I have been on HRT for 2+ years now and it has changed my life. My gynae says blood tests can only ascertain two things - a) that a woman has gone through (and hit the other side of) menopause or b) that a woman is undergoing fertility issues. For the rest of us we are on an menopausal arc so to speak. One step forward, two steps back. So you can be menopausal and still have periods, for example.
I had the mirena coil put in for terribly heavy periods. Not long after that I was also starting to have wicked hot flushes, night sweats and palpitations, not to mention a constant desire to commit mass murder (or at least it felt that way; everybody pissed me off!) Anyway with the mirena and the HRT I am relatively normal again, sleeping fine etc. The only downside has been it is harder to lose weight but in fairness that gets tougher as we age anyway.
There seems to be a weird reluctance out there (and I speak of the women in my life) to even consider HRT. I am monitored closely and have yearly mammograms as there has been a lot of breast cancer in my family, but I honestly feel my quality of life has improved, and that can only be a good thing, and BC is more likely to be caused by overweight than by HRT.