Spotting after raising oestrogen dose

[iammother]

Hello, I'd really, really appreciate any advice/thoughts on this.
I've been on HRT (Everol patches and 200mg progesterone 14 days of the month) for 5 months - I'm 43 and had regular periods but lots of peri symptoms.

I started on the 50 patches then was advised by the GP to go up to 75 and then to go up to 100s. I have chopped and changed doses quite a lot over the last few months worrying that my symptoms were getting worse but my progesterone dose has stayed the same.

I've stayed with the 100s for two weeks and feel generally better, although the 2 weeks of progesterone make me feel horrendous- I'm waiting an appointment for a mirena.

Is this spotting normal? It's a light bleed, mainly when wiping (TMI sorry) and a bit on the pantyliner. Has anyone experienced it when shifting dose like that? I'm cycle day 14 so this is very weird for me- not had any spotting at all on the HRT until now. I have health anxiety so this is really worrying me.

Anyone? X

Hi @iammother yes increase in oestrogen can cause spotting, especially as you have swapped and changed. They usually say to give each change 3 months to settle down .

usually the reason for spotting is an imbalance of estrogen to progesterone.
Too much estrogen and not enough progesterone can result in the lining getting thick and shedding at odd times, not just the withdrawal bleed.

The advice now for women on 100mcg patches (or other high doses) is to consider more progesterone (so maybe 300mgs ).

However, as you are still young and in peri, you will be producing your own progesterone as part of your natural cycles.

There are 2 possibilities -

you're still producing your own estrogen as well.
And the outcome is that the dose of progesterone isn't controlling the cycle so your are having a period between the withdrawal bleeds.

The other is that your own estrogen is adding to the HRT estrogen, and the dose of progesterone isn't controlling the lining so it's shedding outside of the usual monthly bleed.

It's not usually considered dangerous because you're still in peri but mention it to your GP if you are worried.

Thank you so much for taking the time to reply, that's really helpful info.
I went back down to 75 patch and I think I'll just stick with that til I get a mirena.