Hi
I'm sorry you are struggling with it. I don't know if a doctor would prescribe Premarin and Utrogestan. I can't see why not. But I don't know anything about Premarin. Isn't that the old fashioned one? If so, you would be better off on Estrogel if you can find your dose because it's body identical and going though the skin means less liver stress. But the dosing from a tablet to a gel will be very different. When you swallow a tablet a lot of it gets lost to the digestive processes.
I think you are asking how you should proceed. I'm not a doctor or course, just a patient feeling her way through this and finally starting to feel a bit better as a result of my recent changes.
If you feel flat then you are probably short of oestrogen. Too much is more likely to make you feel anxious and jittery. Flat and dull is likely to not be enough. So the tablet must have been pretty well absorbed in your system. Why don't you try using 4 pumps of gel a day (none of the menopause specialists seem to think that's too much at all, in fact one of them, can't remember who, says if you are going to do it, do it properly and get some benefit). Apply 2 in the morning and 2 in the evening so that you don't get a big hit in one part of the day. Your levels should be more stable if you split the dose. See how you feel. Do this now, when you are in the non-Utrogestan phase so that you can be sure how you feel is from the Estrogel. We all absorb differently hence why some women need 2 pumps others 4 or even more.
You should tell quite quickly if you feel better or worse from adding in that 4th dose. Probably within a week, certainly within 2 weeks. If you feel worse, jittery, anxious, on edge, snappy etc. it's perhaps too much and then you can reduce back to 3 pumps but keep the split between morning and evening. Your levels will come down and you will either feel like you do now or a bit better. If you end up feeling like you do now, drop to 2 pumps a day. And wait and see how you feel on the lower dose.
Being hypothyroid, I've learned over the years that when I feel bad, I have to consider I may need to increase my dose. But I also must remember that too much feels just as bad as too little and sometimes I might need to reduce my dose. It must always be there at the back of our minds. More might do the trick, but if it doesn't, try the other way. With Estrogel it's really easy and the changes settle very quickly. It's a bugger with thyroid meds as the slightest change takes 6 long weeks before it has it's full effect!
Chances are, you need a little more and that should also help you to not feel down the next Utrogestan cycle. As soon as I upped my dose of gel from 1 to 2 pumps in the first few weeks, I sat down and painted my toe nails. I hadn't done it all summer! So that gel is pretty quick. But after a week or thereabouts I felt tired again and so added in the 3rd pump. Good luck!