Menopause is defined a permanent cessation of menstruation that occurs after cessation of ovarian function. The average age of menopause is 51±4 yrs. The main endocrinal changes during climacteric is estrogen deficiency this lead to accelerated bone mass loss, increase the risk of cardiovascular diseases, genitourinary atrophy and Alzheimer's disease. Hormone replacement therapy reduce all of these risks.The main risks of HRT are beast cancer endometrial cancer, ovarian cancer, DVT and hypertension. Non steroidal drugs can be used as an alternative of HRT if it's contraindicated.