Perimenopause is divided into three stages: premenopause, menopause and late menopause, with an age range of 40 to 65 years. Generally, 5 to 10 years before menopause, reproductive function begins to decline, and 6 to 8 years after menopause, it can be recognized as having entered old age, as seen in perimenopause up to 20 years. Where women over 40 years of age experience irregular menstruation or amenorrhea, accompanied by hot flashes, sweating, chest tightness, palpitations, irritability, insomnia, depression and agitation, anxiety, sadness and crying for no reason; memory loss, inattention; frequent urination, painful urination; vulvar itching, vaginal dryness and pain, difficulty in sexual intercourse, etc., that indicates insufficient ovarian function and low estrogen levels. The average age of menopause for women in China is 49 and 5 years old. In the past 10 years, perimenopausal medicine has developed rapidly internationally, and the focus of research on perimenopause has shifted from self-limiting diseases such as perimenopausal syndrome to cardiovascular disease, osteoporosis, genitourinary tract atrophic diseases and Alzheimer’s disease, which are briefly described below. 1, cardiovascular disease (1) morbidity profile: many studies at home and abroad have reported that the risk of cardiovascular disease in premenopausal women is lower than that of men, but once menopause, the risk continues and increases rapidly, similar to that of men, and is the main cause of disability and loss of life in postmenopausal women, as well as the main cause of death in postmenopausal women, and the mortality rate is significantly higher than that of cancer, cerebrovascular disease, lung disease, infectious diabetes mellitus and other diseases. A follow-up survey of perimenopausal women found that the incidence of postmenopausal coronary heart disease in women aged 45-51 years was 2 or 7 times higher than that before menopause, which shows that perimenopause is closely related to cardiovascular disease. (2) Mechanism of occurrence: As the ovarian secretion of estradiol decreases during perimenopause, it causes lipid changes, in which high-density lipoprotein, which has a protective effect on cardiovascular, decreases, and low-density lipoprotein and triglycerides, which are unfavorable to cardiovascular, rise, so the arterial intima wall gradually thickens and oxygen entry is blocked, resulting in hypoxia in the middle layer of the vascular wall, which affects the conversion and transport of lipids, further promoting increased cholesterol deposition and causing Atherosclerosis, and thus the incidence of coronary heart disease increases. (3) Interventions: The main primary prevention measures for cardiovascular disease (in addition to smoking cessation and diet control) are weight loss, blood pressure reduction, and control of diabetes and lipids. There is evidence that hormone therapy is cardioprotective if initiated during perimenopause and continued over time. Hormone therapy can significantly reduce the risk of diabetes by improving insulin resistance, and it may also have a role in other risk factors for cardiovascular disease, such as lipoprotein profile and metabolic syndrome. In recently menopausal women <60 years of age without cardiovascular disease, starting hormone therapy does not cause early harm and can actually reduce the incidence of cardiovascular disease and mortality. whether to continue hormone therapy in women over 60 years of age requires an analysis of the pros and cons based on the overall situation. 2. Osteoporosis (1) Mechanism of occurrence: The most common, most studied and relatively clear mechanism of postmenopausal estrogen deficiency-related complications is postmenopausal osteoporosis, which usually occurs 5 to 10 years after menopause. Although osteoporosis is caused by a variety of high-risk factors, postmenopausal decline in ovarian function and reduced estrogen levels in the body are its main causes. Recent studies have found that estrogen receptors exist not only in the reproductive system and secondary sex organs, but also in many parts of the body, such as the cardiac muscle, coronary arteries, and carotid arteries in the cardiovascular system, as well as in the bones, skin, urinary tract, and liver. The osteoblasts and osteoclasts of bone have estrogen receptors, and estrogen has a protective effect on bone. The occurrence of postmenopausal osteoporosis is mainly related to the following two factors: first, the level of peak bone mass obtained in premenopausal adulthood: peak bone mass is related to genetic, lifestyle and nutritional factors, and those with low peak bone mass may develop osteoporosis early; second, the rate of bone loss accelerates after menopause, and estrogen deficiency is an important factor in bone loss. (2) Interventions: Because postmenopausal osteoporosis is usually asymptomatic, it is easily overlooked by physicians and patients. The current effective intervention is to strengthen health care for the elderly and to perform regular bone densitometry, which helps in early diagnosis. Once osteoporosis occurs, there are no effective drugs that can restore the patient's bone mass. Prevention mainly targets its etiology, such as increasing peak bone mass and preventing accelerated bone loss. The