In perimenopausal and menopausal women, low estrogen levels contribute to the development of vasodilatory symptoms and are one of the main causes of vulvar and vaginal atrophy symptoms and bone loss. Hormone replacement therapy (HRT) is effective for perimenopausal symptoms such as hot flashes and excessive sweating, sleep disturbances, and genitourinary tract atrophy and related symptoms, and is effective in preventing osteoporosis. For perimenopausal and postmenopausal patients, the most common form of HRT is oral administration. There are also non-oral routes such as transdermal and transvaginal. When HRT is administered, the type of sex hormone, the route and method of administration should be selected according to the specific conditions of sex hormone deficiency and the resulting clinical manifestations of different individuals.1. Oral routeOral estrogens have a good effect on menopausal symptoms, especially vasodilatory symptoms such as hot flashes, excessive sweating, etc., and can prevent osteoporosis caused by postmenopausal estrogen deficiency.2.1.2 Oral estrogens are commonly used for perimenopausal and postmenopausal patients. Commonly used oral estrogens include natural estrogens and synthetic estrogens. Natural estrogen has the advantages of weaker effect on liver metabolism and easy to monitor estrogen level in the body. The main types of natural estrogens are supplemental estrogens (estradiol valerate), norethindrone (micronized 17β-estradiol), and conjugated estrogens (beclomethasone). Among them, the common method of Tranexamicin and Nocodazole is 1 mg/d for 21d, and progestin should be added in the last 10d for those who have a uterus. Combined estrogen is given orally at 0.3 – 0.625 mg/d for 28 d, with progestin added later. Sequential combined regimens of combined estrogen and progestin can also be used. The synthetic estrogen vinblastine (Nylestriol) is also used for HRT, and can be given at 2 mg every 2 weeks or 5 mg per month for long periods of time. Maintenance dose is 1 to 2 mg once or twice a month after symptoms improve. Progesterone needs to be added monthly. The dose of progesterone added, in a sequential regimen, is in principle based on the ability to convert the endothelium to the secretory phase, usually for 10 consecutive days per cycle (usually on days 17 to 26 of the cycle). The drugs of choice include Kinexin 200-300mg/d, Imaxin 200mg/d, Anketamine 10-20mg/d, Amnion Progesterone 6-10mg/d, Daflon (dextroprogesterone) 10-20mg/d, Cyproterone Acetate 1mg/d, Chlormadinone Acetate 1-2mg/d, Norethindrone Acetate 1-2mg/d, and so on. In the continuous combination program, the daily dose is 1/2 to 1/3 of the above. estrogen-progestin combination preparation is also commonly used in HRT treatment. Currently, the most widely used ones are Clomid (11 tablets of 2 mg estradiol valerate and 10 tablets containing 2 mg estradiol valerate and 1 mg cyproterone acetate), Bemeyin (14 tablets of 0.625 mg estrogen-binding and 14 tablets containing 0.625 mg estrogen-binding and 5 mg medroxyprogesterone acetate), Bemeyan (a combination of 0.625 mg of estrogen-binding and 2.5 mg of aminogastrin), Bemeyan (a combination of 0.625 mg of estrogen-binding and 2.5 mg of aminogastrin), and Bemeyan (a combination of 0.625 mg of estrogen-binding and 1.5 mg of aminogastrin). 2.5 mg), Norethindrone (a combination of 2 mg of micronized 17β-estradiol and l mg of norethindrone acetate), and Nocodazole (a cycle-mimicking triphasic combination of 2 mg of micronized 17β-estradiol and l mg of norethindrone acetate), which is administered orally as 1 tablet per day for 21 days, with at least one week of withdrawal. In recent years, fenmadone (14 tablets of 1mg/2mg 17β-estradiol and 14 tablets of 1mg/2mg 17β-estradiol and 10mg dydrogesterone) has also been used for the treatment of atrophic vaginitis and menopausal vasodilatory symptoms, taken orally as one tablet daily. In contrast to the hormones used in conventional HRT, Levitra (tibolone, 7-methylisoinositol) is a steroidal compound with weak estrogenic, progestational and androgenic activities, with estrogenic, progestational and androgenic activities in different target tissues and organs, and is classified as a tissue-selective estrogenic activity regulator (STEAR). Its metabolites strongly inhibit the conversion of estrone to E2, so there is no risk of breast cancer and endometrial cancer. Androgen supplementation can make postmenopausal women feel full of energy and promote sexual function, and vaginal bleeding during the use of the drug is relatively small, so it is considered to be the closer to the ideal postmenopausal HRT drug. It is usually taken orally at 2.5 mg/day, and the dose can be adjusted according to the degree of symptomatic improvement, maintained at the lowest effective dose (e.g., 1.25 mg/d i.e., 1/2 dosage), and regularly checked. 