Women taking hormone replacement therapy to treat menopause symptoms must worry about increased risks for heart attacks, stokes, breast cancer, and blood clots.

Many women have stopped taking estrogen on the advice of their doctor or on their own, based on frightening media reports of these findings from the 2002 Women's Health Initiative study. Now that the benefits of hormone replacement have been thrown into question, what are a woman's options?

A recent survey showed that about 60 percent of menopausal women had stopped taking their hormone therapy, and about three-quarters of them were not taking any form of treatment for their symptoms. Among those still treating their symptoms, about one-third were still taking hormones and a similar number reported using herbal remedies such as gingko biloba, ginseng, black cohosh, or soy products.

How well do these nonhormonal treatments work? The research isn't very encouraging. One review of 43 studies of nonhormonal therapies found that gabapentin, clonidine, and certain antidepressant drugs reduced the number of flashes.

An earlier review by the American Heart Association found that the mild estrogen-like action of the isoflavones in soy or red clover extracts offered little or no relief of symptoms. Other trials have shown mixed results with black cohosh, and no benefit from ginseng or other herbal products.

What's a woman to do? It's easy for a man to say "tough it out," but I don't dare say that. I suppose women could try gabapentin, clonidine, or an antidepressant (paroxetine seemed most effective), but these drugs are all associated with lots of possible side effects that may be more troublesome than the flashes.

My best advice for women with really troublesome menopause symptoms is to take hormone replacement therapy. Its adverse effects seem far less likely to occur in younger, recently menopausal women who'll probably need to take the hormones for months, or a couple of years at most, before symptoms go away on their own.

However, I wouldn't recommend the therapy for women who are at high risk for blood clots, cardiovascular disease, or breast cancer.