I use 17beta estaradiol patch, with sublingual estradiol tablet, and spiro in a higher than usual dose (yes, it's my doctor's Rx....now).
Estradiol is the most potent of the human estrogens, and both estrofem and its generics are bioidentical.
I got excellent results from this combination. Spiro was originally a hypertension medication, and as we who take it know well, a diuetic. I had pitting edema of the lower legs (means when you press the flesh, it remains dimpled there momentarily, showing fluid retention), and the spiro I take has eliminated it, along with its main task eliminating androgen activity.
I started at 54, 3 yrs ago.
Bev