@fearfracture, I started HRT at about 10-11 years out of menopause. I was about 63 at the time and had just finished my 2 year course of Forteo. I weighed all of my options for a follow up treatment, deciding that HRT offered the best opportunity for a more natural bone remodeling process. I decided to take whatever risks (and benefits!) were associated with it vs. the risk of more osteoporosis drugs (for now anyway). It is difficult to assess long-term safety since there are no studies to support that, just observational. In the 4ish years I've been on HRT, I've pretty much maintained my density. I'm a really "fast loser" so maintaining is pretty terrific for me. As you've mentioned, bioidentical is essential and an estradiol patch at the lowest dose of .025 is supposed to effective for protecting bone. Because it is a very low dose, I would think there is also a little less risk involved. If you have a uterus, you must take progesterone and make sure that it is bioidentical as well in the form of micronized progesterone, not synthetic progestin which is what most conventional doctors will prescribe as that is what you will get from the pharmacy and through insurance coverage. I'm not sure if micronized progesterone is even available through conventional pharmacies as I have to get it from a mail order compounding pharmacy. It is pure with no fillers (unlike the pharmaceutical which has peanut oil in it. why??) and the cost is pretty reasonable at about $35 a month.

I have an upcoming appt with Dr Felice Gersh to get a perspective from her on my protocol. I plan to discuss whether I should have some testing done at this point, like a uterine ultrasound, to make sure all is well. Also will discuss whether I should continue taking progesterone daily or begin cycling that which from what I understand is a safer regimen (though you have to contend with some monthly bleeding). I will also get her perspective on long term use. She's an integrative gynocologist/MD and has been at this a really long time. She's very well versed on the research and has her own observational experience over decades in practice prescribing HRT. I'll report back on what I learn from her.