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MICHELE NORRIS, host:

Researchers have presented the strongest evidence yet that the sharp decline in breast cancer cases in the U.S. is due to a decrease in hormone use by menopausal women. The findings that were published in the New England Journal of Medicine found that there were 16,000 fewer cases of breast cancer diagnosed each year because of the drop in hormone use.

That's the good news. But women going through menopause and the intended symptoms face a quandary. If they should avoid hormone replacement therapy because of the increased risk for cancer or heart disease, what's the alternative?

For answers, we turn to Doctor Deborah Grady. She's a professor of medicine specializing in hormone therapy and menopausal symptoms at the University of California at San Francisco. She joins us now from San Francisco. So glad you're with us.

Dr. DEBORAH GRADY (Professor of Medicine, University of California): Thank you.

NORRIS: So what are the alternatives for menopausal women, especially those who have severe symptoms? What are their options?

Dr. GRADY: To be honest, the alternatives for women with really severe symptoms are not very good. There have been some prescription medications that had been studied and found to relieve menopausal symptoms. These include a medicine called Gabapentin or Neurontin, and some of the antidepressants, such as Paroxetin or Paxil.

These medications tend to reduce the frequency and severity of hot flashes, maybe 50 percent or something like that - which is good, but not nearly as good as a hormone therapy. The fact of the matter is, for severe symptoms, hormone therapy is still the best treatment. And I think one confusion I'd like to clear up is that it depends on your perspective how dangerous these things are.

If you're a woman who has very bad symptoms and you can't work and you can't sleep, to have a drug that really fixes those symptoms is really, really a lot of benefit. And the risk that you're trading off there as an individual is really small. The risk of developing breast cancer is less than one in a thousand per year. That, however, is quite different from a public health prospective where - because menopausal symptoms are so common, what we wind up is many millions of women in the United States taking hormone therapy. And because of that, even if the risk is very small, hormone therapy can lead to the development of many thousands of breast cancers.

NORRIS: Doctor, what about herbal therapies?

Dr. GRADY: There are many herbal therapies that have been tried. These include the what are called plant estrogens or phytoestrogens. These are estrogens that are naturally found in plants. These tend not to work very well. They're not very effective. And many people worry that because they do affect the estrogen receptor, that they may have the same harms that estrogen does.

Women have also tried preparations, such as black cohosh and other Chinese herbal preparations. Unfortunately, there's not good evidence that any of those work very well.

NORRIS: What about bio-identical hormones?

Dr. GRADY: Bio-identical hormones is a term for hormones that are compounded in pharmacies - not sold by drug companies. These, in my view, are quite dangerous, because we don't know how they're compounded. The control of the dose and the formulation is not overseen by the FDA. And these are estrogens. These are estrogens just like prescription estrogens. So clearly, it can cause all of the same side effects.

NORRIS: What if you're someone who is presently taking hormone therapy, despite the published risks. How do they transition off that?

Dr. GRADY: Most women who were taking hormone therapy for symptoms will have some symptoms when they try to stop. Those symptoms do tend to get better over time, over a few months, or perhaps it might even take a year. So many physicians recommend that women who have trouble stopping abruptly or cold turkey try to taper.

And one way to taper is to just to stop the hormone therapy - let's say on the weekend. That cuts down the dose by two-sevenths. And some symptoms may occur. But if the woman then waits a month or a couple of months until those symptoms improve, then she could potentially drop off Friday, let's say. And in that way, over multiple months, be able to taper down and stop the hormone therapy.

NORRIS: So weaning your self off the therapy.

Dr. GRADY: Slowly.

NORRIS: Doctor Grady, good to talk to you.

Dr. GRADY: Thank you, Michele.

NORRIS: That was Doctor Deborah Grady. She's a professor of medicine who specializes in hormone therapy at the University of California at San Francisco.

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