Recently it has become clear that hormone replacement therapy (HRT) is a safe option for many women. The National Institute for Health and Care Excellence (NICE) published a guideline in November 2015 which provides guidance as to when HRT can be used and what risks and benefits are associated with its use. HRT is the best treatment available for management of menopausal vasomotor symptoms. If started before the woman turns 60 and within ten years of the menopause, HRT has a good safety profile. The main risks associated with HRT use are venous thromboembolism (VTE), stroke and breast cancer. VTE and stroke risks are increased when oral HRT is used. The increased risk of breast cancer is linked to combined HRT use. HRT is bone protective and can prevent osteoporosis. It is recommended that HRT is used for the shortest time possible, and if used for five years or less serious side-effects are unlikely to occur.