Progestogens are increasingly being advocated as a necessary and integral part of hormone replacement therapy. Yet few studies have measured the acceptability of these regimes. One factor profoundly affecting acceptability, and thus patient compliance, is the presence of adverse psychological effects of progestogens. There have been few double-blind trials which have evaluated such effects of progestogens and compared them with the effects of oestrogen administration alone. There is some evidence of less favourable effects when certain progestogens are added to oestrogen or used alone. Whilst the literature is limited there is an indication that adverse effects of progestogens may relate to dosage, type of progestogen and individual sensitivity of women to hormone provocation of symptoms. Further studies are needed to test these hypotheses.