Cramps and bleeding on HRT

I was on 0.075 estrogen patch 2 times weekly, 100mg progesterone. I was spotting after six months on this dose and we did an ultrasound which was fine and now we have scheduled a biopsy to be safe.

I noticed some sleep issues and I started taking my patch every 4.5 days and the spotting seemed to stop for 3 weeks and I felt a bit better with sleep. however, this week I missed a day and didn’t change my patch for 5.5 days and this morning I am cramping and spotting a lot more.
Wondering if I should be concerned. I messaged my dr but might not hear back for a few days.
Has anyone had this? Mostly the cramping concern me, I have cramps in the past when I used to get my period. I’m in pyramid menopause I believe.