I regard it as a very great honour and responsibility to be appointed Editor of Menopause International. There is no doubt that this journal is the creation of Dr Margaret Rees, who has nurtured this publication from a parochial British Menopause Society newsletter to its present standing as a major international journal. I am the beneficiary of her hard work, which is also evident in the thoughtful handover with well-edited articles already in the can for this March volume. Maturitas is lucky to have her and we all wish her well.

There will, of course, be some new broom changes and it is likely that this first page editorial comment will disappear to be replaced by authoritative and controversial editorials, both invited and by the Editor, on topical subjects. Inevitably, the early ones are those where the subject is felt passionately by the Editor, such as the failure to give appropriate hormone replacement after hysterectomy and even the role of hysterectomy and oophorectomy in gynaecological practice. I also wish to establish a lively correspondence column expecting my views that hysterectomy is a life-saving as well as a life-enhancing operation to start the ball rolling, as I am aware that a strong opinion on this matter is not entirely in step with mine.

Simon Brown has once again given us some remarkable pages analysing important topical papers and presenting the conclusions critically. His views are always very readable as an authoritative review of the current literature. He has always been a huge asset to this journal and we are greatly in his debt.

We have an editorial by Mike Cust and an original paper from Heather Currie's group discussing the problems of menopause and libido as revealed by a computer survey. This is a most worthwhile use of the internet, yielding a great deal of important personal information. Dementia is perhaps the most important health hazard of our increasingly ageing population and Victor Henderson has been in the forefront of research in Alzheimer's disease for many years. If my memory serves me right, he has in the past been optimistic about the value of estrogen therapy in preventing dementia but perhaps he is more cautious these days. We are all very grateful for his continuing work in this difficult area and for producing such an impressive review article for this issue.

The question of the cost-effectiveness of hormone replacement therapy (HRT) always intrigues me as calculations have been performed for every health eventuality. Ingrid Lekander's team from Stockholm has looked at the cost-effectiveness of hormone therapy on skeletal disease, colorectal cancer, coronary heart disease and stroke, indicating that such therapy is indeed cost-effective. Most studies in the literature suggest a cost benefit. However, in reality there is a general agreement that women on HRT live longer, but they still have their acute or chronic terminal disease after varying years of dependency. During this time, they are pension drawing, non-tax-paying individuals requiring costly medical care. Although, even in post-WHI years, there is increasing agreement that HRT is beneficial at many levels, it is unlikely to be cost-effective when lifetime cost is calculated. However, as doctors, this is now not our problem. We have to encourage good medical treatment with few side-effects in order to maintain good health for as long as possible. The politicians will make the financial judgements with little reference to the facts from clinicians or epidemiologists.

Dr de Vrese has written an intriguing account of the use of viable microorganisms as a health benefit to women for various problems such as irritable bowel syndrome, urogenital tract infection as well as possibility of improving osteoporosis and anorexia and premenstrual syndrome. It is difficult to assess the value of such less than orthodox therapy but Elizabeth Thomson and Claire Relton review the value of clinical trials of homeopathy for menopausal symptoms. Such therapy may be invaluable for women with menopausal symptoms who cannot take HRT because of previous breast cancer or who simply prefer not to. The conclusion is that such therapy causes little harm, but the clinical benefits remain unclear. However, such therapy is not only widely used but expensive, so it is important that its true place for the relief of menopausal problems is carefully evaluated.

Although oestrogens might be considered the first-line therapy for insomnia due to vasomotor symptoms, Dobkin and colleagues have indicated that the selective melatonin receptor agonist Ramelteon will be a suitable alternative, however randomized trials and even head-to-head studies against oestrogen are required. The paper by Rashidi discussing evolution of the menopause is more than the usual philosophical discussion but is concerned with real biological explanations for oocyte depletion with age. It is certainly an interesting read.

I see that in the January edition of Menopause, Rocco and his Team, as well as Parker in an accompanying editorial, speak about the folly of 'routine oophorectomy'. Nobody would dispute that. Such surgery should only be performed after full discussion and understanding with the obligation to provide many years of replacement oestradiol and testosterone. The failure to stress this gives the accompanying editorial in this issue of Menopause International even more relevance in its criticism of inadequate aftercare following surgery.

On a happier note, I have been fortunate to attend the IMS workshop on Cardiovascular Disease and Ageing and this will be featured in the June issue of Menopause International. Until then it can be safely stated that oestrogens given to symptomatic early menopausal women have no excess risk of CHD and now there is again evidence that oestrogens alone in women below the age of 60, do reduce the incidence of CHD to the same extent as was suggested by 20 years of observational studies that have been tragically eclipsed by the flawed 2002 WHI study. This at last is being reassessed even by WHI investigators but more about that later.