When the results of the Women's Health Initiative were first published, use of hormone replacement therapy (HRT) in the management of menopausal symptoms dropped drastically. As a result, many women were left with untreated symptoms that cause significant impact on their quality of life. This article will summarize the benefits and risks of HRT, review leading organizational position statements, and highlight ways to support patients in shared decision making to determine if HRT is appropriate to help manage their menopausal symptoms.