For more than 50 years, treatments have been available to replace the declining hormone levels of postmenopausal women. Until recently, an estimated 38% of postmenopausal women in the United States have been using hormone replacement therapy. Women are now living an average of 30 years after menopause begins, and it is during those years that they are at increased risk of chronic medical conditions such as osteoporosis, coronary heart disease, cancers, urinary stress incontinence, and dementia. In addition to managing or minimizing symptoms associated with menopause, hormone replacement therapy had been thought to provide women with some degree of protection against some of these conditions. Numerous studies have examined the proposed risks and benefits; however, a recent, large clinical trial by the Women's Health Initiative concluded that the benefits of hormone replacement therapy do not outweigh the risks and recommends that patients discontinue its use for long-term therapy. This trial has been extremely influential because it is the first well-controlled and adequately powered randomized primary prevention trial of postmenopausal hormones in healthy women. The results have led many to believe that hormone replacement therapy should be limited to short-term use for the treatment of menopausal symptoms. Nevertheless, there are some limitations to this study. This study by the Women's Health Initiative, along with several others, is examined, with a focus on the potential benefits and risks of hormone replacement therapy. At present, most physicians agree that the benefits of hormone replacement therapy include the decreased incidence of osteoporotic fractures and colorectal cancer. The risks include increased chance of breast cancer, coronary heart disease, stroke, thromboembolic events, cognitive impairment, dementia, and cholecystitis. Despite the risks associated with hormone replacement therapy, it should still be considered the best treatment option for the short-term therapy of menopausal symptoms. Furthermore, there may be additional benefits to different regimens of hormone replacement therapy that have not yet been determined. Finally, other possibilities for the use of estrogens and related alternatives for postmenopausal women are also discussed.