Like CLKD says, some start lower on the estrogel. First time I tried hrt, I used 2 pumps and it was too much for me and I quit due to side effects. 9 months later I tried again, this time on 1 pump and it was so much better. Side effects were minor and went away in a couple of months. So with the estrogen part you can always start lower than 2 and gradually increase until your symptoms have gone.