Abstract Hormone replacement therapy (HRT) is one of the more frequently prescribed treatments in the modern practice of gynaecology. Many hours of consultations in clinics are spent discussing HRT. Patients request it and doctors suggest it more and more frequently, convinced of its undoubted beneficial effects. Yet there is not as much evidence to support this view as one might expect. The relatively low prevalence of clinical events necessitates recruitment of large numbers of women over a considerable duration of time to provide adequate power to individual studies. Therefore, results of large, prospective, multicentre randomized trials currently underway are eagerly awaited. This review describes the recent significant developments on the subject and their potential impact in both future research and clinical practice.