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[Briony]

Studd originally thought  you'd need more than 4 pumps to suppress ovulation (they experimented with 200mcg patches - I think 4 pumps is similar to 100mcg patches). However, 4 were then recommended due to potential side effects with a higher dose. In the research, on 4-5 pumps, a small minority of women still ovulated.  Last year, I switched to this regime and found I was one of those minority - some months, I ovulated therefore sending my estrogen sky high. Hated it. I was offered the choice of upping to 6 pumps, but chose instead to go on a bio identical birth control pill. The more sustained progesterone in this (not a particualrly high dose but taken for longer than in a sequential hrt regime) added to the bio identical estrogen, has controlled my ovulation far better and thus my symptoms are better. Not perfect, but certainly better than when on any of the hrt I tried. I am 44 and peri menopausal.