Hi Alison
I don't think I understand why your GP swapped you from patches to Sandrena gel? Why was it thought that this would help the breakthrough bleeding? They are just different types of transdermal estrogen. I don't think that change is going to make any difference to the bleeding, so maybe ask your GP why they thought it would help. They are both the equivalent amounts of estrogen too (50mcg patch = 1mg sandrena). So the dosage hasn't changed.
Some women do absorb one product better than another, so if you think you were absorbing the patches well, you could swap back to them to see if they resolve your symptoms. (Because the other explanation is that you just need more estrogen now and whatever you use, you would have needed more.)
You are on a continuous HRT regime there, taking utrogestan for 25 days with 5 days off. But that is an old and outdated continuous protocol which is more likely to lead to bleeding - because you are stopping the progesterone for 5 days, which results in a bleed. Instead most doctors now prescribe 100mg every single night without a break for continuous. See the very bottom here:
https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf "Micronised progesterone
200 mg orally 12 days/cycle (cyclical)
100 mg PO daily (continuous combined)"
My bet is if you were taking the utrogestan daily without a break, you probably wouldn't have had a bleed - and wouldn't have had these worrying referrals for ultrasounds and checks etc either. If even that doesn't work, your utrogestan can be increased to 200mg - as mentioned in that link above.
The other thing to say is that you are only 48yo, so you may still be peri-menopausal - yet on a continuous regime (not sequential). Which can also lead to breakthrough bleeding. Do you know that you are post-menopausal?
