I'm in slightly premature peri-menopause. I still get my periods. I was having some problems with hot flashes, night sweats and a little dryness. That I could handle. I never had a problem with desire, but my ability to orgasm started to suffer.
I tried all the natural stuff on the market and NONE of it did a damn thing. Finally, my GYNE gave me some estrogen cream and a little progesterone to use the first 10 days after my period, and everything improved greatly! I still have some hot flashes and still need a vibrator for my first orgasm of the session (after LOTS of oral sex) but it has gotten MUCH better. Even my mood is more stable. One of my kids said to me, "Mom, don't ever go off that HRT. You were really a bitch for a while before you went on it!"
I always said I would NEVER use HRT. But, not being able to have orgasms changed my mind. Estrogen and progesterone in small doses also has the effect in many woman of helping with lubrication and desire as well as helping with other symptoms. I only use the estrogen cream, and take a small dose of progestin in pills. It really no different than your real hormones (as it simply replaces what your body used to make) and contains LESS hormones than being on the Birth Control Pill.