Estrogen gel ... how do I know if I need to increase the dose? Can I just do it myself?

[NormalForNuneaton]

I've been on HRT for over a year now... Utrogestan and 1 pump of Oestrogel.
As the initial appt when it was prescribed was mainly done over the phone and the prescription print-out on the label is vague ("take as prescribed") I can't be 100% sure that the oestrogel dose was 1 pump and have had my doubts when reading other posts. Is this the usual starting dose?

All has been fine but the last few months my sleep has been really bad (4-5am wake ups), I'm occasionally starting to feel too hot at times (not full on hot flushes but an inability to regulate my temperature) and have various joint pains.

Does this suggest I need to up my dose? Can I just do this myself or should I go through the rigmarole of speaking to a GP? From what I've read it's not dangerous and would still be within the realms of quite a normal dose.

Two pumps is the usual starting dose, and you can go up to 4. Treat yourself to another pump !

For the sleep I’d suggest you cut out alcohol and get some magnesium glycinate. For the joint pains, a good omega 3.

Usual starting dose is two pumps so you can instantly increase it

I was initially prescribed Sandrena sachets, but when I was switched to oestrogel pumps, and started at 2 pumps a day, the sleep problems, night sweats and joint pain all started to come back. I increased to 3 a day and the symptoms were resolved.

The GP instructions on my boxes state to start at 2 a day, increasing up to 4 if required. I've just found that 3 have been enough to stave off my symptoms.

I also take magnesium glycinate, which has definitely helped with my sleep too, and vitamin D.

Yes I've just upped mine as I've felt needed. Been on it 3 years now and just upped it to 4 pumps. Just keep an eye on your bp.

It might depend on your risk factors for stroke. Usual starting dose is 2 pumps, I've been started on 1 though as have ++migraine with aura and a family history of stroke but that's obviously quite conservative.

Thank you all, sounds like I'm OK to go to 2 pumps then.

I also meant to say that I also have osteopenia so 2 pups will probably be benficial with that too.

Thank you for the tips about magnesium glycinate @DustyLee123 and @skilpadde . I'm finding that my first 4 hrs or so of sleep are pretty good in that I get to sleep quickly and have some deep sleep but then when I inevitably wake at 4-5am it's hit and miss if I get back to sleep. Was that your problem too?

I vary between 2-4 pumps, usually 2 but go up to 4 depending if the night flashes start. The higher amount works straight away.

Waking in the night is said to be high cortisol, so a stress problem.
I have a good sleep routine, no alcohol, and take magnesium. It seems to work for me most of the time, I sleep worst when stressed.