Intriguingly, the part of the WHI study that focuses on the long-term benefits of estrogen alone among women who have undergone hysterectomies is ongoing. So far, the safety board has not detected any excess risk of breast cancer in this group. Apparently, estrogen plus progestin has a negative cumulative effect on the breast that estrogen by itself seems not to have.

Some Questions Still
So much for the major conclusions. Now for the caveats and complications. The WHI study looked at the most popular brand of estrogen and progestin, which is called Prempro and is made by Wyeth. Technically speaking, the WHI findings do not apply to other products. Some doctors have speculated that lower-dose hormones or estrogen-progestin patches and creams might somehow avoid some of the risks associated with Prempro. That has yet to be proved. Even so-called natural hormones (those derived from plants) aren't necessarily risk free. For one thing, they haven't been as carefully tested as Prempro. There is preliminary laboratory evidence, says Dr. Wulf Utian, who heads the North American Menopause Society, that natural hormones may promote tissue growth in the breasts and thereby contribute to a cancer risk.

There is also a chance that certain estrogen-like compounds may be developed that will capture all the hormone's benefits without any of its risks. One such drug, raloxifene, has been shown to prevent fractures, so far without increasing a woman's risk of breast cancer. But a number of women suffer hot flashes and even blood clots while on raloxifene, making it an unlikely candidate to replace estrogen completely.

Though last week's news raises big questions for anyone on hormone-replacement therapy, women taking birth-control pills shouldn't panic. True, these pills also contain estrogen and progestin, but most women take them before menopause, when their bodies are making more of their own hormones. So it's quite possible that their bodies are better able to handle the excess. In any case, it's impossible to extrapolate from the WHI study.

Nor should women panic if they are using HRT for short-term relief of menopausal miseries. For in a strange sort of way, the study brings HRT back to the basics, doing what it always did best—alleviating intense hot flashes, night sweats and mood swings during the limited period in which they occur. "Estrogens," says Dr. Howard Judd of UCLA, one of the WHI principal investigators, "are still the best, and in many ways the only, way of treating menopause."

Is it worth a very slight, short-term risk of blood clots to battle hot flashes? You bet, says Christine Fulbright, 53, who runs her own hair salon in Venice, Calif. Fulbright's menopausal symptoms, which started a year ago, were so bad she thought she was dying. "I was aching all over and crying all the time," she recalls. "At one point I was cutting a man's hair when, out of the blue, I had to fight back tears." Fulbright tried alternative remedies, like yam creams, but relief came only when she tried Prempro four months ago. "It was like a miracle," Fulbright says. "I was back to my normal self."

The tricky part is going to be figuring out just how long women like Fulbright need to stay on HRT, how best to wean them off the treatment and then how to protect them from osteoporosis and other ravages of age without resorting to old- fashioned hormones. "The world of menopause management," says Utian of the North American Menopause Society, "has just become a lot more complex."

And part of that complexity is dealing with the emotional attachment that some women have to their HRT regimen. Many like the way they look and feel on the stuff. Change is scary.

And that, perhaps, is why Susan Pierres, the angry and frustrated Miami photojournalist, has yet to make her move in the wake of last week's news. Along with so many other women, she continues to fret over whether she really has to part with her pills.

—With reporting by Amanda Bower/New York, Wendy Cole/Chicago, Jeanne DeQuine/Miami and Jeanne McDowell/Los Angeles

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