Spotting on HRT

[Trixie2012]

Hi , I have posted on here previously regarding spotting & after a pelvic scan I have 5.3 thickening
I was advised by my meno Dr to reduce my patch of Everol 75 to 62.5 & to take 2x 100mg Utrogestan every night .
I had a phone consultation with a Gynaecologist he said 200mg Utrogestan is what I should be taking on 75mg Utrogestan
He also said he prescribes HRT by symptoms so basically forget estrogen blood tests , apparently blood tests for Estrogen aren’t accurate so he would judge dosage by symptoms
Im confused as my meno Dr always does a blood test she wanted to put my dose up to Everol 100 as she felt my Estrogen levels are still a tad low , but because I had a cyst in my breast last year we thought it best to continue on 75

Anyway due to the spotting the Gynaecologist said I could go straight in with a Hysteroscopy or have another pelvic scan to see if the lining has reduced , the spotting has stopped completely since reducing the patch dosage

I’m just confused by two Dr’s difference in how patch dosage is prescribed .

I've always been told by my consultant that blood tests are not accurate for estrogen levels when using HRT. And to go by symptoms.
They are an excellent consultant and specialise in hormones and fertility.

You say your 'meno Dr'- are they a consultant too (ie a gynaecologist?)

The guidance on dosage is clear in the guidance by the BMS- it's increase progesterone if there is spotting etc when using higher doses or estrogen (that's 75 or 100 mgs patch, or 3 to 4 pumps of gel.)

Hi , I see a private menopause Dr once a year she’s not a Gynaecologist. Maybe I should be seeing a Gynaecologist instead .

what he said made sense but I was still a bit confused with the different information.
I don’t feel any different reducing my dosage from 75 to 62.5 but it is a faff cutting the patch to size and they don’t stick as well .
I’ve been told to continue doing this until I’ve had another pelvic scan he advised continuing with 2x 100mg Utrogestan.

Im just wondering that if I’ve reduced the patch dosage if my lining has thinned .