"Hormone replacement therapy in menopause is back and its come a long way. In the late s the treatment became standard for menopausal symptoms  the hot flashes night sweats headaches incontinence and other problems that eventually strike almost all women. Most American women begin to experience menopause around age  with some changes in their menstrual cycles earlier. Hormone treatment gives the body a smoother landing from menopause to postmenopause. But in  when concerns were raised by a set of studies by the Womens Health Initiative of the National Institutes of Health showing hormones correlated with elevated breast cancer heart disease and stroke risk women and their doctors hit the brakes. For most women menopausal symptoms degrade quality of life for at least some amount of time maybe two years maybe as long as . Even after the Womens Health Initiative news broke some women couldnt face the changes without hormone treatment. Now doctors are once again saying they shouldnt have to. The difference For one thing the conclusions of the study have been discredited by subsequent studies. Many women in the Womens Health Initiative study were well past menopause were obese or were smokers and therefore already at risk of heart disease and stroke. For another the formulations used were less safe in their dosage mix of hormones and delivery method pills which travel through the liver and can cause clots. The sheer number of choices today and the need for a thorough initial health assessment make the decision on hormone therapy highly dependent on close communication between a woman and her doctor experts say. Getting educated Some women need higher doses some need lower doses. Once a woman is educated then she knows what to go in and ask for. If a doctor wont work with you then find another doctor says Dr. Marina Johnson a Dallas endocrinologist and pharmacist and author of Outliving Your Ovaries An Endocrinologist Weighs the Risks and Rewards of Treating Menopause With Hormone Replacement Therapy. Dr. Noushin A. Firouzbakht an obstetriciangynecologist at Texas Health Harris Methodist Hospital Fort Worth says that despite the alarm provoked by the Womens Health Initiative study much was learned especially about the ideal candidate for hormone replacement. New rule of thumb We also learned that we see fewer strokes and heart attacks from nonoral methods like a patch or a cream she says. The rule of thumb now is the lowest dose for the shortest amount of time. Its no longer that you need to stay away from hormone replacement therapy its that you need to use it wisely. That wisdom comes from a careful medical assessment and ongoing surveillance of blood pressure blood work breast changes side effects and effectiveness.Women whove had breast cancer cannot take hormone replacements. This requires a thorough exam and a thorough history and individualized care but women need to know Its not a death sentence or a dependence. Its an unfortunate thing that thats out there Firouzbakht says because women also need to know You dont have to suffer you dont have to have incontinence or vaginal prolapse or hot flashes. There is help available. Its a process but hormone replacement therapy is helping women have a better life in an era when they live longer. Johnson Firouzbakht and other experts will tell you that hormone therapy protects against heart disease a much more common killer of women than breast cancer as well as against dementia colon cancer osteoporosis and other health issues. The doctors emphasized not just the medical benefits but that the treatment can enable and boost a womans overall daytoday existence too. Too many women have been taught to accept suffering in this stage of life they say. Johnson notes that in her book she included chapters aimed at young women far from menopause in an effort to dispel that notion. There was a time when most women were just patted on the head and told Honey thats just what happens when you get old she says. But this is going to help you improve the quality of your life and prevent serious diseases. Why wouldnt you want to learn about it Bioidenticals Bioidentical hormones which come from plants are getting a lot of attention and add to the confusion about the treatment. Johnson who runs the Institute of Endocrinology and Preventive Medicine in Dallas says she only trusts the qualitycontrolled safetytested pharmaceutical bioidentical hormones that are made by drug companies and approved by the Food and Drug Administration. Bioidentical hormones are made from plants. Still commonly prescribed synthetic drugs are made from the urine of pregnant mares and although they are FDAapproved she considers them less effective and less safe. Johnson who runs the Institute of Endocrinology and Preventive Medicine in Dallas says she only trusts the qualitycontrolled safetytested formulations that are made by pharmaceutical companies and approved by the Food and Drug Administration whether the hormones come from plants or equine sources. Older still available drugs are made from the urine of pregnant mares. Firouzbakht prescribes pharmaceutical hormones and also works with a pharmacy she trusts to develop bioidentical hormone combinations for some patients. Such custom compounds are not FDAapproved. It doesnt matter what formulation of the hormones you are using its the surveillance of it all that is very important Firouzbakht says. We need to know about side effects unwanted adverse effects those risk factors dont go away with bioidentical hormones. When you have a good relationship with your gynecologist you will get what you need. Daphne Howland is a freelance writer in Portland Maine."