An important and understandably sensitive decision for every woman following menopause is the use of estrogen replacement therapy ("ERT"). While some view menopause as a natural part of aging, others view it as a medical condition requiring treatment. Physicians commonly prescribe ERT to postmenopausal women for a variety of reasons, including primary or secondary prevention of coronary heart disease ("CHD") and prevention or treatment of osteoporosis. Parts of the medical community have generally favoured long-term use of postmenopausal ERT on the basis of its ostensible benefits on cardiovascular outcomes and osteoporosis. Although ERT is clearly effective in the treatment of menopausal symptoms, great uncertainty exists about its long-term use to prevent disease and prolong life in postmenopausal women? Prior to initiating therapy, it is the responsibility of the physician to review extensively with each patient the risks and benefits associated with taking ERT and consider relevant issues that will affect the delivery of care. In particular, three areas of decision making warrant further consideration, namely issues pertaining to the existing evidence, patient compliance, and appropriate communication with the patient.