Hormone replacement therapy (HRT) is in use for more than a half of century, but the question of indications and ideal candidates for HRT remains unclear. Postmenopausal women are a population with the increasing risks for cardiovascular diseases which are the main cause of death in this group. Decline in oestrogen concentrations is linked to a number of changes in peri and postmenopause: increased total cholesterol, triglycerides, and low density lipoprotein, increased insulin resistance and impaired fibrinolysis. These changes are the main components of metabolic syndrome, the epidemic of the modern age. HRT is currently recommended as the gold standard for the management of vasomotor symptoms, but the benefit of HRT on components of metabolic syndrome and risk for cardiovascular events is still uncertain. In the initial reports from the Women's Health Initiative trial (WHI), overall health risks exceeded benefits in the cohort taking combined estrogen-progestin trial. Observational study in postmenopausal women, some meta-analyses and subsequent analyses of WHI had suggested that the timing of exposure to postmenopausal estrogen therapy may be an important factor in determining subsequent cardiovascular risk. It seems that the early therapy onset is a key factor in accomplishing positive results, but there are almost no surveys regarding the effects on the metabolic syndrome components in perimenopausal women. We hypothesized that the early, low dosage HRT in healthy perimenopausal women would have beneficial effects on the compounds of metabolic syndrome and could decrease the risk of cardiovascular events. Beneficial effect of HRT on cardiovascular diseases is due to the maintained integrity and functional status of the endothelium in younger women. We are aware of the fact that further studies are necessary to test the effects of different doses and routes of administration of HRT on cardiovascular outcomes.