The introduction of sex hormone supplementation therapy has brought hope for women to realize this dream, but also some controversy. As the benevolent and the wise, let’s learn more about sex hormone supplementation therapy. Sex hormone supplementation therapy (HRT) is to give appropriate sex hormones to women who lack ovarian hormones in order to relieve the clinical symptoms caused by low ovarian function and to improve the health problems caused by it, and to improve the quality of life of postmenopausal women. Ovarian hormones contain estrogen, progesterone and androgen. However, since the decline in estrogen and progesterone has the most pronounced effect on the body, the main supplementation in treatment is estrogen and progesterone, with the aim of improving the symptoms that arise in the near future and preventing those that will arise in the distant future. Since the successful production of the first natural estrogen drug in the 1940s, sex hormone supplementation therapy has been widely used worldwide for more than 60 years and has been used in China for more than 20 years. Although there was a period of time when the international community questioned HRT and caused anxiety, Chinese experts analyzed a large amount of data and insisted that the early use of hormone supplementation therapy for menopausal women when menopause-related symptoms appear can effectively relieve symptoms, prevent osteoporosis, delay aging and improve quality of life while reducing risks. 1. HRT is beneficial to menopausal women mainly in the following aspects ① regulating menstrual disorders in the perimenopausal period ② relieving the symptoms of vasodilator instability ③ relieving the rapid loss of bone mass after menopause ④ reducing the risk of ischemic cardiovascular disease and the rate of death ⑤ reducing the incidence of Alzheimer’s disease; etc. 2. The indications for HRT are currently considered to be ① serious menopause-related symptoms that affect (2) Atrophy of the genitourinary tract and related problems (3) Osteoporosis after menopause. 3. There is no definite conclusion on how long HRT needs to last. If it is used to relieve symptoms related to low estrogen, it can be used for a short period of time, usually 1 to 2 years, but the symptoms may appear again after stopping the drug, and it needs to be re-evaluated before deciding whether to continue the drug. If it is used for the prevention of degenerative diseases, it should be used for a long time, usually for more than 10 years, or even for a lifetime. Data show that HRT is safe to be applied for up to 4 years. Regular visits to the doctor are the key to increase the compliance and safety of HRT. Regular follow-ups can detect the side effects related to the drug in time and relieve the patient’s mind, and the observation of the efficacy is also very important. 4. Commonly used HRT preparations (1) Estrogen Natural preparations for oral administration include linked estrogen (Bemelia), estradiol valerate or micronized estradiol, and domestic preparations include Nilestrol. Transdermal preparations include Estrogen gel (containing natural estradiol) and estradiol patches (domestic Eur Patches), which penetrate the body through the skin. There are also subcutaneous estradiol implants and transvaginal estriol suppositories, the latter of which is indicated for patients with vaginal symptoms as the main complaint. (2) Progestins Natural progestins, such as micronized progesterone (Angiotensin), can effectively protect the endometrium. Synthetic progestins include 19-desmethyltestosterone derivatives, such as vinblastine, 18 methyltestosterone, 17α-hydroxyprogesterone derivatives, and amnestic progesterone and cyproterone. (3) Androgens Methyltestosterone, used in small doses to improve libido, is often used in combination with estrogen. Livial is a commonly used drug, containing estrogen, progesterone and androgen activity. 5. Commonly used regimens for HRT (1) Estrogen alone Only for patients whose hysterectomies have been performed, but some studies have shown that the use of the drug for longer than 5 years may increase the risk of breast cancer. (2) Combination of estrogen and progestin The aim is to prevent endometrial hyperplasia and endometrial adenocarcinoma. The regimen includes: (1) Cycle sequential method with estrogen for 25 days and progestin for 10 to 12 days later, with withdrawal bleeding after stopping the drug. (ii) Continuous sequential method, continuous application of estrogen with progestin for 10-12 days per month, mostly with withdrawal bleeding. (③) Continuous combination method, continuous application of estrogen and progestin without interruption, the dose of progestin can be reduced. It is suitable for women with longer menopausal years. It is a simple method with low rate of vaginal bleeding and better compliance. (4) Combined cycle regimen with continuous application of estrogen and progestin for 25 days each and repeated after withdrawal from the drug. (3) Combination of estrogen and androgen Only in a few women with osteoporosis, weakness and reduced libido. (4) Combination of estrogen, progesterone and androgen is more suitable for women who have been menopausal for more than one year. The advantages are ease of use and possible increase in bone mass. The main side effects are weight gain, edema and breast swelling and pain. 6. HRT is a medical measure, and the indications should be strictly grasped when applying it, except for contraindications, and only women who meet the indications should be considered for this therapy. The dose of hormones used is the core aspect of HRT, and finding the effective dose of estrogen and progestin that can make menopausal women achieve the therapeutic purpose while minimizing the side effects has become an important topic of current research. There is no best, enough is good enough. It should be noted that when using HRT, estrogen and progestin should be reasonably matched. If the dose of progestin is insufficient, it is difficult to achieve the effect of protecting the endometrium; the dose of hormone replacement therapy should be small enough to meet the minimum physiological needs. 7. Medical monitoring during the course of medication Review every 6 to 8 weeks after the initial dose, and every 3 to 6 months thereafter, to understand the efficacy, compliance and side effects. Monitoring indicators generally include blood pressure, weight, blood lipids, bone density, pelvic, hepatobiliary ultrasound, etc. 8. Withdrawal from treatment Vaginal bleeding is the patient’s main concern and the primary reason for withdrawal from treatment. If estrogen and progesterone sequential therapy patients with regular bleeding may not need to undergo diagnostic scraping. Patients with irregular vaginal bleeding should undergo pelvic examination, vaginal ultrasound for endometrial thickness, endometrial biopsy and diagnostic curettage if necessary to rule out endometrial atypical hyperplasia or endometrial cancer. In recent years, vaginal ultrasound has been found to be helpful in determining endometrial thickening. HRT, which has been used for decades, does have risks, but the flaws do not overshadow the benefits and still outweigh the harms for menopausal women with indications. Specific prescriptions must be individualized and require specific, thoughtful guidance from a medical professional for each applicable woman and should not be abused. As time ages and as women gradually adapt to or overcome some of the discomforts of menopause and enter the sunset of their old age, some may experience another common problem, that of pelvic organ prolapse and urinary incontinence.