Estrogen deficiency and hormone replacement therapy in postmenopausal women Due to ovarian failure, postmenopausal women have decreased estrogen levels, which can cause a series of physical and psychological symptoms, such as menstrual disorders, vaginal dryness, bombastic fever, fatigue, headache, dizziness, irritability, apprehension, depression, insomnia, apathy, etc. In the distant future, it can lead to osteoporosis and fractures, cardiovascular disease, etc. The diagnosis of hormone deficiency relies on the following points: 1) the presence of severe symptoms or multiple symptoms, 2) signs of estrogen deficiency, 3) response to 3 months of experimental treatment (remission or disappearance of symptoms), 4) hormone level measurement (FSH > 30-40iu/l, E2 < 50pg/ml), where, as a clinician, the clinical manifestations of the patient are the most important and hormone measurement is only used as reference indicator. The perception of any therapy, we have to analyze objectively based on the information of evidence-based medicine. It is generally classified into 3 levels: Level A (special recommendation): information from credible and consistent randomized controlled studies; Level B (advocate recommendation): information from credible trials or observational studies; Level C (limited evidence), reports or opinions of expert committees guaranteed by authoritative experts. Perception of risks and pros and cons of HRT application in postmenopausal women The current perception of the pros and cons of HRT application can be viewed according to the following two scenarios: ① Short-term application (<5 years) of HRT benefits are: alleviation of hot flashes and genitourinary tract atrophy, maintenance of bone mass, and improvement of sleep, and its risks are: a slight increase in cholecystitis and a possible increase in the risk of embolic disease in the first year; ② Long-term application (>5 years) of HRT benefits are: alleviation of (ii) The benefits of long-term application (>5 years) of HRT are: relief of genitourinary tract atrophy, improvement of quality of life, maintenance of bone mass, reduction of fractures, and reduction of colon cancer; its risks are: possible increase in the risk of coronary heart disease, stroke, embolic disease, and the development of cholecystitis, and a slight increase in the risk of breast cancer development, but no increase in mortality. Conclusion 1. It is not recommended to apply HRT routinely after menopause; 2. HRT is the most effective method to treat menopausal symptoms, and it is difficult to replace other therapies. 3.HRT should be applied at the lowest effective dose for as short a time as possible, and the necessary monitoring should be carried out during the application process; 4.The results of WHI further confirm the long-known risks of long-term application of HRT, including breast cancer and venous thrombosis; 5.It is not proved that HRT has primary and secondary prevention effects on coronary heart disease, and may actually slightly increase the incidence of coronary heart disease; 6.Whether to apply HRT or not should be decided by the patient and the doctor according to the specific situation. 7. For patients with osteoporosis, other therapies such as diphosphonates and SERM can be applied, while for patients with osteoporosis who also have vasodilatory symptoms, HRT can be applied and benefit.