The menopause coincides with the appearance of many of the common arthritic conditions and with the lessening of severity of others such as SLE. The hormonal changes that occur may modulate these diseases. Thus, hormonal manipulation may have either beneficial or detrimental effects on the incidence and activity of a number of common joint diseases. We review the evidence regarding the effect of the menopause and oestrogen replacement therapy on the pathogenesis, incidence and prevalence and disease activity of osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus and carpal tunnel syndrome.