In thinking about this debate I suggest two broad themes to consider before turning to precise clinically based contraindications. The first is that if hormone replacement therapy really is so good for you why do so few women take it? The figures may be changing slightly, but at present in the United Kingdom fewer than 15% of eligible women are thought to start the treatment and fewer than 5% persist with it for more than a couple of years. When patients reject our advice doctors tend to lapse into omnipotence and berate them for their ignorance or fecklessness. It is therefore of great interest that Isaacs et al recently published the results of a study of 1200 women doctors aged between 40 and 60: they found that 40% of those who were postmenopausal had never even tried hormone replacement therapy.1 Is it that our medical colleagues are feckless and ignorant, or is there something they know that Toozs-Hobson and Cardozo and I don't?