In a survey in 1989 Spector observed that 70% of women who had had bilateral oophorectomy had never received hormone replacement therapy. Ten years after his survey we decided to audit not only the number of women who started hormone replacement therapy following bilateral oophorectomy, but also to determine long-term compliance, as this is vital if the full benefits of oestrogen replacement are to be obtained. We carried out a survey of 91 women age 45 years and below who had bilateral oophorectomy in a teaching hospital and who were under the care of GPs in 53 general practices in the north-east of England. Of these women, 72.4% were prescribed oestrogen replacement therapy in hospital before discharge. However, within 2 months following bilateral oophorectomy, 97.4% of these women had commenced hormone replacement; 88.4% have maintained hormone replacement for 5 years or more, 11.8% who had started hormone replacement had discontinued within 5 years and 2.6% have never been on hormone replacement therapy, despite the lack of any medical contraindication. This survey shows a marked improvement in the long-term compliance of women on hormone replacement following bilateral oophorectomy. Continuous education of medical staff and patients on the benefits of hormone replacement therapy, preoperative counseling of patients with the opportunity for them to choose the route of administration that best suits them, and regular review of patients on hormone replacement therapy may further enhance long-term compliance.