The effect of hormone replacement therapy (HRT) on platelet size was examined in 38 post-menopausal women before and at end of a 6 week period of HRT. Subjects were treated with cyclical L-norgestrel 75 mg daily from days 17 to 28 of a 28-day cycle combined with continuous conjugated equine oestrogens 0.625 mg daily. Platelet-rich plasma was obtained to measure platelet indices by Coulter analysis. Plasma measurements of luteinizing hormone, follicle stimulating hormone and 17 beta-oestradiol were measured by immunoassays. Platelet membrane fatty acids were measured by gas-liquid chromatography. A significant reduction in platelet membrane linoleic acid, di-homo-gamma-linoleic acid and arachidonic acid of 8.1%, 14.3% and 17.8%, respectively was noted after 6 weeks of HRT (p < 0.01). There was an increase in the platelet count (not significant) and platelet volume (MPV) (P < 0.05) after 6 weeks of hormone therapy. HRT appears to increase mean platelet volume which may indicate an increase in platelet reactivity. There was no correlation between the changes in mean platelet volume and membrane fatty acid changes in platelets after such therapy.