Hi
Not sure I have any solutions as I'm in the same boat. The meno specialist I spoke to said I have a strong cycle underneath (I get heavy bleeds too, although until I increased E on sequi, they were always regular) and I'm properly into peri, but not far enough in to be able to handle conti. She likened it to trying to put a 'lid on a boiling pot'.
So like you I'm at the point where I need 4 pumps of gel, but I can't hande the dose of progesterone I'd need to balance that out. I've recently had a one cycle disaster trying conti utrogestan, and it made me feel so utterly awful, jittery, revved up, sleepless - yet when I take it sequi, it does the opposite. According to what I've read (from Louise Newsom and in the BMS meno management guidelines) the whacky bleeding is because the endometrium is not yet stable enough, plus we'll be having a random zap of hormones from our sputtering ovaries, as the HRT won't override our own cycle.
It's frustrating. Boob soreness - I read somewhere that WHERE the soreness is can indicate the issue and if it's at the front and around the nipple that usually indicates it's oestrogen, and around the side and under the armpit is more prog. I'll try to remember where I read that. Another thing I've found super helpful is tracking my symptoms on a calendar. Day 1 - 28 across the top, and then a list of symptoms down the side (breast pain, water retention, weight gain, hair loss, sweats, jittery, sleep issues etc) and I score them 0 - 5 (5 being the worst they can be), this would over a cycle or two, quickly show you if your symptoms follow a pattern in line with your underlying menstrual cycle.
Re absorption I've been advised to test my E on the same day of my cycle (day 5) for a few months to just check the absorption issue, for £50 at the Nuffied, I thought it was worth a go! We will see.
Some women with bleeding issues seem to do better on 200mg utro a day, although not all of us can cope with that much, and from what I gather it can take several months for it to settle down. I think in that instance the wisdom is orally is better than vaginally for bleeding. I'm in a facebook group run by Jane Pangbourne (who runs Menopausal Not Mad) - it's quite strictly moderated, but this means they keep it really factual, I've gleaned quite a lot in there (I think half my issue is HRT education, nobody really takes the time to properly teach us about HOW to take this stuff properly, and in hindsight some of the changes I've made would have been better handled with tweaks to doses, rather than wholesale changes of regime).
Anyway, in sympathy!
Reb
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