How many pumps of oestrogel are you all taking once you’re in menopause?

[Cherryblossom200]

Hello!

Just curious I think, I’m almost 51 and well over a year of no periods. I currently take two pumps of oestrogel at night before bed. I’m fairly petite and 5’3 so I don’t think I need loads. I know this is the baseline like amount. I want to start a third pump soon because I’m finding during the end of the following day I’m starting to feel anxious again.

@Sidge Many thanks. I'll make an appointment. I've been trying to decide for weeks whether the hot flushes are back or if I'm just hot because it IS hot and I'm fat..

This week with the period appearing, the weather cooling and still being roasting hot, particularly at night, has made me decide it's probably the change of HRT. 😁

My doctor who is a specialist hasn’t recommended this. I’ve just had a new one put in and she was happy with what I had.

The blood test is just to check if you are in the correct range for testosterone. Mine were normal too, so that meant it was ok to prescribe it. It has been a game changer for me.

The amount of oestrogen isn't height dependent, it's symptom dependent. I'm on the highest dose because I needed that to manage my symptoms.

I’ve been on two pumps for the last two years but have had more brain fog & anxiety recently. When I requested my latest repeat prescription, I mentioned this and the GP told me to up it to three pumps and then made me an appt for a month’s time (which is this week coming) so we could assess how I was doing. I am feeling much more “on it” again so it seems to be working. It does take a while to dry now though!

Apologies I missed that you had a Mirena - I was referring to oral progesterone.

I’m not being pedantic but just wanted to update this for information.

BMS's updated 2026 dose table classifies 4 pumps of Oestrogel as a high dose of oestrogen.

BMS says higher oestrogen doses can require more progestogen for adequate endometrial protection when using progesterone/progestogens separately.

But a 52 mg levonorgestrel IUS (Mirena) is specifically recognised by BMS as providing adequate endometrial protection with oestrogen therapy. Their guidance says it is commonly used for up to 5 years for HRT endometrial protection, even though the manufacturer's HRT licence has historically been shorter.

The BMS guidance therefore does not say that someone with a Mirena automatically needs extra progesterone when using 4 pumps.

@Askandyforcompooh thags fab, how has the testosterone helped you? When I spoke to the specialist for testosterone they told me that it could make my hair fall out which petrified me! They said it’s hard to reverse or something so it put me off!

I’ve just had my dose upped to 4 pumps ( been on HRT for 8 years ) as the symptoms were creeping back but my women’s health specialist said I didn’t need to take anymore progesterone - I specifically asked - on one tablet orally .

I had no libido and no sensation. Testosterone changed that completely. My hair hasn't fallen out!

Look up the guidance as your specialist is wrong. It was changed a few years ago.

My understanding about 4 pumps of gel and double the dose of progesterone is the BMS says 'consider' rather than 'must'. (It's a while since I looked at the doc so they may have changed it.) @Sidge

Women respond differently to how estrogen stimulates the endometrium. Some women will bleed a lot , others hardly at all even on the same doses.

I thought (and will check) that the double dose of progesterone was an option for women who have heavy bleeds, breakthrough bleeds or a spotting if using continuous.

There is also a difference between how specialists and GPs interpret the BMS guidance- it can appear black and white to make it easy for GPs to follow, whereas on a more individual basis with a specialist it can be tailored more precisely. My own HRT is off-licence in terms of dose but is suggested by an extremely experienced consultant.

@JinglingSpringbells in my area at least prescribers are erring on the side of caution and suggesting increased progesterone with high doses of oestrogen, to avoid bleeding issues at all. I suspect it’s cautious prescribing as women would be unhappy bleeding when they haven’t for so long, and it may trigger unnecessary referrals to the gynae and PMB clinics. Certainly in my area when we do advice and guidance they tend to suggest more progesterone or Mirena (where no other red flags obviously) for HRT related bleeding issues. We are scanning a lot of women, quite a few are using more oestrogel than originally advised.

HRT management is not black and white, so many shades of grey and that’s why individualised treatment is so important 🙂

I’m post menopause and take everything going! 2 pumps oestrogen, daily progesterone, daily testosterone and twice weekly vaginal oestrogen. I feel ok on this. Can’t say I feel the same as pre menopause, I’ve lost a lot of my get up and go but I feel more stable than I did pre HRT. I tried 3 pumps but the breast pain was dreadful and wouldn’t go away even after months but it did make me feel more like myself.

Just one - with more I get too much vaginal moisture. I read maybe you can decrease during weight loss though so I should read more about that.

I was advised to increase my progesterone as
well as oestrogen. Now use 3 pumps of oestrogen gel and take 2 x 100mg progesterone capsules.

I am menopausal and it really made a difference.

Well last night I woke up starting to get hot again, so I know I need to up my dose. I’d like to do three pumps before bed, for some reason I don’t like taking the gel during the day.

Yes, I agree. I've just checked the BMS guidance. It says for 4 pumps use 200mg daily or 300mgs on sequential.

As you say, it's very individual. There will be some women who cannot tolerate those doses of micronised progesterone. They should consider other options, perhaps. Also, as you say, the NHS has to reduce unnecessary scans because of the time/cost issue.

Women I know who are on doses that are different to the official guidance usually have regular scans (privately) to check all's okay but the NHS doesn't offer that.

I apply my gel to inner thighs - one for each pump - but am not sure how precise you need to be. If I go up to three pumps (still having night sweats) would it be better to go to shoulder as well as inner thighs or just spread on outer as well as inner thighs?

When I was on this it didn’t really matter how many pumps I used as I wasn’t absorbing it anyway.

I’m 53 but not in meno yet. Still have regular periods. When you say pumps what do you mean? Is it a lotion and also does everyone need it? Sorry to hijack

I use the gel morning after my shower and take the capsules before bed.

I have been doing this for a year now on advise of private menopause GP who also advised increase number of pumps from2 to 3 and double does of progesterone. This was agreed by my NHS GP, who also upped my prescription.

I would advise going back to your GP because you should also increase your progesterone if you increase your oestrogen. Not doing so could cause a bleed.

I did have one bleed after increasing
and was quickly referred for ultrasound, all was normal.

I switched from Kliovance at 61 (I knew I still needed HRT because I'd stopped for a month and the symptom I was taking it for returned). Started on two pumps, got annoying breast tenderness so dropped to one, and that has been enough.

I’ve booked in with my menopause nurse and will chat with her then 😊 They do scans here on the nhs as I had one before x

I was up at 4 for a while, and now am menopausal and down to 3.

I tried going to 2, but had more breakthrough symptoms so back to 3 for now.

It's an oestrogen gel. The prescription is for between 1 and 4 pumps from the container. It depends on your level of symptoms how many pumps are prescribed. You can also use patches which are different strengths.

Some people have no symptoms, some have severe symptoms. In perimenopause you still have periods.