2. Transdermal route Estrogen is absorbed percutaneously, avoiding the hepatic first-pass effect, and is suitable for patients with gastrointestinal and hepatic, gallbladder, and pancreatic disorders, and for patients needing to avoid the effects of metabolism on the liver. For example, women with severe hypertension, abnormally elevated blood triglycerides, diabetes mellitus, history of embolism. As well as patients who cannot tolerate or do not want to take oral medication, oral can not be well absorbed. Transdermal estrogen preparations are available in patches, gels, ointments and other dosage forms. Commonly used patches include Sonech (each patch contains 1.5 mg of estradiol hemihydrate, the active ingredient), which is used once a week for 3 weeks at the start of treatment and discontinued for 1 week. And add progestin for the last 5 days of patch use for 5 consecutive days. If symptoms do not resolve well, the dose can be increased to 2 tablets once a week after a few months. It may be used for 3 weeks and discontinued for 1 week, or applied continuously. The maximum dose is 2 tablets at a time, changed weekly and not exceeded. There are also OxyContin (5 mg or 10 mg of 17β estradiol per patch), Demetrexin (2 mg or 4 mg of estradiol per patch), Morel, and Il Patch, which release 25 μg or 50 μg of 17β estradiol into the body per day, respectively, and are applied 2 times per week. Gel agent mainly has Estro gel (each half dose scale equivalent to 1.25 g, each 1.25 g contains 0. 75 mg of estradiol), menopausal people can use 1.25-2.5 g each time, once a day, applied to the shoulders, arms, abdomen and thighs and other parts of the skin, used for 25 days, and since the 14th day to start adding progesterone, used for 12 days, stop for a week, and then repeat the treatment for 25 days, stop for 5 days. Those with a uterus should be used with progestin for 25 days. Those who are not yet menopausal need to add progestin for 10 to 12 days in the later stages. Estradiol benzoate ointment can also be used on the skin, 1.5g (containing 1.35mg estradiol benzoate or 0.98mg estradiol) applied once a day, once a day, every month according to the lunar calendar 1-24 consecutively, on the 15th-24th day of the daily co-prescription of progesterone. 3. Transvaginal route estrogen is administered by the oral, percutaneous, or intramuscular routes (used sparingly) in postmenopausal vaginal dryness, dyspareunia, genito-urinary infections, urinary difficulties, and urogenital disorders. Infections, dyspareunia, burning pain in the urethra, and other symptoms of genitourinary atrophy and atrophic vaginitis are all useful, but the fastest way to improve vulvar and vaginal symptoms and signs is to administer estrogen vaginally. Commonly used vaginal estrogen preparations are: Beverly ointment (containing 0.625mg of estrogen per gram), each time the use of 0.5 ~ 2g, 20 consecutive days for a course of treatment, 7 days after the cessation of drugs to start the second course of treatment; Ovitin ointment (containing 0.5mg of estriol per gram), the first week of daily use of 0.5 g ointment, then according to the situation of the relief of the gradual reduction to the maintenance of the amount (eg, 2 times a week) Geroprofen capsules (Prostaglandin, Merck, Germany), each containing Prostaglandin 10mg once daily for 20 days. If the cause or influence persists, the application may be continued, or the drug may be discontinued for 7 days and then reapplied. Gerberforce capsules are administered vaginally, the drug acts directly on the vaginal mucosa and is not absorbed by the mucosal tissues, and has a strictly local estrogenic effect, with no systemic estrogenic effect. The transvaginal route of estrogen is more advantageous for improving the symptoms of genital tract atrophy: faster onset of action, and more flexible in terms of duration of use and dosage.The ideal effect of HRT is to effectively alleviate the symptoms of vasodilatation, prevent the atrophy of the genitourinary organs, prevent accelerated postmenopausal bone loss, protect the cardiovascular function, and improve the quality of life, while there is no vaginal bleeding, and no increase in the risk of cancer. According to the status of ovarian function decline, the specific situation of sex hormone deficiency and the resulting different clinical manifestations of different individuals, targeted physiological supplementation in order to alleviate the symptoms, delay the onset of degenerative diseases, and improve the quality of life without causing important adverse effects is the principle of HRT treatment. The route of administration and dosage of sex hormones can be determined according to the severity of the patient’s main symptoms and the condition of the body, and adjusted according to the patient’s individual response and as the condition changes. It should be emphasized that HRT should be treated with individualized therapy, using the smallest effective dose of hormones to minimize the side effects of hormone therapy, so that patients can benefit safely. The patient’s wishes must be respected during treatment, and individualized risk/benefit assessments should be performed periodically (every 6 months) to determine whether to continue, adjust, or discontinue the medication.