Hi Julie! Pellets are notorious for having wildly inconsistent hormone dosage. They typically release way too much at the beginning of their lifespan and too little at the end, and can’t be adjusted once they are placed. The gold standard is a transdermal patch for estrogen and micronized progesterone in pill form. Typically, you only do something different if you have an issue with either of the above. Most people do not, and pellets are generally avoided because of the inconsistent dosages I mentioned above. Did your doctor say why they prescribe HMT in pellet form for you, and not the standard patch and pill?
If you are bleeding still, what that almost always means is that your estrogen is too high and stimulating your uterine lining to build up and then shed. That would be your pellet releasing too much estrogen, without enough progesterone to counteract it.
I was having bleeding issues as well, but an ultrasound of my uterus showed no problems apart from a slightly thickened lining. In my case, it was because I was both taking DHEA as a supplement outside of the MHT regimen (which was raising my estrogen levels) and I was also taking too low a dose of progesterone (which counteracts the excess estrogen and helps thin your uterine lining so it can’t build up and then shed in the form of a period). I wrote a post about what I learned, it might be helpful to you? Not just patients, but many doctors seems confused about how Menstrual Hormone Therapy actually works, what to use, and how to adjust based on symptoms.
Why Am I Still Having Periods at 55??