You say you’ve been menopausal for 20 years, and on HRT for part of that time. You still have night sweats and hot flashes, nearly every day and night. You’re missing your sex drive. Your doctors have told you these symptoms may or may not stop.
I’m afraid I have to agree with your doctor: Over time, most women will have fewer and fewer bothersome symptoms of menopause, but for others the symptoms will be for life. We don’t have any way to predict for whom the symptoms will resolve or when that might happen.
While lifestyle—diet and exercise—matters, it isn’t the complete solution. Congratulations on losing weight and building an exercise habit! I suspect your symptoms would be worse if you hadn’t lost the weight or were not exercising.
While estrogen is the most effective treatment for hot flashes, some women will benefit from other treatment options such as certain antidepressants, gabapentin, clonidine, and the herbal product Relizen. You could speak with your provider about considering a non-estrogen option.