An incorrectly fitted breast pump teat can cause pain and trauma to the nipple and areola, affect milk supply if breasts are not being emptied, lower the amount of milk expressed, thus leading to problems such as blocked milk ducts and mastitis. You can tell if your nipple is too big or too small for the pump if you are experiencing discomfort, pain or inadequate milk expression when pumping. The easiest way to determine if your current pump teat is the right size, or if a smaller or larger size is required, is when you are actually pumping. Make sure your nipple is positioned in the centre of the teat funnel before starting to pump. Your nipple should be moving freely in the funnel and not rub against the sides and you shouldn't feel pain. Perhaps this graphic table from (http://www.nursingangel.com.au/page/resources/choosing-the-correct-breastshield-size/) can help:
I think Izda;s explanation is pretty thorough. Trial and error is the best method unfortunately. I was using teats that were too small and it made my nipple really sore as it rubbed against the sides and was super painful. Pumping should not be a very painful exercize so if your nipples feel like theyre being pulled or squeezed, or are getting irritated getting rubbed against the walls, chances are your teat size is wrong.
I was worried about the effects of hormone therapy on the kidneys, and this article helped me a lot. https://ways2well.com/blog/can-hrt-cause-kidney-problems-risks-myths-and-truth offers an in-depth analysis of the risks and debunks several erroneous beliefs. This is essential reading to understand the true impacts before starting treatment.
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thanks