Objective: To compare the cost of hormone replacement therapy (HRT) and traditional Chinese medicine (TCM) in the treatment of perimenopause syndrome, and to evaluate the economic benefits of HRT. Methods: Based on the Danish Osteoporosis Prevention Study (DOPS) model, this study enroll in 10, 000 perimenopausal women in the cohort, and analyze direct cost and indirect cost of treatment therapy by cost-effectiveness analysis for a period of 1 year and 5 year. Result: Under the hypothesis of the same treatment effect, compared with the traditional Chinese medicine treatment group and the HRT group, the treatment can reduce fracture in 60 cases and reduce the number of cardiovascular events in 188 cases druing one year; the treatment can reduce fracture in 298 cases and reduce the number of cardiovascular events in 923 cases during five years. Calculated at 65% compliance, HRT group compared with the traditional Chinese medicine treatment group, the HRT group can reduce the cost of 66.3114 million yuan and save the total treatment cost of 72.9521 million yuan during one year.This treatment can reduce the cost of 285.4148 million yuan and save the total treatment cost of 313.727 million yuan during five years. Conclusion: Compared with traditional Chinese medicine treatment, HRT treatment has lower cost and better benefit in the long term. It can save health resources and reduce the burden of patients.It is a good treatment for perimenopausal syndrome.