Menopause is defined as permanent cessation of menstruation that occurs after cessation of ovarian function. The main endocrinal change during climacteric is estrogen deficiency this leads to accelerated bone mass loss; increase the risk of cardiovascular diseases, genitourinary atrophy and Alzheimer’s disease. Hormone replacement therapy reduces all of these risks.The main risks of HRT are beast cancer, endometrial cancer, ovarian cancer, DVT and hypertension. Non steroidal drugs, herbal remedies, macrobiotis, chinese medicine, acupuncture, yoga, ayurvedic medicine, homeopathy and aromatherapy can be used as an alternative to HRT if it is contraindicated.