are taken daily without interruption to provide lasting relief from menopausal symptoms.

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Things worth knowing about "Continuous hormone therapy"

Continuous hormone therapy is a form of hormone replacement therapy in which oestrogen and progestogen are taken daily without interruption to provide lasting relief from menopausal symptoms.

What is continuous hormone therapy?

Continuous hormone therapy (also referred to as continuous combined HRT or continuous hormone replacement therapy) is a medical treatment in which hormones – typically oestrogen combined with a progestogen – are administered every day without any treatment-free breaks. Unlike sequential (cyclical) hormone therapy, this approach does not involve artificially induced withdrawal bleeds. It is primarily used in postmenopausal women whose last menstrual period occurred at least twelve months prior to starting treatment.

Indications

Continuous hormone therapy is mainly prescribed to relieve symptoms caused by the natural decline in hormone production during menopause. Common indications include:

Hot flushes and night sweats (vasomotor symptoms)
Sleep disturbances
Vaginal dryness and discomfort during intercourse
Mood changes and depressive symptoms
Osteoporosis prevention in women at increased risk of fractures

Mechanism of Action

Continuous hormone therapy works by compensating for the decline in the body's own oestrogen production that occurs during and after menopause. Oestrogen acts on numerous tissues throughout the body, including the uterine lining, bones, skin, and the cardiovascular system. To prevent excessive thickening of the uterine lining (endometrial hyperplasia), a progestogen is added for women who still have a uterus. By maintaining a consistent hormonal level every day, the therapy stabilises hormone concentrations, avoids fluctuation-related bleeding, and supports overall quality of life.

Dosage and Routes of Administration

Continuous hormone therapy can be delivered in several ways:

Oral: Tablets or capsules taken daily
Transdermal: Patches or gels applied to the skin, bypassing the gastrointestinal tract
Vaginal: Creams, pessaries, or rings for localised symptoms
Subcutaneous: Implants or injections (less commonly used)

The dosage is determined individually by the treating physician and should follow the principle of using the lowest effective dose for the shortest necessary duration.

Advantages of the Continuous Approach

A key advantage over sequential therapy is the absence of regular hormonal withdrawal bleeds, which many women find significantly improves their quality of life. The regimen is also simpler to follow, as there is no need to track a cyclical schedule.

Side Effects and Risks

Like all hormone therapies, continuous hormone therapy is associated with possible side effects and risks. Early in treatment, the following may occur:

Irregular spotting or breakthrough bleeding (especially in the first months of therapy)
Breast tenderness or breast pain
Headaches and nausea
Fluid retention (oedema)

Long-term risks that must be considered when making treatment decisions include a slightly increased risk of:

Breast cancer (particularly with combined oestrogen-progestogen therapy over several years)
Deep vein thrombosis and pulmonary embolism (especially with oral preparations)
Stroke

Individual risk depends on factors such as age, existing health conditions, family history, and duration of therapy.

Contraindications

Continuous hormone therapy is not appropriate for women with:

Known or suspected breast cancer or oestrogen-dependent tumours
Unexplained vaginal bleeding
A history of thrombosis or pulmonary embolism
Severe liver disease
Pregnancy or breastfeeding

Important Notes

The decision for or against continuous hormone therapy should always be made on an individual basis in close consultation with a healthcare provider. Regular review of the therapy (at least annually) is recommended to continuously assess the balance of benefits and risks. The guiding principle of modern hormone therapy is to use the shortest possible treatment duration at the lowest effective dose.

References

Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG): Guideline on Peri- and Postmenopause – Diagnostics and Interventions (2020). Available at: www.dggg.de
Stute P. et al. – Individualized hormone replacement therapy – an update. Climacteric. 2019;22(1):1-10. PubMed PMID: 30234410.
World Health Organization (WHO): Menopause. Available at: www.who.int/news-room/fact-sheets/detail/menopause (2022).

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