Registered nutritionist from the UK - 2 Qs about HRT

[Sarah17]

Hi, a couple of questions please: After taking cyclical progesterone (Utrogestan) a few years ago, and then a break, I started Vagifem pessaries for vaginal dryness. General symptoms of sleeplessness, headaches etc. were settling down, and now nearly 54, almost a year without periods. If not in a relationship I probably would have been fine with just the Vagifem, but due to wanting to improve libido and thinking of future brain and bone health, I started a few months ago Oestrogel, one pump, and continuous Utrogestan, 100mg at night. In relation to Ch6 of Hormone Repair Manual, and p141, I experienced similar to Deborah (though no hysterectomy):
1) waking at 3am again, and sudden stabbing breast pain (not pain that started at the beginning of Oestrogel and got better, but started after a few months of Oestrogel, and seemed to be getting worse). So if that maybe meant I was producing my own oestrogen, yet I'm pretty sure vaginal dryness, without Vagifem would still be an issue, and low libido definitely was? It seems you can have symptoms of both low oestrogen and high oestrogen? I always get headaches by the way, to a greater or lesser degree, as sensitive to any changes in hormones. I have therefore reduced the oestrogen to a quarter of a pump, and taking religiously 6mg of Violet iodine per day for my breasts. I must be one of those women (as noted on p142) who develop breast pain on hormone therapy, so must be careful. I always did have lumpy breasts, but have regular thermal breast scans, and the last one a few weeks ago showed things were fine.
2) On p142 you said that Professor Prior said no menopausal women should need more than 50mcg of oestradiol. You recommend then starting with a 25 mcg patch and only going up if needed, and the highest dose patches are 100mcg. Yet if using Oestrogel, one pump is 750mcg which is a lot more. So if I am taking a quarter of a pump, that's still just under 200mcg, which could still mean too much? Yet many women take I think two whole pumps a day. Would it be effective do you think Lara, to take just a pea sized amount of oestrogel for someone in my situation? Thank you so much. Sarah