Hormones and the health of women: past, present, and future. Keynote address.

The past and possible future roles for hormone use to prevent or encourage pregnancy and to manage or prevent menopause are considered. Beginning in the 1880s, gonadal extracts were used for 50 years to improve health and vigor; evidence for the benefit of these extracts was lacking. Oral contraceptives revolutionized women's lives in the 1960s but had side effects unsuspected until after marketing. Hormone replacement therapy, used for 50 years without large clinical trials of disease outcomes, now proves to have rather similar side effects. Physicians and politicians played interesting roles in their initial distrust and later embrace of hormones. Future uses of sex hormones are likely to be viewed as overmedicalization initially, and time will tell whether these uses are healthy or merely controversial.