The incidence of cardiovascular disease (CVD) is lower in pre-menopausal women but increases with age and menopause compared to similar-aged men. Based on the prevalence of CVD in the post-menopausal women, sex hormone-dependent mechanisms have been postulated to be the primary factors responsible for the protection from CVD in pre-menopausal women. Recent Women's Health Initiative studies, Cochrane review, ELITE and KEEPS studies suggest that beneficial effects of hormone replacement therapy (HRT) are seen in women less than 60 years of age and if initiated in less than ten years of menopause. In contrast, the beneficial effects of HRT are not seen in women greater than 60 years of age and if commenced after ten years of menopause. The higher incidence of CVD and the failure of HRT in post-menopausal aged women could be partly associated with fundamental differences in the vascular structure and function between men and women and in between pre and post-menopausal women, respectively. In this regard, previous studies from human and animal studies identified several sex differences in the vascular function and the associated mechanisms. Female sex hormone 17βEstradiol (17βE) regulates the majority of these mechanisms. In this review, we summarize the sex differences in vascular structure, myogenic properties, endothelial-dependent and -independent mechanisms and the role of 17βE in the regulation of vascular function.