Hi again Chrislm
In answer to your question about conti HRT - this is not meant to be taken by peri-menopausal women because you are likely to get bleeding at unpredictable times whereas the cyclical HRT is better if you still have a cycle because there is generally less unscheduled bleeding (although you can still get spotting if your cycle kicks in!).
The other thing is that conti HRT involves taking a progestogen all the time - which certainly won't do anything to help your tiredness. At best progesterone ( the bio-identical one - ie the same as our own) has a sedative effect which can make you more tired and lead to fatigue. At worst some of the synthetic progestogens can have worse side effects eg headaches, anxiety and depression.
My view is that our bodies are not adapted to have a constant raised level of progesterone all the time so I would prefer to stay on a cycle as long as possible.
The reaction to a couple of nights of taking a higher dose of pills should not be taken to mean that this is unsuitable. A sudden increase in oestrogen is bound to cause some immediate effects but as with all HRT, you are supposed to give it 3 months to settle. Also taking tablet HRT does give more of a daily "spike" in oestrogen levels compared to transdermal methods (patches or gel).
Dancinggirl mentioned the effect of too much oestrogen - this is a phenomenon known as "tachyphyllaxis" where the body has levels of estrogen in the blood higher than would ever occur naturally - ie "supraphysiological" levels. I would have thought it unlikely this would be happening in your case because 2 mg tablets is still only a medium dose - although if you still have a strong cycle then your own peak of oestrogen at ovulation combined with a constantly increase dose of extra oestrogen from your HRT will increase levels to a certain extent. Prof Studd talks about this in his article on hormones implants:
http://www.studd.co.uk/implants.phpYou will need to scroll down.
Finding the right level of oestrogen ie the "sweet spot", can be tricky but usually with post-menopausal women it's not an issue as high levels are rarely achieved.
How old are you by the way if you don't mind my asking?
You might find that changing to a different HRT such as Femoston might suit you better, as this has a different type of progestogen in it - but this depends on whether you feel worse during the combi pills, or all the time, or just after you change from the combi ones back to the oestrogen!
Hurdity x