Candace Talmadge was determined to get through menopause without using hormones, and she tried just about every alternative treatment she could find, like soy tablets, herbs and acupuncture, a chiropractor and even an anti-anxiety medication.
Two months ago, Ms. Talmadge's doctor suggested that she consider hormone therapy, and she relented.
''There are always risks to any medication you take, whether it's traditional or nontraditional,'' said Ms. Talmadge, 51, an author from Lancaster, Tex. ''But I've been going through hell. I think my doctor's attitude was, 'Do the benefits for you, right now, outweigh the risks?' ''
Three and a half years after a landmark study stunned physicians by finding that hormone therapy had serious risks and did not prevent heart disease in postmenopausal women, many women continue to turn to hormones for relief. Many gynecologists continue to prescribe them as a first-line therapy for severe menopausal symptoms.
Debates over the study's findings remain heated, with doctors divided between those who believe in the power of hormone therapy to protect the heart and relieve menopausal symptoms and those who think that any heart benefits have been discredited.
Some researchers are testing a new theory, that hormone therapy is beneficial for the heart when it is initiated early, during a narrow ''window of opportunity'' around the time of menopause and before women develop an excessive buildup of atherosclerotic plaque.
A chief criticism of the hormone study, part of the national Women's Health Initiative, was that it included women much older than the average hormone user, who typically initiates therapy around the time of menopause. The average age of the participants in the study was 64. The average age of menopause is 51.4, and some studies suggest that women who initiate hormone therapy later may miss the chance to benefit from the treatment.
This month, a paper in The Journal of Women's Health added credence to that idea. It reported that women who started therapy soon after menopause reduced the risk of coronary heart disease 30 percent, but that the benefit appeared to diminish the longer women waited to initiate treatment. The paper, based on data from the Nurses' Health Study, the large observational trial that reported many years ago that estrogen protected women's hearts, suggested that timing the therapy was critical.
''We still don't have a final answer,'' said Dr. JoAnn Manson, the chief of preventive medicine at Brigham and Women's Hospital in Boston, an author of the new study and a principal investigator for the Women's Health Initiative.
The new report, she said, does not mean the findings of the health initiative are invalid, but that the picture is complex. Viewing hormone therapy as ''good for all women or bad for all women is an oversimplification,'' she added.
Many doctors, however, have already made up their minds. ''Personally, in my heart of hearts, I think there is a benefit,'' said Dr. Mary Jane Minkin, a clinical professor of obstetrics and gynecology at Yale. ''However,'' Dr. Minkin said, ''I'm politically incorrect if I say that.''
Still, she said, the tenor of discussion about hormone therapy at the annual scientific meetings of the North American Menopause Society in the fall was substantially different from the scene in 2002, when the figures from the Women's Health Initiative set off a hormone panic.
''Three years ago, the message was, 'You're going to die if you don't stop taking this,' '' said Dr. Minkin, who takes estrogen and is a paid speaker for drug companies that make the estrogen products she prescribes. At the meeting last fall, she said, the feeling was: ''Gee, estrogen is pretty good stuff. If you need it for relief, you shouldn't be afraid to take it.''
The Women's Health Initiative trials, among the largest randomized controlled clinical trials of hormone treatment, were carried out under the auspices of the National Heart, Lung and Blood Institute and other centers at the National Institutes of Health. One section included 16,608 postmenopausal women from 50 to 79 who were taking a popular combination of estrogen and progestin, which is a synthetic form of progesterone, or a placebo pill.