Menopausal hormone therapy (MHT) has always been the matter of uncertainty and dispute. Even today, despite ample scientific and clinical evidence, there are still significant differences in recommendations and indications for MHT between regulatory agencies and professional societies. The relief of menopausal symptoms, maintenance of the bone mass and connective tissue, prevention of urogenital atrophy, beneficial effects on sexuality, reduction of risk for colon cancer and cataract, reduction of atherosclerosis development, reduction of general mortality and improved quality of life are undisputable benefits of MHT, particularly in women aged 50 to 60 who are in the early menopausal period. The main risks of MHT are breast cancer and venous thromboembolism, which are rare, and ischemic stroke, which is very rare. Contemporary principles of MHT include early start of therapy, use of hormones as similar as possible to naturally occurring hormones, low doses, individualisation of treatment and regular check-ups, including calculation of risk/benefit ratio.