Thirdly - 500 mg prometrium is a HUGE dose. No gynae or menopause specialist would prescribe this amount (except for fertility indications). I'm amazed you've been able to function at all! I would be more worried about this in terms of potential increased breast cancer risk then the tiny amount of estradiol you are now taking.
I've not come across any studies showing an increased risk with bio-identical progesterone, only with progestins.
Climacteric. 2020 Jun;23(3):226-228. doi: 10.1080/13697137.2020.1735797."In the Lancet paper, they state that, in general, the relative risks did not vary by progestogen type, including oral micronized progesterone, although the risk appeared to be somewhat lower for dydrogesterone. But users of estrogen plus dydrogesterone comprised just 2.1% of HRT users, and
users of estrogen plus oral micronized progesterone comprised only 0.4%. It is therefore impossible to draw any firm conclusions from these figures. The vast majority of combined HRT preparations contained medroxyprogesterone acetate, norethisterone acetate or levonorgestrel. "
Fourth - here in UK, the recommendation for women post 60 taking HRT is to use transdermal HRT ie patch gel or spray - because of increased stroke risk and cardio-vascular problems in older women, especially if you have other risk factors such as High BP, excess weight etc.
I've not come across any studies showing conclusively that oral bio-identical estradiol results in increased cardiovascular risk and increased blood pressure. Actually, the opposite of that.
Hypertension. 2005;45:399-405“We studied 13 normotensive postmenopausal women (54±2 [mean±SE] years) before and after 1 month of oral estradiol 2 mg daily”
“In summary, in normotensive postmenopausal women, estradiol increases angiotensin II, but not aldosterone, at rest and during orthostatic stress, yet lowers, rather than raises, BP under both conditions. Downregulation of vascular and adrenal responsiveness to angiotensin II may protect healthy women against this activation.”
Circulation 76, No. 4, 753-758 1987.“In the present study we found no change in systolic blood pressure and a tendency toward a lowering of diastolic blood pressure during both percutaneous and oral estradiol therapy. Exactly the same response has been reported during oral estrogen replacement therapy with higher estradiol doses*.27”
*4 mg oral estradiol vs. 2 mg in this study
Acta Obstet Gynecol Scand Suppl. 1975;43:1-11.“Two different dosages of the oestrogen hormones were used: 4 mg 17-B-oestradiol with 2 mg oestriol, and 2 mg 17-B-oestradiol with 1 mg oestriol”
“The tablets containing oestrogen alone (E 42 and E21) were given with an intermission of 3-7 days between each treatment period, or in some cases with an intermission of 2 days each week.”
“The material comprised 352 patients, each of whom underwent 3 to 18 four-week treatment periods on one and the same preparation. The investigation covered a total of 2 101 four-week periods (Tables I1 and HI).”
“Neither thrombosis nor any rise in blood pressure occurred in any of the patients.”
“In menopausal women the blood pressure is often raised. During the treatment, if there was any tendency it was towards normalisation. In no case was an increase in blood pressure noted during the oestrogen therapy.”
Ann Clin Res. 1983;15 Suppl 38:1-121.“Blood pressure, central hemodynamics and peripheral blood flow were measured at rest in 20 normotensive and 20 hypertensive postmenopausal women during cyclic placebo/estradiol-17 beta treatment. Micronized estradiol-17 beta was given in daily doses of 2 mg and 4 mg."
"Estradiol-17 beta substitution decreased the systolic and diastolic blood pressure in normotensive, hypertensive and borderline hypertensive postmenopausal women."
"Irrespective of the pretreatment blood pressure levels, heart rate decreased during estradiol-17 beta substitution”