Hormone replacement therapy is usually indicated for women in the perimenopausal period who are experiencing significant symptoms and other conditions. The main agents usually chosen are estrogen supplemented by progestin. The choice of estrogen can be made from natural preparations, and currently the commonly used estrogens are estradiol valerate or combined estrogens. Tissue-selective estrogen activity modifiers are also available, the most common being tibolone, and adjuvant progestins are required. Progestin preparations have tended in recent years to be natural progestin preparations, such as micronized progesterone. The specific route and regimen of administration need to be chosen according to the patient, either estrogen alone for hysterectomized patients or a combination of estrogen and progestin. The specific details of the regimen need to be selected on an individual basis after consultation with a gynecologist.