&NA;Micronized 17&bgr;‐estradiol (E2) was used as oral replacement therapy in 369 patients with estrogen deficiency and related menopausal symptoms. Over 95% of 319 patients evaluable for efficacy gained satisfactory relief of their symptoms from cyclic (on 21 days/off 7 days) E2therapy. Approximately 77% required no adjustment of their initial daily dose, viz, 1 mg (5 or less hot flushes per day) or 2 mg (6 or more flushes daily). In addition, 80% (58/72) of the patents who did not obtain adequate control from their starting dose were successfully titrated, either upward to a maximum of 4 mg/day or downward for maintenance. Overall, a higher percentage of patients were treated successfully with 2 mg daily (209/319; 66%) than with 1 mg/day (22%). About 8% of the patients required 3 or 4 mg daily, while 4% failed to derive adequate benefit from micronized E2. Oral E2therapy was well tolerated; hence, the attrition rate due to side effects or lack of control was only 6% (22/369). Moreover, all laboratory findings were within normal limits, even in patients treated with E2for over 12 months. Coincidental endometrial changes were found in 9 patients, all of whom had received long‐term (9 months‐3 years) estrogen therapy prior to entering this study. Thus, the state of the endometrium should be determined before any estrogens are given for the menopause. It is concluded that micronized E2is highly efficacious, well accepted, and safe for oral estrogen‐replacement therapy in menopausal women.