Hello, Welcome to Healthcare magic. I have read your question completely and understand your concerns. Regarding your hot flushes, there are quite a few options you could ask your ObGyn to try: 1) Your doctor can increase the dose of your present compound HRT (hormone replacement therapy), to the maximum tolerated dose. Once your symptoms settle, your doctor can then reduce the dose. 2) Your doctor can change your current HRT to an altogether different one. There are many different HRT preparations available which differ in the ratio of the estrogen and progesterone. Your doctor can try you on different HRT preparations, until you find something which suits you. 3) If you do not want to change your HRT or the dose either, you could take some medications which are non-hormonal in addition to taking your current HRT. - One of them is Clonidine, which is used for management of high BP. It can be started at 50 micrograms twice daily dose and then increased up to 200 micrograms twice daily maximum as needed. It is helpful for hot flushes. - Methyl dopa , another BP reduction medication can be used for hot flushes at dose of 250 mg-500 mg twice daily. - You could also try Gabapentin at a maximum dose of 300 mg three times a day. Start at 300 mg once a day and then increase to 900 mg/day. This is also useful for hot flushes. - There are few anti-depressants like Fluoxetine, Paroxitine, Venlafaxine which can be used. - Natural preparations like Black cohosh, Red clover etc have also been tried by patients. For your exhaustion: can you ask your doctor to run some blood tests to check if your anemic or not, to check your Thyroid status and if you are diabetic or not. May be your hot flushes and night sweats are disturbing your sleep and causing you the exhaustion. Is it possible for you to take a short nap during the day so that you can recover? I understand that you may have checked quite a few online websites for your condition. There is a website which is managed by a leading ObGyn from UK. The website is called www.menopausematters.co.uk. Can I ask you to go through that as it contains a wealth of information. Last but not the least, over a period of time, you would see that your hot flushes would gradually settle. I hope this answer has been helpful to you Thank you Regards Dr Sunita Sayammagaru