Until recently, observational studies suggested a decreased risk of cardiovascular disease, osteoporotic fractures, cognitive decline and colon cancer with the use of hormone replacement therapy (HRT). Recent randomized controlled trials have failed to show a protective effect of HRT in reducing the risk of coronary artery disease and instead have revealed an increased risk of heart disease, stroke, invasive breast cancer and venous thromboembolism, but a decreased risk of colorectal cancer and osteoporotic fractures. In this article we review the current evidence of the risks and benefits of HRT.