Aim: This study was to investigate the effect of estrogen replacement therapy (ERT) on clinical outcomes for postmenopausal women with established coronary heart disease (CHD). Materials and Methods: The authors conducted a meta-analysis using 12 eligible studies. The overall odds ratios (OR) or standardized mean difference (SMD) and their corresponding 95% confidence interval (CI) were calculated. Results: For the incidence of adverse events, significant difference was observed in the occurrence rates of CHD death (OR = 1.166, 95% CI: 1.000-1.360, p = 0.050) and death of any cause (OR = 1.221, 95% CI: 1.057-1.410, p = 0.007) in postmenopausal women with CHD between ERT and placebo groups, whereas there was no significant difference (p > 0.05) in the occurrence rates of CHD events, myocardial infarction (MI), revascularization, unstable angina (UA), venous thromboembolic event, stroke/transient ischemic attack, and congestive heart failure between two groups. With respect to the alterations of other clinical outcomes, the SMD for the alteration of TC level was -0.192 (95% CI: -0.346—0.047, p = 0.015), and a significant difference was detected between the two groups, whereas there was no significant difference (p > 0.05) in the alterations of MLD and TG in patients between the two groups. Additionally, patients treated with ERT had lower LDL and higher HDL levels. Conclusion: This meta-analysis suggests that postmenopausal women with CHD receiving ERT are more likely to suffer from CHD death, death of any cause, lower LDL, and higher HDL and TC levels. Therefore, ERT should not be recommended to postmenopausal women with CHD for the secondary prevention of cardiovascular disease (CVD) clinically.