Irregular periods starting at age 37 signifies that ovarian dysfunction that eventually leads to menopause has become a factor in your bleeding episodes. Regularity of periods while on bioidentical hormones may indicate that this bleeding is simply from hormone imbalances that occur in most women past the age of 35 or so. You don t say what is in your bioidentical hormone cream and this information would be helpful. However, having increased flow and 2-3 menstrual periods a month is a warning sign. These need to be evaluated since frequently, the only sign of impending uterine cancer or uterine cancer itself is a change in menstrual flow. In women past age 35 with increased flow or menses more than once monthly, we evaluate the uterine lining tissue with hysteroscopy and biopsy to make sure cancer or conditions that lead to uterine cancer are not present. These procedures are used to evaluate for bleeding that is anatomic in nature rather than hormonal in nature. We also evaluate for benign causes of abnormal uterine bleeding such as polyps, fibroids, adenomyosis and endometriosis. Ruling out these issues is important since most of them are estrogen dependent and may get worse with hormone replacement if not found and treated. If these issues are not found, your bioidentical hormones may need to be adjusted based on lab values in order to keep bleeding under control and eradicate the quality of life symptoms of menopause. I would like you to see a gynecologist well versed in perimenopausal hormone symptoms and abnormal bleeding for further evaluation. I hope this helps answer your questions. If you have further issues, I am available for follow up.