Objectives: The authors evaluated uterine perfusion in postmenopausal women receiving hormone replacement therapy (HRT) by using transvaginal Doppler ultrasonography. Materials and methods: A total of 60 postmenopausal women receiving HRT were included in this prospective case control study. The patients were divided into two groups. The study group received HRT for at least one year. Uterine perfusion was evaluated by transvaginal Doppler ultrasonography and pulsatility index (PI) and resistance index (RI) of uterine arteries were also recorded with a 5-7.5 MHz transvaginal probe. All patients gave informed consent to the study. Statistical analyses were carried out by using the statistical packages for SPSS 15.0 for Windows. Results: Demographic characteristics of the cases showed no statistically significant difference between the groups. There was a statistically significant difference between PI and RI of uterine arteries. In the study group PI and RI were lower than in the control group. As the duration of HRT use was prolonged, a decline in PI and RI increased (p < 0.05). Conclusion: The current study showed that HRT has positive effects on uterine blood flow in postmenopausal women and may be evaluated by transvaginal Doppler ultrasonography.