With your history of TIAs, hormones seem very risky, regardless of your age. Have u tried other, nonhorminal medications?

Fezolinetant, an med designed for hot flashes, is the most effective nonhormonal medicine in population studies to stop hot flashes and increase sleep. Studies of populations doesn’t mean it’s necessarily the correct medication for any specific individual. You may need to experiment with your doctor and try a variety of meds, either alone or in combination, but I can tell you that in my practice I never had a patient with your story whose symptoms I couldn’t improve. In most I could resolve the symptoms entirely.

Gabapentin reduces flashes by half generally. It is also sedating and aids sleep. Sometimes it can be combined with doxepin, another sleeping aid, at low doses.

SSRIs/SNRIs (antidepressants ) like venlafaxine or paroxetine offer relief, though milder than hormones.

If a patient was only partially controlled, sometimes I would add clonidine, though this is a blood pressure lowering medication so if your BP runs in the low side, I would avoid it.

This is all to say thee are many alternatives to hormones. They might not work quite as easily as hormones. But they do work.