I agree with Dotty Callisto, blood tests are no good. I am the same as Dotty I use 4 pumps, but other ladies can control their symptoms on on 1/2 pr 3. My GP and Consultant go on controlling symptoms. What's the good of a blood test that says in theory you have enough oestrogen but you still have flushes, anxiety, aches pains etc? GP's always err on the side of caution about increasing doses because the majority of them don't really understand what they are talking about although they should!
Only you know how your body feels and can judge What is good about the gel is you can vary the dose without having to ask them every time. Up to 4 pumps is absolutely fine - in fact there have been ladies on the forum who have used 6 but they are definitely under supervision! Up to 4 is perfectly ok. It does take a while for your body to settle and sometimes when you up it you feel a bi rough for a couple of days whilst the body adjusts. it has take me a 1 whole year to get my hrt right - there is no quick fix.
I do the same as Dotty - 4 pumps in the morning and rub it in. I think if you don't rub it in the carrier agent evaporates and you lose some of the dose, so I rub it in until its gone. I put it on my thighs.
How long have you been on Utro Keyellvee?