Hormone therapy with estrogens (combined with progestin for women who have not been hysterectomized) is the most efficacious treatment for climacteric symptoms. A few years ago hormone therapy was considered to be an ideal prevention for cardio-vascular disease, osteoporosis, dementia and other diseases. Large prospective randomized trials have changed this paradigm. Hormone therapy should only be used with a clear indication (moderate to severe climacteric symptoms and - with limitations - prevention of osteoporosis). The lowest effective dose should be used for the shortest possible time.