Menopausal bleeding again - do I need another urgent hospital referral?

[smokingcarriageonly]

I'm just trying to work out what to expect because my GP is so useless and the menopause clinic is stretched thinly and I'll email them but I don't know how long it'll take to get a reply.
I had some bleeding in March, GP made a referral on the two week pathway, ultrasound and gynae examination. They found some fibroids but nothing of concern so no further action. Spotting in June, menopause clinic said if they didn't find anything in March then I didn't need another hospital referral.
Now I'm bleeding again (like a normal period). I have an appointment with the GP this afternoon. I just want to know what the appropriate action is and I don't want to be fobbed off, but also don't want to press for a referral if it isn't necessary if you see what I mean.

If you had investigations so recently it's not really possible that something serious has gone wrong already in 3 months.

Are you actually post menopause? Are you at least 12 months after your last period and over 54? (80% of women are post meno by 54 but that means 20% aren't.)

It does sound as if it's your own periods.

Depending on the expertise of who did the scan, they should have been able to view your ovaries and see if there were any signs of follicular activity or some eggs still there, or if you ovaries were already atrophied and small which they are when post menopausal- did they talk you through this at the time?

Thanks for your reply. Sorry! I must have deleted some crucial information when editing before I posted.

It's been 2.5yrs since I had a period, I'm 55. I had some fibroids removed late 2020 and had one more period beginning of 2021. On HRT for about 1.5yrs. Now on 75mcg Estradot and 100mg Utrogestan. Tried Utrogestan vaginally on the recommendation of the menopause clinic (I felt progressively worse on oral Utro) and that was a recent change so I wonder if that's provoked the bleeding. I also have fibroids.

I have phone appointments with a menopause-trained GP, so it's not my own GP who's working out the HRT.

I don't remember if anything specific was said about my ovaries during the US but I'm well past the 12mo stage.

So you are using Utrogestan continually, vaginally?
It might be that you need a higher dose if you have used combined continuous HRT for more than 6 months.

A 75mgs patch is a highish dose of estrogen. The BMS has said that women who are on high doses (75/100mcg) may need to double up the Utrogestan.

Maybe you just aren't absorbing Utrogestan very well vaginally, or you need mor e of it.

It doesn't sound as if anything sinister is wrong, just a blip in the hrt.

Thank you, that's reassuring!

On a higher dose patch (100) I tried a higher dose of Utrogestan (orally) but I don't think it agrees with me, so I've gone back down to 75 patches and 100 Utrogestan. Tried it vaginally and after two weeks or so I started bleeding. Im not confident that I get it in the right place tbh, so when I started bleeding i went back to taking it by mouth, but I feel rotten again.

Thanks again for your reply.

You can get Utrogestan as a 200mcg pessary that comes with an applicator- might that help? Ask your GP for it?

I tried the 200 pessaries, i still had problems getting them in (they stuck to the applicator) and anyway I felt like a zombie. But thanks for the suggestion, it's good to know about options.