Without the bio-identical hormones, I have hot flashes every 20 to 30 minutes without ceasing 24 hours a day. I was so sleep deprived before the hormones. They are easy to take or administer and completely painless, unlike the pellets. My sister tried the implantable pellets but could not stand the pain that they caused 24 hours a day and so she had them removed after 3 weeks. Also, all of the other menopausal issues are cleared up with the hormones. Sex is no longer painful.