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Post-menopausal oestrogen deficiency symptoms may cause mood disturbances and affect compliance, yet clinicians are reluctant to prescribe oestrogen replacement in view of adverse risks.A 51-year-old woman was referred with poor glycaemic control. Compliance with diet and medications was poor. Intercurrent problems included depression, dyslipidaemia and severe vasomotor symptoms following hysterectomy one year prior.HbA1c was 12.4%; fasting total cholesterol 5.92mmol/L (NR 2.5-5). The patient was prescribed oestrogen replacement and no adjustments were made to diet or insulin. Over several months, mood and energy improved and weight fell from 110kg to 81kg, HbA1c dropped to 7.6%, cholesterol was 2.56mmol/L and insulin dosage halved.The impact of menopausal symptoms on health and wellbeing is often underestimated. In selected post-menopausal women with type 2 diabetes, short-term treatment with hormone replacement therapy may be useful if benefits obtained outweigh potential risks.