How do I knwo how many pumps of gel is enough

[Pippilina]

I am 52 - periods stopped totallya about 9 months ago and I got the hot flashes and various symptoms. I went on oestrogen gel (2 pumps) and Progesterone tablets (12 days). I see most people seem to be on 4 pumps - how do I know if this would be better for me? 2 pumps has stopped the flashes and night sweats but can't say I feel on top of the world nearly 3 months in. Thanks

Ideally you'd need to ask your GP for a review in a month or so. Realistically, you could probably get away with adding another pump and see if it makes a difference.
I had to increase mine when I had my ovaries removed and joint pain became hideous. 4 pumps gave me other issues, so I settled for 3: 2 in the morning and one at night.

The 'dose' is two pumps (says on the leaflet) but you can go up or down.

Two pumps is 1.5mgs of estrogen. It's classed as a medium dose.
This is the same as a 50mcg patch
A bit higher than a 1mg tablet.

Very few people are on 4 pumps- where have you seen they say 4 pumps?
4 pumps would be 3mgs estrogen and that's higher than any tablet form (2mgs is the highest).

Also, don't expect HRT to do everything. Exercise, diet, etc are all really improtant.

Agree with previous, you've given it a decent time and still having symptoms, so back to GP and ask about increasing it a bit.

@Pippilina You probably won't need to ask your GP about increasing the dose.

The whole point of using gel is to use what you need. It will be a waste of an appt, TBH. They will likely just say 'yes, fine'. The only issue is if it means you will need to change how often you get your repeat subscription.

The only times you need to ask about increasing the dose is if you go above 4 pumps which is above the licensed range. There has been some recent discussion on this by the BMS who suggested that women on much higher doses need more progesterone each month.

If you normally have a review every 6 months for your HRT I'd just mention it then, that you have increased it.

But also, it's not a silver bullet and a lot of us find that lifestyle changes can really help as well.

Isn't there a real risk that increasing oestrogen builds up the lining of the uterus which could cause cancer, so wouldn't you need to increase your progesterone too?

I assumed that 2 pumps of Oestrogel is countered by 200mg Utrogestan for 12-14 days (cyclical)?

If you applied 4 pumps, surely you'd need twice the Utrogestan?

The dose of gel can be anywhere from 1- 4 pumps.
The advice from the BMS is that doses above this (which would be off-licence) may need more progesterone.

If someone is on 4 pumps and they find they are bleeding very heavily or at odd times, then the advice is to try using more progesterone.

Endo cancer can take a very long time to appear and if someone is having a monthly withdrawal bleed it's far less likely.
The biggest risk for endo cancer is being overweight or smoking.

I was prescribed two pumps but increased to three out of curiosity and I felt great on it. The gp agreed to increase my dose officially. Then I got greedy and tried four and got a zit outbreak... not fun at 48 with grey hair!