"Ever since the large government study called the Womens Health Initiative found a number of risks associated with menopause hormones millions of women who are in or near menopause have been weathering hot flashes and other symptoms on their own. But now new research suggests that the benefits of shortterm hormone treatment to control lifedisrupting menopausal symptoms outweigh the risks  as long as the treatment is started at or near menopause. There are also lots of products now available and different ways to use them that enhance the safety of hormone replacement. And there is even an app to help women and their doctors explore various options and choose the most suitable treatment. For women without a history of cancer blood clots or heart disease most professional medical societies concerned with womens health now recommend treatment for menopausal symptoms for up to five years using therapy that combines estrogen and progesterone and even longer for those who take estrogen alone. Every day about  women in the United States  more than two million women a year  enter menopause. At an average age of  they stop having their periods because their ovaries no longer produce enough estrogen to stimulate growth of the uterine lining that is shed each menstrual cycle. For months before and up to a decade or more after menopause begins many women have symptoms that can seriously diminish the quality of their lives by disrupting their productivity sleep moods and ability to enjoy sexual intercourse. The most common symptom  hot flashes  can leave some women dripping with sweat for minutes at a time several times a day and especially during the night. Menopauserelated vaginal dryness and atrophy can result in severe sexual discomfort pain and bleeding with exercise vaginal and urinary infections and incontinence. Until the early s many women with menopausal symptoms took hormone replacement therapy  H.R.T.  to counter them. Even some who did not have disturbing symptoms used H.R.T. because observational studies indicated it lowered the risk of cardiovascular diseases and popular books and articles suggested it delayed signs of aging. Then in  the results of the largest randomized clinical trial httpsjama.jamanetwork.comarticle.aspxarticleid of hormone replacement the Womens Health Initiative W.H.I. created a kind of menopausal panic prompting millions of middleage women to stop or not start hormone treatments and doctors to not prescribe them. The study found that among the women treated with the hormones there was an increased risk of heart attacks strokes blood clots and most frightening of all to many women a slightly higher risk of breast cancer among those randomized to take the leading H.R.T. regimen of conjugated equine estrogens Premarin and a synthetic progesterone Provera recommended for women who still had a uterus. Those without a uterus who were randomized to take conjugated estrogens alone had no increase in breast cancer in fact they had a slight decrease over all. The hormone combination did protect against hip fractures and reduce the risk of colorectal cancer but for the overwhelming majority of menopausal women the risks of H.R.T. seemed  on the surface  to outweigh the benefits. However according to Dr. JoAnn E. Manson an endocrinologist and one of the principal investigators for the W.H.I. The W.H.I. findings have been seriously misunderstood and misinterpreted and millions of women for whom the benefits clearly outweigh the risks are needlessly being denied treatment. The pendulum has swung too far she said. The W.H.I. study actually had nothing to do with menopausal symptoms. Most of the  women entering the study were already in their s and s already a decade or more past menopause. Rather the study was designed to determine whether H.R.T. did in fact reduce the risk of heart disease the leading killer of American women. Among these older women it found no such effect. In the years after the W.H.I. findings many new analyses and studies httpsdx.doi.org... have prompted experts to rethink the wisdom of avoiding hormone replacement especially for women within a few years of menopause whose personal and family history do not place them at high risk of breast cancer. Experts like Dr. Manson professor of medicine at Harvard Medical School and Brigham  Womens Hospital maintain that the results of the W.H.I. study are not relevant to the more common use of H.R.T. for women in their s and for those experiencing earlier menopause as a result of medical treatments. Dr. Howard N. Hodis a preventive cardiologist at the University of Southern California said the billiondollar W.H.I. study made a big mistake by starting the hormones in older women when cardiovascular damage may have already occurred. The cardiovascular protection found in observational studies involved women who were younger and within a few years of menopause when they started taking H.R.T. he said. In a Danish randomized controlled trial https of  women entering menopause among those given hormones for  years there was a reduction in cardiovascular disease and breast cancer  a clear benefit with nominal risk Dr. Hodis said. These benefits persisted after  years of followup according to the study which was published in . Dr. Hodis is especially disturbed about the reluctance to prescribe estrogens for menopausal women who have had a hysterectomy and dont need progesterone to prevent endometrial cancer. In an analysis in  in the American Journal of Public Health https Dr. Philip M. Sarrel and his coauthors calculated that based on reduced death rates among women taking only estrogen in the W.H.I. study avoiding hormone replacement resulted in the premature deaths of  to  women in the decade after the studys release. Dr. Manson is distressed about the large number of women  about a third of those now on hormone replacement  who are relying on customcompounded products that have not been reviewed for safety and effectiveness by the Food and Drug Administration. They come with no warnings in a package insert and could contain contaminants and inconsistent dosages she said. Theres little or no reason to go the customcompound route she said. Women today have so many options  a wide array of doses from low to traditional and ways to use them. In addition to pills there are patches gels and sprays applied to the skin. Vaginal and urinary symptoms can be treated with vaginal inserts containing very small amounts of estrogen that do not enter the bloodstream and thus are safe for women who have had breast cancer. To help women and their doctors assess H.R.T. options and select the best treatment for women  and older with menopausal symptoms the North American Menopause Society has developed a mobile app MenoPro https for iPhoneiPad and Android devices."