In low dose, oestrogen (together with a progestogen in women with a uterus) is appropriate for alleviating menopausal symptoms such as vaginal atrophy or vasomotor instability. Oestrogen given systemically in the perimenopausal and postmenopausal period, or tibolone given in the postmenopausal period, also diminish postmenopausal osteoporosis. Hormone replacement therapy (HRT) can be used in women with early natural or surgical menopause (before age 45 years), since they are at high risk of osteoporosis. For early menopause, HRT can be given until the approximate age of natural menopause (i.e. until age 50 years). Alternatives to HRT should be considered if osteoporosis is the main concern.