The aim of our controlled study was to evaluate peripheral microcirculation at the level of the nail-fold capillaries in relation to menopause status and postmenopausal hormone replacement therapy (HRT). A total of 105 postmenopausal women were randomly allocated to three different HRT groups of equal size. A fourth group of 35 similar healthy volunteers served as controls. HRT was either peroral or transdermal 17-β-oestradiol with cyclic addition of dydrogesterone or 2.5 mg Tibolone (Org OD 14) in a daily peroral dose. Morphological parameters such as capillary diameters, loop width, papillary width and capillary density, measured by video-capillaroscopy at the nail-fold, were unaffected in early menopause and also under HRT. A significant decrease of capillary blood flow velocity (P < 0.001) could be demonstrated in postmenopausal (n = 41, v = 0.53 ± 0.16 mm/s) as compared to premenopausal women (n = 37, v = 0.65 ± 0.15 mm/s). HRT resulted in an increase of capillary blood flow velocity in the nail-fold after 6 and 12 months leading to an increase in capillary blood flow in the order of 20%-30% of the initial values, and was independent of the type of HRT.