Eleanor, a 45-year-old perimenopausal woman, is considering hormone replacement therapy mainly to prevent osteoporosis. lately, she has been experiencing severe hot flashes and nausea. in addition, her back has been sore on and off. eleanor has smoked for the past 20 years and has a family history of breast cancer and heart disease. although she vows every new year to quit her costly habit, she has yet to follow through completely. two years ago, eleanor's mother underwent a double mastectomy after her struggle with breast cancer. the experience was a slap in the face for eleanor and she vowed to take better care of herself. aside from smoking, she eats healthier now and doesn't drink. her husband is an avid walker, and every morning before work they both walk around the park with tosha, the family labrador. everywhere she turns, eleanor is reading about hormone replacement therapy (hrt) and women's health. although she worries how her body will respond to hrt, she doesn't want to risk her bone health like her 58-year-old neighbor, janice. janice refused her doctor's advice about taking hrt a few years back and now walks with a cane. eleanor has lately felt the pressure building to make a decision about hrt. she wants to stay healthy for her husband and 25-year-old son, chad, but is unsure of the consequences of hrt. she's heard that it might have some bad effects.