Systemic hormone replacement therapy was proven to improve the symptoms of menopause that are related to vasomotor disturbance. These symptoms include hot flushes, sweating and palpitations. Systemic hormone replacement therapy is also effective in managing the urogenital symptoms of menopause such as vaginal dryness, superficial dyspareunia and urinary frequency or urgency. Topical estrogen creams can be also used to relieve vaginal dryness and superficial dyspareunia. Urogenital symptoms usually improve after prolonged and continuous hormone replacement therapy and are known to recur after stopping the treatment.