Hormone replacement therapy (HRT) using bio-identical hormones can improve quality of life for many women. Studies have established that estrogen replacement decreases the risk of colon cancer, estrogen and progesterone combined decrease fracture risk, and hormones can increase energy levels and enhance libido. It is also used to relieve moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy. There are molecular differences between the hormones we produce naturally, versus synthetic and animal-derived hormones. Typically, women experience much less unwanted side-effects using bio-identical hormones. Compounding pharmacists can work with patients and prescribers to customize a bio-identical HRT program that meets the needs of individual patients, and helps alleviate symptoms specific to each patient. Monitoring and medication adjustments may be necessary.