: ObjectiveTo investigate the effects of combined hormone replacement therapy (HRT) on various parameters of coagulation and fibrinolysis that may contribute to increased risk for venous thromboembolic events.: DesignProspective, randomized, double-blind, placebo-controlled study.: SettingAcademic hospital.: Patient(s)Sixty-one healthy postmenopausal women with intact uterus.: Intervention(s)Patients were randomized to receive continuous combined HRT (estradiol, 2 mg/d, and norethisterone acetate, 1 mg/d) or placebo for 6 months.: Main outcome measure(s)Markers of coagulation and fibrinolysis were measured before therapy and after 3 and 6 months of therapy.: Result(s)The groups did not differ significantly in levels of prothrombin fragments 1 and 2 and thrombin–antithrombin III complex after 3 and 6 months of therapy. After 6 months of HRT, significant decreases in activity of antithrombin III and protein C and levels of plasminogen activator inhibitor-1 antigen, tissue-type plasminogen activator antigen, and euglobulin clot lysis time and a significant increase in d-dimer level were found compared with placebo.: Conclusion(s)Continuous combined HRT for several months produced no net activation of coagulation but improved fibrinolysis in healthy postmenopausal women with no risk factors for venous thromboembolic events. [Copyright &y& Elsevier]