The controversy surrounding how best to treat the unpleasant and debilitating symptoms of the female menopause has been around since at least the days of the ancient Egyptians. According to historical texts, the highly intelligent and sophisticated designers and builders of the pyramids believed a menopausal female exhibiting a certain moodiness - a common psychological manifestation of the condition, as so many women will tell you - was best relieved with a firm blow to the face.

Mercifully, treatment has moved on. However, five millennia later, people are still debating the best way to treat those menopausal hot flushes, night sweats and palpitations - not to mention the many other symptoms, such as aching joints, headaches, mood swings and forgetfulness.

The menopause is basically the end of a woman's menstrual periods, and occurs when the ovaries stop producing certain hormones. The medical treatment we have come to know as HRT - Hormone Replacement Therapy - was introduced in the 1950s, and by the 1970s had become particularly popular. High-profile fans are said to include Joan Collins, Teresa Gorman, Dorothy Paul, Fay Weldon and Nanette Newman.

But HRT has also been dogged by controversy. In 2002, for example, in a study for the Women's Health Initiative (WHI), American scientists warned that it could cause heart attacks and strokes. But last week, in what one British HRT expert called "a dramatic U-turn", a new WHI study suggested that HRT could in fact protect many patients from such conditions, and said that the additional risks might apply only to older women. HRT, it is now claimed, could boost the health of women in their fifties or within 10 years of the menopause.

When the original study was published five years ago, health chiefs warned against prolonged use of HRT and millions of women in the US and UK stopped taking the treatment or did not start it. As a result, some experts now believe, they have endured painful and unnecessary symptoms that could have been alleviated.

The latest announcement, published in the respected Journal of the American Medical Association, sparked a heated response among doctors - and many women no doubt uttered a collective beleaguered groan of: "Here we go again."

But where exactly does this news leave HRT and menopausal women? How should women, and indeed GPs, view the drug in the light of this updated analysis? And, perhaps most importantly, does this mean HRT is absolutely safe?

Dr Heather Currie, a Dumfries-based consultant gynaecologist with a specialist interest in menopause, believes last week's announcement is good news for women. Currie also runs the Menopause Matters website, visited each day by an estimated 30,000 women.

She describes the significance of the amended analysis as "extremely important", explaining: "The really important thing is that this study is not a new one and the findings then in 2002 were just the initial results. This further information is for the same study, which has been further analysed and is therefore more accurate.

"Most experts felt that the main problem with the study was that its participants were not representative of the women who would choose to take HRT. In particular, the study's age range was 50 to 79. There were a lot of women in the study over the age of 60, and they are going to have very different health profiles compared to those in their fifties, who would be the main group of women who would be going for HRT.

"This further information has come from analysing the data according to age groups, which is extremely important to notice.

Moreover, Currie points out, the initial health risks the Women's Health Initiative Study reported were "overall risks". This is an important distinction, she says. "When people were subdivided into age groups, the health risk of increased heart disease or a heart attack did not apply to women within 10 years of the menopause."

In other words, among women in their fifties, the risk of heart disease and strokes as a result of taking HRT for a period of approximately five years (or even earlier in premature menopause cases) is "virtually negligible".

This latest news brings some balance back, says Currie. "We can't go as far as to say that taking HRT is entirely without risk, but we have to get back the confidence of using HRT with younger menopausal women. We have to realise that, in this group of women, the risk of heart disease and strokes is very, very small. The risk of heart disease and strokes exists in the higher age group of women - but these women wouldn't be using HRT commonly.

"A lot of people who are putting up with their menopausal symptoms because of the 2002 results and subsequent guidance can now be reassured that HRT is still the best treatment for them and their symptoms."

Dr John Stevenson, an HRT expert from the Royal Brompton Hospital in London, is a member of the British Menopause Society and chairs Women's Health Concern. It was he who described the updated research as a "dramatic U-turn".

"At the moment there are too many people either not taking or getting HRT from GPs because of unfounded fears," he says.

Currie and Stevenson agree that, when doctors use HRT, they need to look at the individual woman, their general health, their medical history and their diet and lifestyle. There is no blanket approach to menopause treatment, and the aim is to individualise treatment further and help each woman come to an informed choice about whether or not she wants to opt for HRT.

What many experts want now is a statement from the regulatory authorities stipulating that HRT is safe when used appropriately, so that those who want to use it can do so without undue worry.

"The Medicines and Healthcare Products Regulatory Agency, which is responsible for drug safety, has to go back and look at the subject again and come out with reassuring recommendations in the light of these findings," says Stevenson. "Women and GPs need reassurance about using HRT urgently."

Currie thinks more information should be given to GPs: "At the moment, the information given to women by their GPs is very variable. I'm not knocking GPs at all - it is very difficult for them to keep up-to-date with every development concerning HRT. And the British Menopausal Society is already doing a lot to encourage GPs who look after menopausal women to become members, which is good. Every women becomes menopausal, and it is not like we can expect every GP to stay up-to-date. But, as we have seen last week, there is still a lot going on in this field and I think more needs to be done to encourage women and GPs to consider using HRT where appropriate."

As in 2002, the revised analysis also reported on the threat of developing breast cancer. "The information about breast cancer is the same as before," says Currie, "which is that women who take HRT for a prolonged period of time do have a slight increase of developing breast cancer, while those who take HRT for a shorter period of time - say anything up to five years after the age of 50, or after they reach the menopause - are not likely to experience breast-cancer problems."

Some women, she adds, may decide - for whatever reason - that HRT is not for them. But for Currie the bottom line is simple: "We need to help them come to an informed decision about their treatment."