Women often experience many symptoms during the perimenopausal period, such as hot flashes, joint pain, osteoporosis, cardiovascular disease and sexual dysfunction, as well as irritability, depression, anxiety, forgetfulness and lack of concentration. These symptoms can be very detrimental to their future aging and health. The first nadir in hormone supplementation therapy (HT) occurred after the initial hormone therapy (HT) revealed a risk of endometrial cancer with estrogen alone. With the addition of progestins, the risk of endometrial cancer was significantly reduced and there was a protective effect against cardiovascular disease. However, after 2002 it was found that estrogen plus progestin increased the risk of other cancers such as breast cancer. This was followed by a significant decline in HT use and a second trough. Among other things, the Women’s Health Initiative (WHI) study showed that estrogen plus progesterone HT was detrimental to the treatment of coronary heart disease and increased the incidence of venous thrombosis, stroke, coronary heart disease and breast cancer. However, it is undeniable that there are some limitations in the WHI study, such as: a single type of study drug, older age of the study population at menopause, and lower completion rate of the study. In the follow-up study of WHI, the benefits of HT in relatively young people aged 50-59 years (less than 10 years of menopause) outweigh the negative risks. HT has the following advantages: 1. Improvement of vasodilatory symptoms The most common vasodilatory symptom is hot flashes (incidence of 60%~80%).HT can effectively relieve 75% of hot flashes and 87% of severe hot flashes. 2.Prevent osteoporosis and bone fracture HT can effectively improve the density, prevent bone loss and reduce the incidence of non-vertebral bone fracture. A study has shown that osteoporotic women with an average age of 68.3 years significantly reduced the risk of vertebral fracture and non-vertebral fracture after taking low-dose tibolone. The protective effect on bone quality was more pronounced with the combination of estrogen and alenphosphate, and this effect was maintained for up to one year after discontinuing the drug. For postmenopausal women younger than 60 years old, HT is their first choice for the prevention and treatment of osteoporosis, but it is not recommended for women older than 60 years old. 3, reduce the incidence of cardiovascular disease Cardiovascular disease is the leading cause of death in women. Some studies have confirmed that women endogenous estrogen’s delayed atherosclerosis. Estrogen can indirectly improve and protect cardiovascular effects. In clinical trials, HT reduced abdominal obesity, insulin resistance, LDL cholesterol/HDL cholesterol ratios, improved vascular status, glucose metabolism, cholesterol levels, lipoprotein A and blood pressure fibronectin.The WHI-ET study demonstrated that HT reduces the risk of cardiovascular disease in patients less than 60 years of age by 35%.The CACS study demonstrated that in 50 year old females using HT Coronary artery calcification was significantly less in 50 year old women.HT should be initiated early in the course of cardiovascular disease, but late in the course of cardiovascular disease may increase the incidence of cardiovascular events. The use of HT in patients who have been menopausal for more than 20 years may increase the risk of coronary artery disease, and the 2011 IMS guideline proposes the concept of a “window of therapeutic potential”, which means that timely administration of HT to women in the early stages of menopause can result in long term cardiovascular and neuroprotection. 4.Improve the symptoms of genitourinary atrophy 80% of the studies show that estrogen is beneficial for overactive bladder disease, that is, to reduce urinary frequency, nocturia, urinary urgency or incontinence and other symptoms. However, systemic use of HT does not prevent incontinence; topical use is more effective. The prevalence of urinary incontinence in women increases with age; 25% of menopausal patients have urinary incontinence, of which 7% have more pronounced symptoms. Studies have shown that tibolone improves urogenital symptoms and reduces conditions such as vaginal dryness and difficulty with intercourse. Local use of estrogen can teach oral better relief of symptoms, improve the vaginal cytological environment, relieve vaginal atrophy, but breast cancer patients should be cautious of local use of estrogen. 5, improve mood, sexual life quality Sexual dysfunction is mainly manifested as decreased libido, vaginal dryness and atrophy, and difficulty in sexual intercourse. Estrogen and progestin alone and in combination can effectively improve low libido, and local vaginal administration is similar to oral treatment. Tibolone is better than estradiol-NETA in improving sexual dysfunction and low libido. 6, reduce the risk of colon cancer Estrogen plus progestin therapy (EPT) used for more than 4 years can reduce the risk of colon cancer, and the effect can be discontinued after 4 years. Patients with a history of HT use reduced the incidence of colon cancer by 20%, while current HT users reduced their incidence by 34%. Among them, Tibolone was more effective in preventing colon cancer after 4 years of use than patients who used estrogen (ET) for 7 years and EPT for 5.2 years. 7, protection of joints, skin, connective tissue Postmenopausal women in the incidence of multiple recurrent osteoarthritis is significantly higher. HRT can protect connective tissue, skin, joints and intervertebral discs, and effectively alleviate and improve the degeneration of the dermis of the skin, carotid arteries in the middle layer of the intervertebral discs and connective tissue. The side effects of HT are mainly manifested in the stimulation of breast endometrium proliferation and triggering cardiovascular diseases. 1, increased risk of breast cancer China’s peak incidence of breast cancer in the pre-menopausal (40~49), 10 years earlier than the United States. The formation process of breast cancer needs to go through 7~8 years, the specific process is shown in Figure 1. The time of menopause and obesity are the most important factors to induce breast cancer, while the probability of HT induced breast cancer is not high. Studies from the United States reported that the use of ET in women with less than 5 years of menopause increased the risk of breast cancer by 3%, while for patients with more than 5 years of menopause, ET reduced the risk of breast cancer. And information from the French E3N study shows that both ET and EPT increase breast cancer risk, and EPT has a greater risk wind than ET. The incidence of breast cancer was significantly reduced after discontinuing HT, with the incidence dropping to a rate similar to that of those who had never used HT. Only tibolone reduces the risk of breast cancer in healthy women, but HT is still contraindicated in patients with breast cancer. 2. Increased risk of vascular embolism and cardiovascular disease Venous thromboembolism (VTE) is one of the major side effects of oral HRT, and the risk increases with estrogen dose, patient age, and body mass index. The effect of different routes of administration on the risk of thrombosis and cardiovascular disease varies considerably, with oral administration having a higher incidence than percutaneous administration.The WHI study showed that both EPT and ET increased the risk of cardiovascular disease. Menopause is a risk factor for coronary heart disease in women. Ovarian failure adversely affects blood pressure, cardiovascular function, and metabolic factors in vivo, and the cardiovascular effects of hypertension, hyperlipidemia, and diabetes are greater in women than in men. Progesterone alone reduces the incidence of cardiovascular events, whereas estrogen will increase their incidence. For stroke, both oestrogen and progestogen will increase its incidence, while HT increases its incidence by 29%.The NHS states that both ET and EPT increase the duration of menopausal hormone therapy (MHT), and the risk of stroke is increased by 1/3.