It was not long before the use of estrogen followed suit, thanks largely to a book called Feminine Forever by New York gynecologist Robert A Wilson, which made estrogen drugs sound like the best thing ever. Wilson's book represented "estrogen replacement" as a kind of youth pill that would save poor fading women from the horrors of age. The crusade which he launched almost singlehandedly to rescue women from what he termed the "living decay" of menopause has all the hallmarks of a fundamentalist religion. And only estrogen carried by the noble White Knight of medicine is able to save her from its clutches."The unpalatable truth must be faced", says the good doctor, "that

all postmenopausal women are castrates. . ." Wilson obviously felt it was his mission to identify the "serious consequences" of the loss of estrogen which happens to a woman at menopause. According to Wilson they include heart attacks, osteoporosis, tough, dry, scaly and inelastic skin, "atrophic" breasts and shrivelled genitals. As author Sandra Coney says, 'There is something unpleasantly voyeuristic about his desire to ensure that all women are walking around with plump, juicy genitals. Wilson. . . was the Hugh Hefner of Menopause."

In 1963 Wilson founded a private trust known as The Wilson Foundation for the sole purpose of promoting the use of estrogen drugs. Its funding of $1.3 million came from the pharmaceutical industry. Each year Wilson received money from pharmaceutical companies including Searle, Wyeth-Ayerst Laboratories and Upjohn, all of which made hormone products which he claimed were effective in treating and even in preventing menopause.

In the 1970s it became known that estrogen used in the way Wilson had pioneered it unopposed led to a tenfold increase in cancer of the womb, as well as gall bladder disease, the increased development of fibroids and increased frequency of breast and ovarian cancer.

Overnight, estrogen replacement lost its glamour with both doctors and the patients who had been using it. The US Food and Drug Administration (FDA) demanded that all estrogen medications carry a package insert warning of its dangers as well as back-pedalling their sale as a "youth pill". But with the backing of the American Medical Association which is supposed to be an independent body United States drug manufacturers went to court in an attempt to resist printing the package inserts.

Their main argument was that such information would unnecessarily "frighten women". Before long, the first studies indicating that estrogen replacement is associated with reduced fractures from osteoporosis brought hope to drug manufacturers who were trying to pick up the pieces left by the cancer scares.

In 1976 Wyeth-Ayerst Pharmaceuticals hired a top American public relations firm to help refocus their marketing of Premarin, taking it away from the eternal youth image towards a product used for the prevention of osteoporosis and heart disease. Their advertising was altered. The pharmaceutical companies as a whole also came to the rescue by altering the product they were selling. By adding one of the newly developed progestogens such as Provera they were able to come up with a new "product" a cocktail of hormone drugs which (they insisted) would reduce the risk of estrogen's overstimulating the womb lining and causing cancer. Some also started referring to hormone treatments not so much as Estrogen Replacement Therapy but as hormone replacement therapy. A new product. A new name. A new image. Over the next 15 years hormone manufacturers funded study after study and publicized the findings to doctors and the press in an attempt to demonstrate the benefits of HRT.