GPs can handle HRT changes and adjustments. If they need any advice, they can always contact the gynaecological department through advice and guidance services.

HRT does not affect or determine when one goes through menopause. Hormone replacement therapy (HRT) can be given to women who are going through menopause and to those who have gone through menopause (cessation of periods for 12 months or over). The indication for prescribing HRT is symptom control. Average age of menopause is 51 in the UK and by the age of 54 nearly 90% of the women are menopausal.

While the average age of menopause in the UK is around 51, having periods at 57 is considered late-onset menopause and while not normal in the sense of the average, it is still possible and not necessarily cause for immediate alarm, but it's important to discuss with your doctor and have further evaluations if necessary. eg: Check your cervical screening history, assess your bleeding pattern, assess your risk factors etc.

If you are having heavy periods while on HRT (I assume, you are on cyclical HRT), please approach your doctor for further evaluation and an ultrasound scan to assess the lining of the womb. A Mirena coil for the progesterone part of HRT would be a helpful option.

If you have concerns with low libido, please see your doctor for an evaluation of your symptoms. If necessary, you can be referred to the menopause clinic for consideration of testosterone supplementation, if you are postmenopausal and you testosterone levels are low.

The symptoms can sometimes be cyclical especially if you are perimenopausal due to hormonal fluctuations associated with menstrual cycle and perimenopause. This can change over time and from cycle to cycle due to fluctuating hormone levels.

Endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, often improves or resolves during menopause due to reduced estrogen levels, but can persist or reappear in some women, especially if they take hormone replacement therapy (HRT). During menopause, estrogen levels naturally decline, which can lead to a reduction or resolution of endometriosis symptoms for many women. While symptoms often improve or disappear with menopause, some women continue to experience endometriosis symptoms, or the condition can recur or be reactivated, particularly if they take HRT. Recurrence of endometriosis symptoms and risk for malignant transformation are potential risks to weigh when prescribing menopausal hormonal therapy. Choice of treatment should be guided by the presence and severity of current endometriosis symptoms, nature of menopausal symptoms, risk assessment of potential contraindications for treatment in patient history, and preferences of the woman after an informative discussion.

You can find more information from the British Menopause Society (BMS) - Induced menopause in women with endometriosis.