Brief Answer: Detailed below. Detailed Answer: Hi, Thanks for writing to us. Please confirm if this is the first cycle of treatment you are on. If that is so, the possibility is there is a breakthrough bleeding as the dosage of the hormone is not in confluence with your systemic needs; it is either in excess or lower in dosage. Please make sure you have rectified your thyroid insufficiency properly. As you are in the perimenopausal age, there is fluctuation in the natural hormone levels in the body. This makes it difficult for empirical treatments to be successful. For a better effect, a hormonal profile followed by replacement therapy is suggested. To treat the current episode of bleeding, you should use styptics and if the bleeding does not subside within the next couple of days, go for another course of hormone therapy. Dosage adjustment should be made to see that there is adequate maintenance level and this can be adjusted after a hormonal profile. Active adenomyosis can be countered by using combination pills. Proper weight management helps a lot in maintaining proper hormonal balance. Hope your query has been clarified. Please feel free to contact for further clarifications. I will be happy to help. regards, Shanti.V.

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