Teresa Gorman, former Conservative MP and enthusiastic free marketeer, nevertheless has a monopolistic view of the 'cure' for the menopause. 'Until you get to 50, he chases you around the bedroom,' she once said. 'After HRT, you are chasing him. HRT keeps you out of hospital, out of an old folks' home and out of the divorce courts.'

But as we learnt last week, it might not keep you out of the cancer statistics. Long-term use of a combined form of HRT doubles the chances of getting breast cancer. Doctors say it affects a small number and that survival rates have improved hugely. Still, not for the first time, women on HRT face a decision - which matters more: dicing with disease or alleviation of the symptoms of the menopause?

The problem is that the media's love of the 'miracle drug', acute ageism and the negative and patronising attitudes of some of the medical profession make it almost impossible to make a balanced decision. A questioning woman is marooned high on the debate, because loaded on the other side is a 10-ton bag of powerful influences, flogging the drug hard.

Perhaps most weighty is the worship of youth and the underselling of the benefits of the post-menopausal HRT-free life. In theory, HRT means you are never over the hill, but being caught in a permanent loop, dancing on the flat plains with the young, must be something chronic.

'The Change' means a woman's fertility has come to an end and it affects individuals in varied ways. In spite of this, mention the menopause to a GP and it will either be dismissed or, more often than not, HRT advocated. As one doctor told a 54-year-old friend: 'Put a bit of oil in the old jalopy.'

It may work well for some, but far less reported are the thousands who abandon the drug because it makes no difference - or because of side-effects, such as enlarged fibroids, depression, weight gain and the risk of heart disease. These women are often doubly upset because, as HRT so often seems the sole solution, they believe there is little else that can help.

A small industry, however, is emerging, fostered by the eco-organic movement, by bolshie women not prepared to take what the doctor ordered and by the health pages of newspapers, which have an insatiable appetite to fill space. This strange ménage à trois is promoting alternatives - diet, homeopathy, vitamin B supplements - and acceptance of the psychological adjustment that the menopause signals.

But such remedies do not make big profits for the pharmaceutical firms. Nor do they bring in perks that GPs are offered for prescribing certain drugs. Some doctors have become complementary practitioners, but they are in the minority.

The truthful message is that the body changes gear, and so does life. Discomfort can be ameliorated but, for many, navigating the menopause is the grit in the oyster. It brings reappraisal of ambition, goals, personal relationships. Many women testify that, post-Change, life can and does get better. Those on HRT, of course, will never know.