Hi.Iam 6m into Livial and under gynae instruction to add Estrogel to it to top up. I have had Estrogel since my subtotal hysterectomy with ovary removal since October 2014 so iam in Surgical menopause . I started to feel under the weather October 2016 and felt it wasn't working as well.Tried different Hrt,Zumenon, elleste, non helped. So put on Livial after Xmas 2016 with 2 pumps of Estrogel in morning and one at night.Felt a lot better, no anxiety ,calm, but lethargic and hard to motivate myself. I dropped nighttime gel in May as I felt fine and was ok.For past 6 weeks I have been on a decline feeling anxious, pins and needles, lack of concentration, mixed up, tearful, lack of interest...etc really creeped up on me.Took me a while to work out but I must be low in oestrogen!! I have upped my dose to 3pumps a day and low and behold iam starting to feel 'back in the room' I feel all this gel and Livial is a lot to take but Gynae consultant has said I must need it as we aren't all the same. Apparently Livial works differently in the body than other hrt. Nobody seems to have a correct answer for dosage. Not everybody is the same . (So I have been told many a time)