Women currently can expect to live thirty or forty years of their life in the postmenopausal state. The lower amount of estrogen during these decades puts them at greater risk for cardiovascular disease, osteoporosis, and possibly even Alzheimer's disease. Hormone replacement therapy is proving to reduce many of these risks, but obtaining specific health benefits depends on the selection of the appropriate hormone therapy. Estrogen replacement therapy (ERT) uses estrogen alone, called unopposed estrogen, to combat diseases related to estrogen loss, particularly heart disease and osteoporosis. Unfortunately, ERT significantly increases the risk for endometrial (uterine) cancer. Women who have had hysterectomies are generally good candidates, then, because their uteruses have been removed. Hormone replacement therapy (HRT) combines estrogen with natural progesterone or its synthetic version, called progestin, which offsets the risk for uterine cancer. The HRT combination appears to offer benefits similar to those of ERT and is now the usual choice for many postmenopausal women who are at risk for osteoporosis or heart disease. There are a number of other considerations, however, as well as alternatives to HRT that women should discuss with their physician.

Timing. For women who choose hormone replacement therapy, the next question is when to start it. Some experts believe that HRT should begin as soon as possible after menopause to achieve maximum benefits for the heart and bones and possibly the brain. Because of possible increased risks for breast cancer with long time use, some physicians suggest that therapy should continue for about ten years or until a woman reaches her mid-sixties and then stop. The problem with this approach is that the protective value of HRT declines and ceases five years after stopping. Some experts, then, advise waiting 10 years after menopause before taking hormone therapy and then staying on HRT to life. They argue that HRT still protects against osteoporosis and heart disease -- even after age 60 -- but the odds of a women then developing HRT-related cancers before the end of her life are very low. It is a difficult issue, and women should discuss the problem with their physician, in the context of their particular risks and needs.