The first menopausal symptoms are the beginning of the "therapeutic window," the so-called premenopause, when it is time to be introduced to hormone replacement therapy (HRT). During this period, it is very important you lead a full, high-quality life. Among the contraindications are persistently high blood pressure and other cardiovascular diseases, heart attack, stroke, thrombosis, cancer, and some liver and kidney diseases. ## Fears associated with HRT __Take hormones seriously__ Every woman has a hormonal background. There are those for whom HRT is contraindicated or simply not needed. Therefore, it is extremely important to undergo an examination every year so that the gynecologist can adjust the dosage of medication. Modern drugs contain ===minimal doses of estrogen and progesterone-positive effects, but side effects have not been proved yet. Vitamin D, selenium, omega-3, and probiotics are prescribed individually. __Risk of cancer__ HRT is given with estrogen (if the uterus is removed) combined with progesterone. Progesterone is added to protect the lining of the uterus from cancer. During fertility, endometrial cells die off and are excreted in the blood during menstruation. However, during menopause, estrogen can cause strong cell growth in the uterus, including potentially cancerous growth. Progesterone thins the lining of the uterus, which reduces the risk of endometrial cancer. The American WHI study in the early 1990s, which studied postmenopausal women aged 60 to 80 years old, is to blame for rumors regarding HRT dangers. Those aged 60 to 80 were too old to start HRT, so women had many contraindications. Although a decrease in the incidence of osteoporosis, colon and lung cancer was confirmed, the study also showed an increase in venous thrombosis, heart attacks, and breast cancer. However, with early and correctly selected hormone therapy, there is no evidence of an increase in the incidence of breast and pelvic cancer. __Likelihood of thrombosis__ Thrombosis appears in obese women over 60 who smoke with hereditary thrombophilia and chronic venous insufficiency. Research shows that the use of estrogen preparations in the form of vaginal cream and a patch can reduce the risk of blood clots. In postmenopausal women who have been using HRT for 5 years, there has been no increase in the risk of stroke. __You will have to "sit" on hormones for life__ The hormonal drug is prescribed for longer than just a couple of years, but the duration of therapy should not exceed 10 years. A woman needs to have an examination either annually or once every 2–3 years to adjust hormone dosage. __Side effects__ The side effects of hormonal medications include blood discharge, sensitivity, and density of the mammary glands, edema, headaches, and skin pigmentation. These and other side effects can be reduced by adjusting the dosage or form of the medications with your doctor's advice. ## The benefits of HRT Research suggests that hormone replacement therapy is safe and effective with an individualized approach and can bring 15 years of a full life to a woman over 50. __No risk for the heart:__ HRT reduces the risk of cardiovascular disease because estrogens suppress inflammation and protect blood vessels. __Prevention of osteoporosis:__ Prevents bone fragility and fractures. Prolongation of youth: Estrogen retains collagen and moisture in the skin, keeping it elastic. But with its reduction, the aging process accelerates sharply as the skin ages and wrinkles appear. __No excess weight gain:__ Modern hormonal drugs do not contribute to weight gain. However, estrogen deficiency disrupts metabolism, and neither diet nor fitness can shed extra weight. __An active mind:__ Experiments on elderly monkeys showed that animals receiving HRT coped with tasks as well as young ones, although their peers from the control group were less smart. __Active sex life:__ Estrogens prevent vaginal dryness and increase libido. ### To start HRT, the following tests are required: - Ultrasound of the pelvic organs and abdominal cavity - Mammography - Smear for oncocytology - Triglycerides - Lipidogram - Coagulogram - Measurement of bone density. ### Analysis for hormones: - Follicle-Stimulating Hormone (FSH) - TSH - Prolactin - Estradiol - Anti-Müllerian hormone.