Hi @ohhhthepain
My gp prescribed on symptoms. I started crying in the surgery because I honestly thought I would never have a sex life or any kind of life again! My nice gp had a look and diagnosed vaginal atrophy and that coupled with my other symptoms were enough to get hrt.
It has taken me a few tries to find the most suitable but even the least suitable made me feel so much better.
I have to also use vagifem every day and am also on the highest dose of hrt premarin 1.25 which I take everyday apart from Wednesday and Saturday when I halve it. Everyday made me a bit jittery. I take this alongside 100mg utrogestan every day. I prefer to do this rather than cycle because my moods are stable this way. Although some women get erratic bleeding with this.
Patches and gel did not suit me - premarin felt like it was made for me.
Yes there are risks of course - as there are with everything. Heart risk strike risk obesity blah blah but I drink within limits don’t smoke exercise am healthy weight so my risk is overall very low.
Oh I have a blob of testosterone daily too.
My happiness and quality of life, sexual response etc is very important to me and now all of those things are great again. Hair, nails, skin etc lovely.
You can take my hrt out if my cold dead hands - not before 
Sirry rushing out not proofed anyv question ask away!