Many reports show a reduction in cardiovascular disease events in cohorts of women taking postmenopausal hormone replacement. Newer reports detail the possible mechanisms for reduction in cardiac events, including beneficial changes in arterial function and lipid metabolism. Clinical studies now show that combination estrogen and progestin therapy appears to also result in a reduction in cardiovascular risk, but women are receiving mixed messages about why they should or should not take hormones and many discontinue or never start therapy. Several organizations have provided guidelines for evaluating the individual risk-benefit ratio for hormone replacement therapy for a given woman. Until randomized clinical trials are reported, adherence to established guidelines for treatment is the recommended course of action.