You're not a complex case at all. Many women struggle with HRT for years until they find a suitable regime. I think you could try other patches, Estradot, Estraderm, Progynova, and even Femseven when it becomes available again. There's also the spray, Lenzetto. Plenty of options. I think 4 sachets of Sandrena is not your best option. Your skin will suffer in the long run. And what if you need to increase the dose? It's a lot of alcohol being put on the skin, not to mention a waste of time and money if you're not absorbing it properly. Do you know that only 10% of the gel, as estradiol, enters the blood?