@loplady
I think the fears with HRT are probably 3 fold for your doctor; 1. her experience 2. the old WHi report that was not about BHRT but still strikes terror in the hearts of many who aren't aware of the old vs new HRT/BHRT, and 3. the need for her to be sure that you do not have health concerns that would cause a problem with any HRT and all the responsibility that goes with keeping you safe.
Ex: Many of the concerns about beginning any HRT, if the patient has not been on any hormones for 10 years or more, stems from concerns about plaque in the cardio system breaking loose. When you are in menopause for many years then the lack of hormones may cause cardio changes....stiffening of the cardio vessels and possible build up of plaque. When hormones are reintroduced then there is a chance that as the cardio system becomes more pliable that the old menopause plaque may loosen and cause problems.
Because of this, you need a doctor that is willing to do all the tests before and during your use of hormones; tests to keep you safe...plus, many doctors put their patients on vit k to help keep the calcium in your bones and remove it or prevent it from entering your cardio system.
A hormone expert familar with these concerns and who is going to test you regularly is imperative; also a gyn who will check your uterus one to two times a year with a uterine ultrasound is, I feel, also imperative.
Your gyn's fear of the old HRT and progestins is well founded. BHRT does not carry the same risks, but those HRT concerns are hard for drs to shake and to put into context. Plus, her fear of HRT is based on her knowledge of the old HRT and responsibility towards you.
If you take osteoporosis drugs then that responsiblity would be with another doctors, your endo, so that doctor will be responsible....so she is passing that responsiblity on to your endo; which she should do. Still, it explains her concerns for what is her responsibility and her passing of other concerns to an expert on osteoporosis drugs.