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Drohobyczer also tried an estrogen patch that was 100 percent estradiol, and this had positive results as well. She then used homeopathic remedies, and felt best using this treatment.

Bosarge took a different tack. She warded off the symptoms before they ever struck. She took low-dose oral contraceptives for three years, and then, at age 54, went straight to traditional HRT. Bosarge said this method facilitates a smoother transition by preventing vaginal dryness, hot flashes and heavy bleeding.

"I never had symptoms," she said. "The quality-of-life issue for most people my age is very important. Many are working professionals, and we don't have time for hot flashes and vaginal dryness."

Koithan, however, never had the chance to strategize before the onslaught began. Her battle started after she'd had a hysterectomy and oopherectomy (removal of the ovaries). Doctors prescribed the traditional treatments of Premarin and then the estrogen patch, but these drugs did little to improve her concentration or sudden panic attacks.

The desperate but determined nurse went online to find other solutions, and stumbled onto Triest. Her doctor was opposed to trying an untested drug, but Koithan was frantic for help and called a nurse practitioner who would prescribe the treatment. Once she started taking Triest, Koithan's mental clarity returned almost instantly, although she was still plagued by panic attacks and sleeplessness. Her nurse practitioner suggested she try taking small doses of progesterone for these symptoms, and this proved to be the solution.

Just when Koithan began feeling functional again, she received the shocking news that she had breast cancer.

"I wasn't afraid of the breast cancer, but I was afraid they would take away the hormones I was taking," she said. "I was terrified."

Koithan's cancer was the type that could be stimulated by estrogen and progesterone, a condition that usually prompts patients to stop HRT. But Koithan continued her dogged research and discovered that only one of the three estrogens in Triest was associated with breast tissue and tumor growth: estrone. She and her oncologist decided she could continue HRT as long as she eliminated estrone and gradually reduced her levels of estradiol and estriol.

The nursing professor continues to live relatively symptom-free, and she welcomes the chance to share her experience with friends, co-workers or relatives. She's one woman who has learned just how important it is to make informed personal decisions.

"Women need to think about HRT cautiously," she said. "For some women, going off hormones is devastating. You have to weigh the options. When people ask my opinion about the risk of breast cancer, I tell them I want to live, but not without being able to think."

Contact Heather Stringer at heathers@nurseweek.com