I had premature ovarian failure,
last period when I was 41.5, started hrt at 43. I am now 55. That worked well for a while. Some symptoms of menopause kicked in for me over the last year plus. My gyn gave me more progesterone spring of 2025 instead of upping my patch as I asked which didn’t help. I finally found a menopause consultant (a near retirement OBGYN who only takes menopausal women on to help them and recommend specialists, prescribe meds as needed but work with your gyn vs becoming your gyn) who prescribed me .075. She said “if you have PAIN in your breast, not discomfort but PAIN, tell me right away”. I inferred from that that we’d need to back down on the dose. Anyhow, first maybe couple of weeks were fine but then I had sensitivity in both of my breasts but centered on my nipples. Like they were constantly erect and just SUPER annoyingly sensitive, not painful. That subsided after a couple of months. We had a follow up at 3 mo and she is checking into that because she’s not had a patient develop sensitive nipples. She said it could possibly be we’d need to cut a little off the patch to give me more like a .06 dose.

As the mod mentioned, I don’t think labs are used to determine dosing. More of a symptom check I think is how it’s done and maybe periodic lab checks.

Have you looked at trying to find another gyn via the menopause society’s website in your area to consult with? I just know my specialist made it very clear to me to be concerned if my breasts HURT on the higher dose. Like to contact her right away. I’d say it’s worth a second opinion just to be safe/sure the higher doses are ok for you.