Estrogen therapy causes changes in a variety of cardiovascular risk factors, including insulin resistance, lipoprotein profile, haemostasis, coronary atherosclerosis and vascular reactive, that suggest a potential cardioprotective effect in postmenopausal women. With respect to the role of adjunctive progestins, currently available data suggest that the cardiovascular effects may differ depending on the type, dosage and route of administration of the progestin. Androgenic progestins antagonise the favourable cardiovascular effect of estrogens, whilst non-androgenic progestins do not impair, or may even enhance, the beneficial effect of estrogens. Therefore, less androgenic progestins would appear to be the agent of choice for combined hormone therapy in postmenopausal women with cardiovascular risk factors.