Erratic bleeding on HRT - concerning?

[GlomOfNit]

I've been on HRT for about two and a half years now (after a few years of peri symptoms). I can't say it's been a magic wand - I'm still troubled by palpitations (and have been checked over so many times, even seeing a cardiologist), low mood, zero libido, and the odd cluster of months where I get breast pain. (And I'm up to date on mammo too) But. I continue taking it for bone health and so on. I'm on three 0.5mg sachets of Sandrena and 200mg utrogestan for 12 days a month.

My bleeding has been increasingly erratic. Usually (this is normal for me) I get a very small bit of bleeding about a week before my period actually starts, then bleed for 3/4 days. Maybe a bit more. It's rarely a lot these days, I use a mooncup and can see what my levels are. Often the blood is more like spotting and often quite bright. (Freaks me out) I rarely have so much bleeding that the cup is more than half full when I empty it, and usually a lot less. Sometimes my bleeds start while I'm still taking the utrogestan, more rarely not until after - this cycle I've had a small amount of spotting and now absolutely no indication I'm about to start my period properly. I'm on day 11 of utrogestan.

I know the purpose of the progesterone is to stop my uterine lining from getting too thick. Is the fact that my bleeding is scanty an indication that 'not enough' is coming away, or that the lining is actually very scanty itself??

And should I run this past a GP?? I'm not under a menopause clinic. GPs here are pretty clueless about HRT and I've been told more than once that I'm only 'allowed' to be on it five years... It really bugs me that they stonewall you and talk about the risks, yet once you're on it you have no guidance or routine checks to make sure you ARE actually ok on it. (Though in fairness, I've got a phone consultation with the practice clinical pharmacist to review my HRT next week)

You’re not only allowed it for 5 years, that’s nonsense. I’d be suggesting that your GP’s read the NICE guidelines.
Have you considered a Mirena coil for progesterone? It’s a continuous lower dose and should stop you bleeding.

Oh I know it's bollocks! I saw on the news the other day that GP surgeries are being given the means to acquaint themselves with the NICE guidelines in an easier way so here's hoping...

I'm not keen on a coil TBH. I've got what I've been told is a 'very sensitive cervix' and have experienced cervical shock a few times (during a really bad period in teens, an early MC and also after an ERPC) I don't want to repeat it! Thanks for the support though.

Has anyone else experienced this sort of very scanty bleeding on Sandrena/Utrogestan? (gentle bump)

Maybe try utrogestan continually? That could stop the scanty bleeding. If it continues, even with continuous utrogestan, I would be inclined to see the GP and get a scan booked in, to check womb lining thickness.

My bleeding has been increasingly erratic. Usually (this is normal for me) I get a very small bit of bleeding about a week before my period actually starts, then bleed for 3/4 days

Can you explain this a bit more?

When you say 'your period' are you talking about the withdrawal bleed?
It should be fairly regular and most often starts 3-4 days after the last day on Utrogestan. Some women find they start to bleed a day or so earlier before the 12 days.

I don't know much about Sandrena but think it's stronger than Oestrogel. So if you're using 1.5mgs of Sandrena that a high-ish dose.

You may be one of those women who need 300mgs Utrogestan OR reduce the Sandrena to 1mgs.

Odd bleeding is usually caused by not enough progesterone.

Just to add @GlomOfNit you should probably have a scan to see that all's okay.
There isn't now the 2-week 'urgency' with this as with post meno bleeds and not on HRT, but it's something your GP should arrange over the coming weeks. And ideally you need the scan timed straight after a bleed or it won't be so meaningful if your lining has built up over the cycle.