Hi Caroline
I can only tell u my experiences
I have stuck with Evorel sequi for 4 years, and experienced some (small) peaks and (bigger) troughs over that time which I put down to my own rollercoaster hormones, but these have levelled out over time (I'm 50).
I see lots of women change hrt a number of times and whilst that's right for some, I didnt want to change as I really needed as much stability as possible and didn't want to risk the small gains I had made.
The main symptoms I wanted to control were psychological (suicidal thoughts etc) and overall these have lessened dramatically each year. I figure ES is giving me a minimum amount and my own hormones kick in every now and then to spice things up. I try to ride these (usually very short) periods as overall I am doing much better.
I occasionally break into a pack and put on an extra half patch of estrogen if things are bad. These times are less frequent now. I keep a mood diary (Daylio app) so I have real data to go by rather than vague memories which can be misleading, so I can see the overall improvements.
Now, overall, I am glad I have stuck with it, but there are times when I wonder (usually in a dip!) Should I change to conti. Its a big step for me, I'm holding off so far.
Good luck