Many women enter the perimenopause and suffer from various symptoms, but they are afraid of the “side effects” of hormone replacement and are reluctant to take medication. So, is it necessary to take medication or not? Here are some basic principles. Identifiable benefits: improved menopausal symptoms, improved quality of life, reduced risk of cardiovascular disease, fractures, colorectal cancer, diabetes, dementia, slower skin aging, and lower overall mortality. The benefits are identifiable, mainly the side effects are undetermined. For sex hormone supplementation therapy, humans are still in a continuous research process. For individuals, there are positive aspects as long as the benefits outweigh the disadvantages. Therefore, it is important to use the benefits well, to monitor known disadvantages and to detect new possible harms in time. The perimenopausal period can be an eventful time for women, not only for the development of menopausal conditions, but also for the “season” of various other diseases. Some potential diseases may be triggered by medication, and some new diseases may be aggravated by medication. Therefore, comprehensive, systematic and detailed evaluation, weighing the pros and cons, individualized treatment and systematic monitoring are necessary and essential. Mistakes should never be made by random drug use. In a word, treatment such as perimenopausal HRT needs to be managed systematically. And research in this area is constantly improving, requiring close cooperation with relevant physicians to adjust treatment plans in real time and avoid side effects.