Resulting from the Women's Health Initiative findings in (2002) there has been a great deal of controversy about the risks and benefits of HRT within the professional and lay communities. The information is hotly debated. In the end it becomes a personal decision for each woman that she should make from an informed viewpoint with the guidance of her physician.

During perimenopause, the amount of estrogen produced by a woman's ovaries fluctuates, as the ovaries slowly reduce production of estrogen over time. These naturally occurring low estrogen levels may cause symptoms that include hot flashes, sleep problems, mood swings, and vaginal dryness.

Hormone Replacement Therapy (HRT) is medication containing one or more female hormones, commonly estrogen plus progestin (synthetic progesterone). Some women receive estrogen-only therapy, if they have had their uterus removed.

HRT is most often used to treat symptoms of menopause such as hot flashes, vaginal dryness, mood swings, sleep disorders, and decreased sexual desire. This medication may be taken in the form of a pill, a patch, or vaginal cream.

Some women may wish to consider HRT for short-term treatment of menopausal symptoms. The key is to weigh the risks associated with taking HRT against a your risk of heart disease or osteoporosis without taking HRT. Every woman is different. Therefore, your entire medical history should be evaluated individually when considering HRT.

HRT is available in various forms, including pills, patches, and vaginal creams. Your health care provider will start you on a regimen that is best suited for you. It may be necessary to try more than one regimen before finding the one that works best for you.

• Cyclic hormone therapy is often recommended. With this therapy, estrogen is taken in pill form for 25 days, with progestin added somewhere between days 10-14. The estrogen and progestin are taken together for the remainder of the 25 days. Then, no pills are taken for 3-5 days. There will be monthly bleeding with cyclic therapy.
• Continuous, combined therapy is where estrogen and progestin are taken together every day. When this therapy is started, or when switching from cyclic to continuous therapy, women may experience irregular bleeding. Most women stop bleeding within one year after starting this therapy.
• HRT is also available as a patch which is applied to the abdomen or the thigh. This patch allows the estrogen to be absorbed through the skin into the bloodstream. Some women prefer this method because they do not have to take pills.
• Vaginal cream containing estrogen may be given to women for vaginal dryness. The cream is usually given along with one of the other forms of HRT because the cream may not relieve many of the other symptoms and does not appear to protect against bone disease.

Additional medications may be recommended for some women with severe symptoms from menopause, or women who are at very high risk for osteoporosis or heart disease.

As with all medicines, there are side effects associated with HRT. Some women taking HRT may experience water retention, bloating, nausea, breast soreness, mood swings, and headaches. Changing the dosage or the form of HRT may help to alleviate these side effects. Some women have irregular bleeding when they start taking HRT, but altering the dosage can eliminate this side effect.

HRT will not treat depression or psychiatric illness, and any concerns about depression should be addressed with your physician.

Wulf H. Utian, MB, BCH, PhD, OBGYN.net Editorial Advisor, is the Executive Director of The North American Menopause Society (NAMS). Dr. Utian and colleagues have developed a Quality of Life Questionnaire for climacteric women and their physicians. You can view the questionnaire online here: http://www.menopausemgmt.com/issues/12-02/Janata%20et%20al.pdf. You can bring the questionnaire to your physician to assist in your discussion about starting or stopping HRT.

You can try to keep a monthly diary of your menstrual cycles, this will assist you in determining if your cycle is changing in duration, the number of days between periods, and any irregular bleeding which can occur. The symptoms can often be addressed with HRT.

More information about natural treatments for Menopause and Perimenopause, or at the OBGYN.net Menopause and Perimenopause Section.

Please see "A Discussion of Natural Hormones" by Dr. Ronald Barentsen.

Please see "HRT: The Ideal Timing to Start and Stop" by J.W.W. Studd and A. Vashishtthe.