This issue illustrates the multiple problems encountered by women in the postreproductive period and the various management strategies.

The review article by Lynne Shuster and colleagues summarizes the growing body of evidence suggesting that the premature loss of ovarian function caused by bilateral oophorectomy performed before the natural menopause is associated with several negative outcomes. In particular, studies have revealed an increased risk of premature death, cardiovascular disease, cognitive impairment or dementia, parkinsonism, osteoporosis and bone fractures, decline in psychological wellbeing and decline in sexual function. In an accompanying editorial, Ailsa Gebbie recommends that women contemplating early oophorectomy should be referred for specialist advice before surgery so that the consequences of early loss of ovarian function can be discussed.

Although women have been treated with testosterone for female sexual dysfunction since the 1950s, the role of testosterone in normal female physiology is not yet fully defined. One of the major safety concerns of androgen therapy is whether androgens could increase the risk of breast cancer. Chrisandra Shufelt and Glenn Braunstein review in vitro, animal model and epidemiological studies and conclude that the preponderance of data suggests that testosterone use in women is not associated with an increased risk of breast carcinoma.

It has long been recognized that women are at higher risk than men to develop depression and that such risk is particularly associated with reproductive cycle events. Recent long-term, prospective studies have demonstrated that the transition to menopause is associated with higher risk for new-onset and recurrent depression. Benicio Frey and colleagues review the mechanisms involved and suggest that identification of individuals at higher risk of depression during the menopause transition should guide preventive strategies.

It is now well accepted that psychological factors substantially influence health and disease. Oliver Wolf and Brigitte Kudielka find that alterations of the hypothalamic pituitary ovarian axis occur during ageing and they appear to be of relevance for health and disease. There is some evidence that these changes are more pronounced in older women.

An original study by Nea Kalleinen and colleagues on sleep and the menopause finds that objective sleep measures differ significantly between young and postmenopausal women. They conclude that the differences may be more due to the physiology of ageing than to rapid changes across the menopause, since similar sleep characteristics are already present in premenopausal women.

France Légaré and colleagues evaluate the impact of a patient decision aid (PDA) regarding the use of natural health products at the menopause in a randomized controlled trial. A Cochrane systematic review found that PDAs were found to enhance decision quality. However, this study found that while the PDA on natural health products for menopausal symptoms impacted favourably on women's decisional conflict, it was not superior to a general information brochure on the menopause.

In the clinical practice section, Olivia Drew and Jackie Sherrard discuss sexually transmitted infections (STIs) in older women. STIs in older women are rising and is important that both women and health professionals are aware of this especially as symptoms are often non-specific or absent, and may be misinterpreted as being due to the menopause.

Urogenital atrophy is a common menopausal problem and is caused by estrogen deficiency. The condition is common, affecting about 25% of women even if they are taking systemic estrogen replacement. The British Menopause Society Council has prepared a consensus statement on the various estrogen and non-estrogen based treatments available evaluating the evidence.

The issue is concluded with the literature review by John McGarry and the news section by Simon Brown.