• Don't take hormones if your symptoms are mild and manageable with lifestyle changes and adjustments.
• Don't take hormones if you have heart disease, or have had a stroke or cancer of the breast, ovaries, or uterus. Don't take hormones if you are at elevated risk of these (for example, if you smoke, have elevated cholesterol, or diabetes).
• If you must take hormones because your symptoms are severe, take the lowest dose possible for the shortest duration possible. The risk associated with such use appears to be quite low, but definitive studies on that are not yet complete.
• Hormones should not be used to treat mood swings, irritability, depression, anxiety, mental lapses, forgetfulness, cognitive difficulties, reduced libido, urinary incontinence, back pain, chronic pain, joint pain, stiffness, or fatigue. They don't help these conditions and could make them worse.
• Herbs, supplements, and "bioidentical" hormone products widely touted as alternatives to estrogen and progestin treatment lack proof of effectiveness and safety and should be used with caution. Consult a physician about them.

The scientific evidence indicates that no one form of estrogen or estrogen plus a progestin is more effective than any other. Taking effectiveness, safety, the choice for mode of delivery, and cost into account, we have chosen the following as Consumer Reports Best Buy Drugs for the treatment of menopausal symptoms:

• Generic estradiol pills
• Gynodiol pills (estradiol)
• Estratab or Menest pills (esterified estrogen)
• Generic medroxyprogesterone pills (when a progestin alone is needed)
• Generic estradiol patch
• Alora patch (estradiol)
• Vivelle or Vivelle Dot patch (estradiol)
• Premarin Cream (conjugated equine estrogen)
• Ogen Cream (estropipate)
• Estring (estradiol, vaginal ring)

Most of these products are used to treat all menopausal symptoms. The creams and FemRing are used primarily to treat vaginal dryness.

All our Best Buys are as effective as other hormone drugs, but less expensive. In particular, the two estradiol pills could save you $300 to $450 a year out–of–pocket compared to brand name Premarin. If you choose an estrogen hormone patch, generic estradiol could save you $200 to $400 a year over the higher–priced products.

Hormone treatment can cause side effects. The most common are heavier or lighter vaginal bleeding, thickening of the uterine lining, nausea and vomiting, breast tenderness, headache, weight change, and dizziness. Heavier vaginal bleeding and breast tenderness tend to be the most bothersome. Between 20% and 25% of women stop taking hormones because of side effects. Lower doses can reduce your chance of experiencing them.