Just incase anybody is having an issue with the performance of their ESTmep whilst trying to use the design line to trace over a PDF, I've found the best solution is to "flatten" a PDF file using a PDF printer program such as CutePDF by printing it as an image. ESTmep usually struggles to process a PDF with multiple layers on which causes the slowdown. Printing as an image when converting to a new PDF and using this as an underlay instead gets rid of all of these layers meaning it massively reduces what ESTmep has to process.
I would usually also PDF this in greyscale to reduce size. It's best to keep the original paper size to make scaling easier, but reduce the print quality to keep the size down (probably 144dpi should be sufficient).