Initially my doctor prescribed prempro and some of the other synthetic hormones but there were too many side effects, i.e. breast tenderness and vaginal discharge. I sought out a doctor who prescribed bioidentical hormones and after a complete workup I started taking the troches. Almost immediately the severe hot flashes, trouble concentrating, being unable to sleep through the night and lack of libido were gone. That was 10 years ago. I see my doctor every year to discuss dosage and how I'm feeling. I hate to think about going back to feeling the way I did before taking bioidentical hormones. I have NEVER had one negative side effect from them and have recommended them to many of my friends and relatives.