Controversy surrounds the optimal use of estrogen replacement therapy (ERT) for the management of vasomotor instability and other perimenopausal symptoms. This fact and the obvious lack of published literature regarding physician prescribing behavior led the investigators to explore these issues with primary care physicians in West Virginia. Data were collected using a mailed, self-administered questionnaire. Issues addressed included reasons for using/not using ERT, patient symptoms, type of therapy prescribed, treatment duration, and symptom resolution or rebound. Approximately 25 percent of the 420 physicians contacted responded to the questionnaire. The overwhelming majority prescribes ERT for their patients. Most physicians prescribe an estrogen/progesterone combination for some or all patients, depending on the clinical situation. Conjugated estrogens in physiologic doses and synthetic progestins are most frequently prescribed and administered on a cyclic basis. Most women prescribed ERT experienced symptom resolution. Treatment outcome was not correlated with treatment duration.