This is the type of HRT that imitates the natural menstrual cycle and it does so by causing regular menstrual bleeding every month, similar to a light period.
Both oestrogen and progesterone are taken, although at different stages throughout the month.
HRT of this type does not trigger natural ovulation and cannot restore fertility, so these are not real periods, nor do they mean the start of your regular menstrual cycle. Instead, the hormones trigger a reaction which causes the lining of the uterus to build up and then shed. If the woman’s natural period has become irregular then the treatment can also be taken so that the bleeding occurs once every three months.
Most types of HRT involve the use of both oestrogen and progesterone, where the benefit of the therapy is from the intake of oestrogen. Progesterone is only taken to protect the lining of the womb.
If the woman has had a hysterectomy, where the womb is removed, there is no need to take progesterone. Oestrogen-only HRT can only be taken if all of the uterine tissue has been removed.
Continuous Combined Therapy (CCT)
Most women start by using Cyclical HRT and then move onto Continuous Combined Therapy (CCT) once they are postmenstrual. Both oestrogen and progesterone are taken every day, balanced so that the monthly bleed does not occur.
This type of HRT comes in the form of creams, gels or vaginal rings.
Oestrogen is absorbed through the tissue to treat vaginal or urinary symptoms such as dryness, irritation or infection. The use of local oestrogen minimises the absorption of oestrogen into the rest of the body and its attendant side effects.
Progesterone can also be taken locally to help protect the lining of the womb.
Tibolone is a man-made hormone of the class of medicine known as a steroid. It is taken in tablet form and mimics the effects of oestrogen, progesterone and to a lesser extent androgen, which is a male hormone.
The benefits of tibolone are similar to Continuous Combined Therapy (CCT). No bleeding occurs as the lining of the uterus is not stimulated to build with each cycle and shed.