preventive effect of hormone therapy has been confirmed by evidence from observational studies and randomized controlled clinical studies. Postmenopausal osteoporosis is a clear indication for hormone therapy, not only to prevent further bone loss, but also to increase bone mineral density and to significantly reduce the incidence of vertebral fractures versus non-vertebral fractures with long-term application. The U.S. Food and Drug Administration has identified hormone therapy as a preventive drug for osteoporosis, while the Scientific Recommendations Committee of the Canadian Osteoporosis Society has identified it as a first-line preventive drug for women with low bone density and as a second-line preventive drug for osteoporosis. Therefore, it is recommended to start its use in early menopause, usually for more than 5 years, with annual monitoring and evaluation. However, there is no consensus on the exact duration of treatment. Some scholars suggest that hormone therapy can be used in early menopause and switched to estrogen receptor modulators or diphosphonates in mid to late menopause. 3. Atrophic diseases of the genitourinary tract (1) Mechanism of occurrence: The genitourinary organs are the target organs of estrogen action, and estrogen deficiency can lead to atrophic tissue changes. The glycogen content of the vaginal epithelium decreases, the vaginal lactobacilli disappear, and the acidity gradually decreases, favoring the growth of other pathogens and predisposing to non-specific inflammation, generally known as atrophic or senile vaginitis. After menopause, due to prolonged estrogen deficiency, the muscles of the pelvic floor, such as the levator muscle, lose their tone, the ligaments supporting the uterus and bladder and the connective tissues, such as the main ligaments, lose their elasticity and toughness, the anterior wall of the vagina bulges, the uterus sags, and the supporting tissues around the urethra become weaker, causing the urethra and bladder to shift, resulting in changes in anatomical relationships, incomplete closure of the bladder outlet, and changes in the posterior angle of the urethra. These anatomical changes make the bladder and urethra function with many abnormal manifestations, such as increased residual urine, urinary frequency, urinary urgency or difficulty in urination, burning, urinary incontinence, recurrent urinary tract infections, etc. (2) Treatment and prevention: Age-related atrophic vaginitis and urethritis are one of the main indications for hormone therapy. Estrogen can promote the maturation of vaginal and urethral epithelium, maintain sufficient glycogen reserves in the vaginal epithelium, promote the transformation of the vaginal flora to mainly Lactobacillus, lower the vaginal pH value, and prevent the migration of pathogenic bacteria to the urethra. The effectiveness of hormonal therapy in the treatment of genitourinary atrophy has been reported to be positive, especially with the local application of estrogen preparations, with almost no adverse effects. For senile atrophic vaginitis, the drug can be given continuously for 2 to 3 weeks at the beginning, and then given 1 or 2 times a week depending on the improvement of symptoms. If the symptoms are completely relieved, the drug can be stopped, and the drug can be used again if the symptoms recur. However, the efficacy of hormone therapy for urinary incontinence is not yet certain, and most believe that it can improve the symptoms, but can not be cured. Meanwhile, for women with hypogonadism, when vaginal atrophy and reduced secretion are relieved, the quality of sexual life is also improved. (1) Indications: Hormone therapy is the most effective way to relieve menopausal symptoms. The preferred indications are vasodilatory symptoms, neuropsychiatric symptoms, genitourinary tract atrophy and osteoporosis. The time of initiation of hormone therapy is early menopause, i.e., the onset of symptoms of ovarian decline. Patients without a uterus are treated with estrogen; early menopause or transition is renewed with an estrogen + progestin cycle, with progestin for not less than 10-14 days. For patients who do not need to have menstrual flow after menopause use estrogen + progestin in continuous combination. (2) Contraindicated hormones: known or suspected pregnancy, unexplained vaginal bleeding or endometrial hyperplasia, known or suspected breast cancer, known or suspected sex hormone-related malignancy, active venous or arterial thromboembolic disease within 6 months, severe liver dysfunction, and patients with systemic lupus erythematosus, otosclerosis, hematoporphyria, and meningioma. Relative contraindications are uterine fibroids, endometriosis, uncontrolled diabetes mellitus and severe hypertension, history of thrombosis, gallbladder disease, epilepsy, asthma, migraine, hyperprolactinemia, benign breast disease and family history of breast cancer. In conclusion, the safety of hormone therapy is highly dependent on age, and women younger than 60 years of age are largely free from safety concerns when using hormone therapy. Recent data and reanalysis of previous studies suggest that for most women, if hormone therapy is initiated in the first few years of menopause, there are many potential benefits and few risks when clearly indicated.