As mentioned on page 36, this is a new form of ‘no-bleed9 HRT produced in response to the high drop-out rate among women who have not had a hysterectomy and who don’t want to have regular withdrawal bleeds. Although there has not yet been very much published data on it, it is increasingly being prescribed in the expectation that women will be willing to stay on HRT for longer. Different brands should be available soon. The brand currently available is livial, and the manufacturers, Organon, describe it as having ‘combined progestogenic, oestrogenic and androgenic properties’, that is, it works in the same way as progestogens, oestrogens and androgens work. By taking a combination of these hormones in tablet form on a continuous basis (rather than by taking progestogen for just 10—12 days each month), it is hoped that eventually bleeds will stop, though this may take up to a year, doesn’t work in all cases, and can produce irregular bleeding in the meantime. (If you continue to get a withdrawal bleed on ‘no-bleed’ HRT, your doctor may feel it is appropriate to prescribe a one-off dose of progestogen to clear the lining of the uterus, which should prevent further bleeds.) This type of HRT helps mood changes and loss of libido, as well as other symptoms of the menopause. More long-term research is needed before its effectiveness against osteoporosis is known for certain, but a ‘no-bleed HRT’ is definitely a step in the right direction. If you would like to take HRT for its benefits, but really cannot face the return of monthly ‘periods’, why not ask your doctor about this new form? It is only recommended for women at least 12 months past their final period.