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Objective: To examine the attitudes and prescription practices of gynecologists in the United States and Israel with regard to hormone replacement therapy (HRT) for postmenopausal women. The current recommendations for the use of HRT for menopausal symptoms were reviewed., Design: An eight-item questionnaire was sent by electronic mail or posted to randomly selected members of The North American Menopause Society ( = 250) and the Israeli Menopausal Society ( = 250), all of whom were physician gynecologists., Results: Eighty-seven percent of the questionnaires ( = 435) were completed and were eligible for analysis. Results showed that 400 physicians (92%) routinely offered HRT to their menopausal patients. For women with an intact uterus, 72.5% preferred to use a continuous estrogen-progesterone regimen, and 27.5% preferred to use a sequential combined regimen. The treatment was prescribed for 10 years or more by 86.4% of the American gynecologists, compared with only 66.3% of the Israeli gynecologists ( = 0.001). Overall, the majority of physicians recommended alendronate for recalcitrant osteoporosis and dietary supplements for all women. However, significant differences were found between the American and Israeli groups: 71% of the Americans versus 55.6% of the Israelis prescribed alendronate ( = 0.02); 97.8% versus 71.33% recommended calcium and vitamin D; and 51.6% versus 38.8% recommended multivitamins ( = 0.001 for both groups). Phytoestrogens, alone or in combination with HRT, were recommended by 57.5% ( = NS between groups), and antidepressive drugs were prescribed by only 11% (15.1% of the Americans and 6.3% of the Israelis; = 0.001)., Conclusion: Most gynecologists recommend HRT during menopause. For women with an intact uterus, the preferred regimen was continuous-combined HRT with estrogen and progesterone. The treatment duration is subject to wide variations, from no time limit to discontinuation after 5 to 10 years. Dietary supplements as well as alendronate, alone or in combination with HRT, are popular for severe osteoporosis. We suggest that, until definitive guidelines become available, an individualized approach should be applied, with careful consideration of both the benefits and risks of treatment.