Primary ovarian insufficiency (POI) is a common condition affecting 1 in 1000 women by the age of 30. It is estimated to occur in 5% to 10% of women with secondary amenorrhea. In most cases POI still remains idiopathic and unpreventable, leading to a woman reaching a state of menopause years before their 50s. The mainstay of medical treatment is with either hormone replacement therapy or the combined estrogen/progesterone contraceptive pill until average age of natural menopause. The aim is to eliminate menopausal symptoms such as hot flushes, night sweats, dyspareunia, and bone loss. I present a case of a 33 year old woman (POI since she was 21), with a strong family history of breast cancer. During a period of five years in which the patient had 2 successful pregnancies with egg donation, her POI was managed using combined oral contraception or hormone replacement therapy. I review her management and discuss the dilemmas of using HRT in women with strong family history of breast cancer. In order to help determine appropriate treatment for such women we shall review current up to date evidence on the risks versus the benefits of treating such cases with HRT.