For years now, conflicting messages and medical confusion have left millions of menopausal women uncertain whether to take hormone replacement therapy. Now, finally, after six years of alarmist reports about the links between HRT, breast cancer and heart disease, last week experts said the drug is actually safe to use.

When the Women's Health Initiative (WHI) report revealed possible dangers in 2002 the numbers of women on HRT halved. But re-analysis of the original findings by experts from around the world who presented their findings at the World Congress on the Menopause in Madrid last week concludes the dangers were exaggerated. Only the older women in the trials, those nearer 70-years-old, had an already increased risk of heart disease due to their age.

But combination oestrogen and progesterone HRT did not raise the risk of heart disease in healthy woman aged 50 to 59. While oestrogen-only HRT, normally reserved for women who have had their wombs removed, cut the risk of heart disease. The experts found that oestrogen and progesterone HRT did slightly increase the risk of breast cancer in this group, but the effect was minimal.

Those against HRT say a slight increase in breast cancer is still too risky, but others believe women can now take the drug in full confidence. Little wonder women experiencing the tumultuous symptoms of menopause will remain uncertain whether HRT really is a safe option.

"There has been a big drop in confidence which is a shame because the bottom line is that women who want to try something for their menopausal symptoms in the early years, it is actually safe," says Dr Heather Currie, a Dumfries-based gynaecologist who runs the Menopause Matters website.

She was at the World Congress on Menopause and says she is delighted the record has now been set straight. "They looked again at each aspect of the trials and time and again it came up that women within 10 years of the menopause have minimal risks and lots of benefits.

"Women can be reassured that it is an option for them because at the moment many are suffering unnecessarily. Breast cancer continues to be the biggest concern for women but they have to be aware it is an association and we can't say that HRT causes breast cancer.

"It may stimulate the growth of cells that are already there, which can then be picked up and treated earlier but HRT doesn't cause cancer. The association is after it has been used for a long time whereas some women only need to take it for a short time to get over the worst phase in their symptoms.

"But other women do suffer symptoms for a long time and if they feel that controlling this is the most important thing then they should be allowed to take it for as long as they want." She added: "There was a huge upset in 2002 but we now have to move on and say that HRT has an important place in managing the menopause alongside other things like lifestyle, exercise and eating healthily."

Many alternative health practitioners believe it is possible to treat the debilitating symptoms of menopause - such as hot flushes, mood swings and irritability - without resorting to HRT at all.

Carol Rogers, a herbalist from Napiers Clinic in Glasgow, treated many women after their GPs stopped prescribing HRT in 2002. "They had nowhere else to go and needed a lot of support," she recalls. "Some were in their sixties and were suddenly taken off HRT so there was a tremendous exacerbation of their symptoms as they went from having the hormones of a 30-year-old to that of a 65-year-old."

Using herbal medicines such as Black Cohosh, which is known to help hot flushes, sage for sweats and Red Clover which mimics oestrogen, herbalists have successfully treated many women. "The time of life is a big change and throws up all sorts of issues and women often need to speak to someone to make sense of their life," says Carol Rogers. "HRT doesn't always treat all the symptoms; it varies in women and not all respond well to HRT so they may need extra help in certain areas. Some women have symptoms so severe that they really need HRT and I would prefer to see it reserved for those women because I think others can get through it naturally."

Dr Keith Spowart, a consultant gynaecologist who runs a menopause clinic at the Western Infirmary in Glasgow, cautiously welcomed last week's findings. "I would never say that any drug is safe, but the concerns were exaggerated and extrapolated from much older women. The public and GPs alike have been in a state of uncertainty for years so this should lead to less confusion."