I'd definitely look into bioidentical therapy, if I became uncomfortable with traditional hormone replacement therapy. I know too many women who have had beastly menopause symptoms without something to help replace the estrogen and progesterone.
I'm standing on the brink of that time myself, and I think I'd rather have quality of life, take the HRT and worry about possible side effects if I have them. I can't imagine the kinds of mood swings I might have -- my PMS can be bad enough. I don't want to feel that bad, and I don't want to inflict that kind of garbage on my sweet husband if it can be avoided. He deserves better.