Hi and welcome,
I am in a similar situation to you - early 40s, still have regular periods, but at times estrogen drops to post menopause levels and other times it's sky high. I get horrible PMT which lasts beyond my period.
I started with 50mcg patches over a year ago, but found - as these top up rather than control your hormones - at times they were making the situation worse. I also hated the feeling I got when the 12 days of Utrogestan stopped, even though I felt fine on it (I agree with DG: dont 'look' for problems with it. Not everyone has issues with this form of progesterone. Take it one day at a time and just see how you feel). The doctors I saw all said at my age I needed something much stronger which would suppress ovulation and keep me more balanced.
I tried a low dose combined pill (Qlaira) which helped massively. I would go as far as to save it was a life changer. However, I stopped it eventually for two reasons - I was affected by the four different doses across the month, and I started getting stomach issues (since been told I have IBS C). I had a brief experiment with a monophasic conventional pill (which was a disaster from day one and made stomach far, far worse) and therefore started to look into a 'nil by mouth' line of treatment.
At the same time I started reading up on PMT and came across this, which I really recommend you read: (Guidelines from the National Association for Pre Menstrual Syndrome)
http://www.pms.org.uk/assets/files/guidelinesfinal60210.pdfhttp://nickpanay.com/Papers%20pdf/Managing%20Premenstrual%20Syndorme%20An%20Overview.pdfReading this has convinced me to try 100 mcg - 150 mcg patches (still far less oestrogen than in a synthetic contraceptive pill) which will suppress ovulation and keep me with a more even rate of oestrogen - in theory, at least
.
Unusually, in my case I would opt for the nearly continuous 100 mg of Utrogestan on days 1-25 to avoid the dip I mentioned, despite still having periods. My GP is happy with this. I'd take this vaginally, as I did before, since I always eat late at night.
I think a number of ladies on here are thinking of trialling a similar approach - mainly younger members still having fairly regular periods who're suffering from extreme fluctuations /PMS rather than more continuously low oestrogen and the different set of 'joys' that can create.
The advice on additional supplements etc is interesting to read too.
Hope what I have said doesnt confuse you ever more - it is very much an alternative hrt/hormonal approach suited to only a small group of ladies, but even just reading the NAPS advice certainly helped for me to see things a different way.
Good luck - hope things work out for you x