If you have a womb you need a progestin to keep the lining thin, a thickened lining is a cancer risk. Evorel conti contains oestrogen and a synthetic progestin, noresthisterone. It can take 3-6 months for bleeding to settle on a new conti regime. After this time if you're definitely meno and that scan shows no other cause you may have to try a different strategy such a mirena, a different type of progestin or an increased dose. Patch or gel usually comes down to personal preference. Gel is oestrogen only so you need to add a progestin, usually utrogestan or provera. Utro is body identical so supposed to be better. But I have no sideceffects from noresthiserone but fatigue on utro. It seems you need the 50mg dose of oestrogen as your symptoms return without it so I would use that dosecand do something different with the progestin if you find you have to.