I initially did not use any hormone therapy after menopause. I went several years thinking it would be fine without it but it wasn't! My genital area got so dried out and fragile it was too extremely painful to have sex! It was painful to even sit; my outer genital skin actually cracked and bled. Quite painful and uncomfortable! Because I went a long time with no hormone therapy and experienced the detrimental result of the loss of hormones, I recognize how helpful, valuable and necessary hormone treatment is for my quality of life.