The effect of progestogens in hormone replacement therapy (HRT) on risk factors of cardiovascular system diseases is attracting more and more attention. As a significant risk factor of cardiovascular diseases, blood lipid abnormality is the most common risk factor. Previous studies have confirmed that exogenous estrogen supplements are beneficial to lipids profile among peri-menopausal women. But the effect of adding progestogens into estrogen on blood lipid metabolism varies. Currently there is only a small amount of studies involve the effect of different progestogens on blood lipid metabolism. This paper reviews research progresses of effects of different progestogens on blood lipid metabolism in HRT.