For me HRT was the ONLY thing. I desperately didn’t want to take any medications or Hrt, but unfortunately an extreme perimenopause created severe physical problems that needed treatment and forced me down a road i didn’t want to go down. I held off hrt for a couple of years, determined to manage without it, but symptoms became so extreme that “informed choice” was not even an option for me and any element of “choice” was totally removed as I was desperate, sleep deprived, ill, in agony, and could no longer function normally. I developed joint pains that severely affected my mobility, night sweats that were so severe I had to change my bedding during the night - shocking sweats, followed by uncontrollable shivering. I started with painful stomach cramps, constipation and IBS. I had extreme hot flushes that made me have to run out of places into the fresh air to be able to cool down and breathe and sometimes they were so bad I actually passed out. I also had something i think is called formication that is described as a sensation of insects crawling on the skin…whereas in reality it was more like standing in a beehive and was actually painful. I have tried to come off HrTat times, but have since developed Vaginal Atrophy which cannot be controlled by local oestrogen only. I have had two severe flare ups recently where I was doubled-up in agony and felt like I had a roll of barbed wire in my bladder, running to the toilet every half an hour to oass 100ml of wee. It was not a UTI but it certainly felt like one, but only responded to vagifem reloading. I know all my physical symptoms noted here (and many others nit mentioned) are meno related as HrT eased or removed all the symptoms completely. I had issues with hrt when my usual product was not available and I was forced to change. I’m back on my usual patch and am doing well…for now I know I’m not the only woman on here who has suffered such an extreme menopause and “forced” onto hrt because symptoms have been off the scale. Mine got to a point that they were so bad I felt like would not be able to live like that. I worry about any talk of there being alternative “natural” ways to treat meno….I agree - there are…but they do not work for everyone. I’ve spent a fortune in the past trying them all. I think I just wanted to say that for some women - hrt (“manufactured hormones”) IS the only option and IS a lifesaver - quite literally, and is not a “choice”, please remember that.