The menopausal transition is a natural phase of every womańs life. Several symptoms emerging during the climacteric may be treated with estrogens. Hot flushes and symptoms of genital ageing may be relieved by estrogen therapy. Progestin therapy is indicated in all women with an intact uterus to avoid endometrial pathology. Given the present risk-benefit scenario, estrogen therapy is no longer a first-line choice to prevent osteoporosis. Counselling requires integration of recent knowledge provided by the first results of the Womeńs Health Initiative and other significant randomized, placebo-controlled, prospective clinical studies with clinically relevant outcomes, not the least unless good-quality data regarding other estrogens and progestins, apart from conjugated equine estrogens/medroxyprogesterone acetate are lacking. Women should be enabled to decide upon estrogen therapy after provision of extensive information by their physicians.