Is there a hormone heaven? You cannot live with them and you cannot live without them … or can you?

THESE DAYS, YOU CANNOT go near a women's magazine, newspaper, or the evening news without encountering yet another alarming discussion or editorial regarding hormone replacement therapy. If you are anything like my patients, friends, colleagues, and family members, you probably have reached a highly informed state of ... confusion.

Should you start taking hormones or stop? If you start, just how long should you continue? Should you take the synthetic or compounded variety? How does your doctor or health care practitioner determine which one to proscribe? What is the difference, anyway? Moreover, when you finally decide what to take, how do you determine in which form--pill, patch, cream, vaginal ling, or lozenge? Is there some sort of test available to help figure it all out? If there is, why hasn't someone offered it to you?

By definition, a hormone is a chemical messenger that targets a designated organ and stimulates it to function according to its design. Without hormones, our organs pretty much would remain inactive. A woman's ovaries, meanwhile, require specific hormones to stimulate them to produce other hormones that make you the woman that you are.

When you went through puberty, your hormones were functioning in their finest fashion, acting as agents of extraordinary change. You transformed from a little girl into a lovely young woman. You developed breasts and hips--and finally could keep a straight skirt up. There also were those pimples, pubic hair, and, off in the distant future, a prom dross to think about.

Pregnancy is another time in a woman's life when hormones, in the right amounts, bring about the extraordinary--a new little person. For the past four decades or so, a unique package of hormones (when in the right amount and in perfect balance) has delivered your regular monthly periods. If you ever have experienced PMS symptoms, however, this was a sign that your hormones were somewhat out of balance. Menopause, too, brings another time in a woman's life when hormones are out of balance.

The confusion began when medical science started exploring ways to help women continue the benefits of hormones after their bodies stopped producing them. After all, why give up a good thing? Then pharmaceutical companies saw the commercial viability of mass-producing and marketing hormones to aging women. Before you could say "testosterone," the market was so flooded with different brands and types of hormones that the days of going solo through menopause are a horror story from the distant past.

Pharmaceutical companies, through aggressive and well-funded marketing strategies, have convinced doctors, health care professionals and, most importantly, women that hormone replacement is necessary if they expect to live long and healthy lives. Advertising campaigns successfully have persuaded women that hormones are the magic elixir that will keep them looking and feeling young. Even if you are not concerned with looking younger, you still can be taken in by claims that hormones will protect you from heart disease and keep you from being hunched over in a wheelchair due to weakened bones.

Hormones have been available and widely prescribed since the 1950s. Through trial and error, a great deal has been learned about the benefits and the risks that come with replacement therapy. Hormones provide many benefits to those going through menopause. There are many uncomfortable physical and emotional symptoms individuals may experience during this transition--hot flashes, vaginal dryness, mood swings, sleep disturbances, irregular periods, memory lapses, and decreased libido. Taking hormones will relieve many of these symptoms, particularly hot flashes and vaginal dryness. Research also has shown that hormones, especially estrogen, help reduce bone loss, which some women experience after menopause. On the other hand, there are risks associated with hormone replacement therapy, including increased rates of breast cancer, blood clots, heart attacks, strokes, endometrial cancer, and gall bladder disease. Recently, dementia was added to the list.

So, how does a woman decide if she should take hormones and how does her doctor determine whether she needs them? Before the 2002 Women's Health Initiative, most physicians and health care professionals suggested that any woman who did not have a medical reason not to take hormones, (i.e., a history of breast cancer or blood clots or gall bladder disease) should consider using them for their supposedly long-term benefits, such as protection from osteoporosis and heart disease. The Women's Health Initiative--the largest randomized clinical trial ever conducted, involving 16,608 postmenopausal women--found that individuals who used a combination of conjugated equine estrogen and Medroxy-progesterone acetate daily had a greater incidence of invasive breast cancer, heart attacks, blood clots, and strokes. On the positive side, there were fewer occurrences of hip fractures and less diagnosed colon cancer.