Hi Penguin
Have you any idea where in peri-menopause you are ie early or late? How often your natural cycles are?
Very early and early peri-menopause can be more difficult to treat with HRT because that's when, as you say the hormones are fluctuating dramatically - huge surges in oestrogen and dramatic falls, leading to sore boobs when oestrogen is high, and flushes and low mood tearfulness etc when it falls. Overall though oestrogen levels on average may not have fallen by much ( and if periods still more or less regular, then perhaps not at all)
At this stage a low or medium dose HRT can help to cushion the falls but as you say you may well not need two pumps of gel during the surges and especially around ovulation when oestrogen will be at its highest.
In terms of the fluctuations, suppressing ovulation could work and this can be achieved eg through the contraceptive pill (ie QLAIRA or ZOELY) that contain estradiol, or through VERY high oestrogen doses ( as per the Studd regime used to treat reproductive depression).
In terms of flushes/sweats - you really want to have the minimum dose of oestrogen that stops these as that is usually the first/main symptom that drives women to want to try HRT....but I get what you're saying about sore boobs....
Yes progesterone also causes sore/achey boobs. When I'm on the prog part of the cycle my boobs enlarge and can be achey (and that really is annoying at my age
).
In terms of prog dose - yes it is dose dependent but there have not been studies looking into lower doses of prog along with lower doses of oestrogen (lower than 50 mcg) and of course one size doesn't fit all as there are so many other factors to take into consideration, though licensed doses can't be individually tailored to that extent unless doc is willing to do regular scans.
If you are having regular periods ie ovulation each month more or less, then you will be producing progesterone after ovulation, so the dose of Utro taken externally may be less of an issue (though also heavy bleeding can occur in peri due to the high oestrogen surges) but at some point as ovulation becomes more sporadic this becomes more important and you probably won't know when this happens. Also knowing when to scan while peri-menopausal is tricky - ideally this should happen immediately following a bleed when the lining is at its thinnest - as it will be growing and shedding both due to the HRT and your natural cycle.
This is a bit of a ramble and a few thoughts and probably not very helpful though hopefully something useful in there!
Hurdity x