GUIDELINES Hormone therapy is part of a total strategy to maintain the health of postmenopausal women, including lifestyle recommendations regarding diet, exercise, smoking and alcohol consumption. Hormone therapy must be individualized, with a treatment plan based on symptoms, need for prevention, personal history, family history, results of relevant tests, and the woman’s preferences and expectations. Perimenopausal women have different risks and benefits of HT use than more elderly women. Hormone therapy encompasses numerous hormone products and routes of administration with different potential risks and benefits. Women who experience natural or medical menopause before the age of 45, and especially before the age of 40, are at higher risk for cardiovascular disease and osteoporosis. They can benefit from hormone replacement therapy, which should be continued at least until normal menopausal age. Hormone therapy is not recommended in the absence of a clear indication. Women undergoing hormone therapy should be seen at least annually for a physical examination, update of medical history, relevant laboratory tests and imaging, and exploration of lifestyle. The decision to continue treatment should be based on the judgment of well-informed hormone users and their health care professionals, relying on specific goals and estimates of benefits and risks. The lowest effective dose is determined gradually. Lower doses of HT than those routinely used are able to maintain the quality of life of most users. Long-term information on fracture risk and cardiovascular disease associated with lower doses is still lacking. In general, to prevent endometrial hyperplasia and cancer, progestins should be added to systemic estrogen use in women with a uterus. However, in addition to having the expected effects on the endometrium, natural progesterone and some progestins have specific beneficial effects to support the rationale for progestin use. To minimize urogenital atrophy, vaginal administration of low-dose estrogen therapy does not require concomitant administration of progestins. Direct delivery of progestins from the vagina or intrauterine system to the endometrial cavity is reasonable and minimizes systemic responses. Women with clinical signs and symptoms of androgen deficiency should follow androgen supplementation therapy. In women with bilateral oophorectomy or adrenal failure, androgen supplementation therapy has significant favorable effects, especially in terms of health-related quality of life and sexual function. Advantages of Hormone Therapy Summary HT remains the most effective treatment for vasodilatory symptoms and genitourinary symptoms of estrogen deficiency. Other menopause-related complaints such as joint and muscle pain, mood swings, sleep disturbances and sexual dysfunction (including decreased libido) can improve during hormone therapy. Quality of life and sexuality is considered a key factor in the treatment of older adults. The administration of individualized HT, including the use of androgenic agents where appropriate, can lead to improvements in both sexuality and overall quality of life. Postmenopausal osteoporosis HT is effective in preventing menopause-associated bone loss and reduces the incidence of all osteoporosis-associated fractures, including vertebrae and hips, even in low-risk patients. Although the degree of reduction in bone conversion correlates with estrogen dose, even treatment below the standard dose positively affects skeletal indices in most women. Based on the most recent evidence of effectiveness, cost, and safety, HT is a reasonable first-line treatment in postmenopausal women with manifestations of increased fracture risk, especially those younger than 60 years of age, and in the prevention of bone loss in women with premature menopause. The protective effect of HT on bone mineral density declines at an unpredictable rate after cessation of treatment, although some degree of fracture protection remains after cessation of HT. Initiation of standard doses of HT is not recommended after the age of 60 years when fracture prevention is the sole objective, and continuation of HT after the age of 60 years when fracture prevention is the sole objective should be considered in light of the possible long-term effects of the specific dose and mode of administration of HT and in comparison with other well-established therapies. Cardiovascular Disease Cardiovascular disease is the leading cause of morbidity and mortality in postmenopausal women. The main primary preventive measures (in addition to smoking cessation and dietary control) are weight loss, reduction of blood pressure and control of diabetes and lipids. There is evidence of a cardioprotective effect of HT if initiated in the perimenopausal period and continued over a long period of time (often referred to as the so-called “time window” concept). HT significantly reduces the risk of diabetes mellitus by ameliorating insulin resistance and may also have an effect on other risk factors for cardiovascular disease, such as lipoprotein profiles and metabolic syndrome. that may also have a role. In recently menopausal women younger than 60 years of age without cardiovascular disease, initiation of HT does not cause early harm and actually reduces the incidence of cardiovascular disease and mortality. the decision to continue HT in women older than 60 years of age should be based on an overall risk-benefit analysis. OTHER BENEFITS HT has benefits for connective tissue, skin, joints, and intervertebral discs.HT may reduce the risk of colon cancer. Starting HT in perimenopausal or younger postmenopausal women may reduce the risk of Alzheimer’s disease Of course, there are side effects to hormone therapy, and it should be applied under a doctor’s supervision.