violetbat I can't help but am in a similar boat so watching with interest - I'm on an even higher regime at 5 pumps estrogel, plus 10 days of utro and while my plasma estradiol has finally gone up after 4 years of non absorption, my bleed this month is agony.
So perhaps it is the case that having more E2 makes the bleeds more painful? And while I would take physical pain over mental anguish and fog, the cramps are really searing.
Everyone is different but Ive been told to get my estradiol up to between 400-800 so your 400 sounds fine