Purpose: This study was conducted to identify menopausal symptoms and quality of life (QOL) according to hormone replacement therapy (HRT) in rural menopausal women. Methods: Menopausal symptoms and QOL were measured by questionnaires. A total of 50 participants in HRT group had received hormone replacement therapy for 12 weeks and another 50 who had not received hormone therapy were assigned to non-HRT group. Results: Vasomotor symptom score of non-HRT group was significantly higher than that of HRT group (p=.013). There were no statistically significant differences between two groups in all menopausal symptoms except for vasomotor symptom. There were no significant differences between two groups in the total scores and sub-scores of QOL. Total scores and sub-scores of QOL were very low in both group. Menopausal symptoms were significantly negatively correlated with QOL. Conclusion: These results showed that there were no statistically significant differences between HRT group and non-HRT group in menopausal symptoms except for vasomotor symptom and QOL. Menopausal symptoms were moderate and QOL was very low in menopausal women. It is necessary to develop nursing interventions to improve menopausal symptoms and QOL in menopausal women.