After my hysterectomy I started bio-identicals. Five or 6 years later I was told by my doctor that HRT wasn't effective for longer than that, so I stopped. At that point my sleep was greatly affected and I began to have occasional hot flashes. I tried many things short of a prescription sleep aid, but most nights sleep was a real problem and this went on for years. After being diagnosed with osteopenia and osteoporosis, a friend suggested I try HRT again so I talked with my current doctor. She has been extremely knowledgeable and helpful and I began using bio-identicals again several months ago. My sleep has improved drastically, and my hot flashes are gone. For me, the hot flashes were inconvenient but losing so much sleep was the much bigger issue, as it affects so many things. I don't like the idea of a non-natural HRT, the bio-identicals fit my approach to life.