You are getting very pedantic advice from your GP which isn't actually very accurate. If you were feeling good on the Elleste 1mg then, in your case I would have stuck with this unless you were starting to get flushes again. Anxiety and low mood are common and are not always associated with hormones - I personally think we tend to get that way as we age anyway. Libido is difficult to treat - there is so much wrapped in with how we feel about ourselves and whether we feel sexy and desirable - some women need a bit of testosterone added to the HRT regime but you will seldom get this on the NHS without specialist advice. If more meno symptoms were breaking through (flushes etc.), then the obvious course of action would be to simply move you to the higher dose of Elleste sequi first - then onto the conti version. Sometimes using progesterone every day can lower mood, some find they feel great on conti progesterone as they feel more on an even keel - we are all different. The conti Elleste is a higher dose and may well suit you as you got on so well with the sequi version, so it is well worth trying this. It is very common to get some bleeding for the first 3-6 month when using a conti HRT, so some erratic bleeding in the first few months is normal and not an indication that you are still peri meno. If after 6 months you still get bleeding then you will need a scan to check the womb lining - you won't get regular womb scans routinely on the NHS. I'm afraid you may have to ride the first few months and see how it goes - but this will be true for any conti HRT.
Tridestra often seems like a tempting option but I believe one is more prone to problematic bleeding due to the longer time on oestrogen alone without progesterone.
The alternative, if you want a bleed free option with fewer progesterone side effects, is to have a Mirena fitted and use oestrogen as gel, pills or patch. The Mirena is suitable in peri and post meno.
As for the cut off at 56, well, unless you are struggling with HRT, if you have a busy life and meno symptoms interfere with your ability to work and get on with things, then I wouldn't be in a hurry to stop HRT until at least 60 and then only review with a break for 3 months or so. The 5 year cut off is really not applicable these days and health risks are very, very small - there are only slight increased risks if still using HRT into your 60s. DG x