The debate surrounding postmenopausal hormone replacement therapy (HRT) has become more contentious in the past decade. The relationship between HRT and venous thrombotic events has been confirmed, although the absolute risk is small. Evidence of a relationship between breast cancer and HRT is stronger. Randomized controlled trials reveal an association with cardiovascular events in women with known heart disease, a possibly diminished overall quality of life due to HRT, and worsening of urinary incontinence. There is also some evidence associating HRT with ovarian cancer. However, longitudinal studies continue to demonstrate over the long term that HRT use is associated with fewer cardiovascular events and a reduced risk of developing dementia. Future studies may show that a lower daily dose of HRT can reduce the risks while still providing benefit.