Hi Sammiejane
I have never ever had my homone levels tested since I started hrt at 45 - I'm 57 now. I was referred to our menopause clinic in July 2018 and saw a consultant there but they didn't do any testing either. My GP and the consultant appear to go on whether the levels of hormones you are taking are controlling symptoms and making you feel any better.
I am on 4 pumps of gel, 12 days of utrogestan 200mg vaginally. I take it on a long cycle and have a bleed because taking progesterone of any kind continuously messes badly with my head and makes me feel really suicidal. My cycle is 28 days gel and 12 days Utro and then I get a good bleed lasting 3.5 days and then we go again for 28 days gel only before I start the Utro. I never get any bleeding or spotting in between nor have I missed a bleed.
When I started out with the gel and the utro, I was prescribed 2 pumps but they didn't control the sweats and particularly the anxiety and panic attacks which were constant and vicious, along with very sore joints, acid reflux, low energy and insomnia so my GP just said up it to 4, which fixed it no problem although it took 7 months to go completely. I talked to the consultant about vaginal use of the utro to minimise side effects and that got the sign off too. The meno clinic prescribed the Tostran testosterone based on 3 pumps a week, which also worked and I have had no problems on the testosterone...they never tested me for that either nor have they since prescribing. I was given the testosterone after 7 months on the gel and utro. I think that because my very bad and lengthy symptoms have come under control with this regime, there is no need to meddle. I have lengthened the cycle by reading a lot of information on the forum because when I was doing the normal regime of 15 days + 12, there wasn't enough time for my head to recover from the progesterone. Even on 28 + 12, the 12 days means I get a bit low and teary and tired around day 8 but now I know that it will only last till day 12 and the drop off over the bleed days I can cope.
There is plenty of consultant agreement put forward on the forum for long cycles so I have found no evidence to say it's not safe and in fact some ladies have stretched theirs further but I wouldn't want to go any longer on mine and its working so I can't see why I would mess with what's working.