The hormonal changes of menopause may produce a variety of symptoms, including hot flushes, atrophic vaginal changes and osteoporosis. For some women these symptoms may be so pronounced that estrogen replacement with opposing progesterone becomes a suitable therapy. Before instituting this therapy, the nurse practitioner must carefully assess the woman and obtain necessary information on the risks and benefits of this regimen. Clinical guidelines for initiating oral estrogen replacement therapy in menopausal women are presented and patient education topics, including additional measures the woman can employ to relieve her menopausal symptoms, are reviewed. The value of diet, calcium and fluoride supplements and exercise in decreasing the risk of osteoporosis is also discussed.