Menopause and the related decline in estrogen result in multiple symptoms including genitourinary atrophy, vasomotor instability, and osteoporosis. The most significant long-term effect of estrogen deficiency is increased risk of cardiovascular disease. Estrogen replacement therapy (ERT) decreases osteoporosis and associated fractures, decreases symptoms associated with menopause, and offers cardioprotection. However, ERT is not without risk because it may lead to increased risk of endometrial cancer if used without progestin, and has been questionably linked to breast cancer. Educating the post-menopausal woman concerning the risks and benefits of ERT is essential to assure compliance. ERT decreases mortality incidence and improves quality of life, and its use for any post-menopausal woman without contraindications is recommended.