Common sense suggests that women who don't know whether to continue hormone replacement therapy (HRT) should ask their doctors for advice.

        But doctors differ on whether patients should continue the controversial therapy since researcher have questionedthe long-term safety and effectiveness of one popular estrogen-progesterone combination.

        The Women's Health Initiative earlier this month announced that it was dropping its large-scale study of the health benefits afforded by Prempro, a combination estrogen-progesterone therapy. Researchers found the combination therapy increased the risk of breast cancer and heart attack. The risk to individual patients was small, study leaders said, but statistically significant if multiplied throughout the population.

        Ultimately, it's the patient's decision whether to continue HRT.

        Two experts, Dr. Margery Gass of the University of Cincinnati and president-elect of the North American Menopause Society, and Dr. Jerry A. Goodman, director of the Cincinnati PMS and Menopausal Center in Fairfield, suggested what questions women should ask their doctors in order to make an informed decision:

        • If you're concerned about a study such as the Women's Health Initiative, ask your doctor, “What do these numbers really mean to me? What is my personal risk?” says Dr. Goodman.

        • Ask what factors in your health history make taking HRT a good or bad idea.

        • Ask if you're on the right hormone combination. Prempro is one of the older estrogen-progesterone combinations on the market. Newer formulations are available. Not everyone needs combination therapy, and dosage needs changing as menopause-related symptoms (hot flashes, insomnia, etc.) change with age.

        • Ask why you're taking hormones. “What does she believe the benefit is for her? And if she doesn't have any strong reason for wanting to be on them, then I think there's good grounds for discontinuing them, because our data from the Women's Health Initiative show the negatives outweigh the positives,” Dr. Gass says. Studies conflict on how beneficial estrogen is for heart health, though it is the most effective remedy for hot flashes. Other remedies can also ease menopause-related symptoms, as well as bone loss and higher cholesterol.

        • Ask when — or if — you should stop taking HRT. Experts differ on this issue. Some recommend taking hormone therapy from menopause until death and others suggest it should be taken only while hot flashes, etc., are problematic. The Women's Health Initiative did seem to show that risks persist as long as the therapy continues, Dr. Gass says.

        • Ask what the alternatives are. Some women, Dr. Gass says, don't need HRT. Diet and lifestyle changes are enough to keep symptoms in check.

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