[Skye is on fire]

GG,

A few things to think about. I read your other thread (My Endo is a Moron) and it sounds like your dosage of estradiol is too low. However, if you are over 40, any oral estrogen, even bioidentical estradiol, has a high risk of forming blood clots. Personally, I don't think the risk is worth it, but that is your call. 

In my professional life, I had a patient whose psychiatrist prescribed her oral contraceptives to help with mood swings she is prone to, but she is over 40 and at high risk for clots. After one treatment in which she was complaining of more than usual pain in her leg accompanied by persistent edema and some other signs, I sent her to the ER for a doppler study. She had a clot in the back of her knee and was immediately admitted to the hospital and put on IV heparin directly from the ER. It's that serious. The next day, they did a thoracic CT scan and found multiple pulmonary embolisms in both lungs. She is presently on long term hemostasis therapy, but she is thrilled that she lived to tell me about it. 

You might suggest to your endo that a higher dosage with a less risky delivery system would satisfy both your needs--he needs to feel confident he isn't causing you potentially deadly harm, and you need to feel good about the treatment and see some results. Less risky delivery methods means transdermal (patches) or intramuscular injections. Patches are very expensive and they also have some major problems from my experience. Injections are easy, safe, low cost (even figuring in the cost of syringes) and you only have to remember to self-inject once a week. Also, the most common form of estradiol valerate comes in 1 ml vials (10 mg estradiol valerate/vial) that are injected all at once, so even the endo won't be able to reduce that dosage, other than decreasing the frequency of injection. For my money, even sublingual administration of oral estradiol is too risky, but again that's your call. 

Hope that helps

Sublingual bypasses the liver and avoids most of the risks...although there are always some risks with hrt in general.  Just what I learned through the years.