The estrogen controversy.

Most people would agree that one of the most important pieces of medical news in 2002 was the announcement that hormone replacement therapies in women cause more harm than good. In the July 17, 2002 issue of the Journal of the American Medical Association (JAMA), two landmark papers reported that the overall health risks associated with the use of combined estrogen plus progestin exceeded the benefits. This startling announcement made the headlines of every newspaper, TV newscast, and news magazine in the nation and across the world. Some of the consequences of these two papers included an immediate 50% reduction in the number of estrogen/progestin prescriptions dispensed and class-action lawsuits against the makers of these drugs. The impact of these two studies hit close to home. We remember a number of conversations within our own families about the pros and cons of hormone replacement therapy (HRT) and how convinced we were of its benefits. Because this development clearly affects every single medical specialty, we will review these two papers in this issue. Moreover, we will speculate on what this means to urologists who have used HRT for voiding dysfunction, incontinence, and urinary tract infection (UTI).