Now that my brain is almost back in gear after weeks of chemotherapy and morphine, I am looking forward to returning to the journal. I must thank Tony Mander and Mourad Seif for holding the fort, by preparing the December issue while I have suffered this temporary Alzheimer's type loss of brain function. This brings us to Tony Mander's editorial about who would assess cognitive change. I am not sure what we could do about it once we recognize this all too common problem of ageing. Frankly, I want to know the timing with some certainty to give me time to nip over to Switzerland for the final knock-out. But his editorial is less pessimistic, informing us that playing the piano, playing chess or even tango dancing reduces the risk of Alzheimer's by as much as 75%, supporting the ‘use it or lose it’ principle. If cognitive change is diagnosed early, attention to general health and diet and a careful use of antihypertensives suggest a slowing down of the rate of dementia.

Bio-identical hormones have become fashionable often in the belief that this idea has come from the USA. In truth, Europeans, particularly the French, have been stressing the importance of plant-based oestradiol, testosterone, dehydroepiandrosterone and progesterone instead of using some of the synthetic oral and equine-derived estrogens used so commonly elsewhere. The arguments for transdermal oestradiol avoiding coagulation changes in liver metabolism seem to be convincing, but the problem seems to be in the choice of gestogen. Synthetic progestogens have their problems, and currently there is a belief that the major side-effects of hormone replacement therapy (HRT) in older women are the result of the progestogen component rather than the estrogen component. For this and other reasons, progesterone cream has become fashionable. Benster and her colleagues have investigated this preparation in an attempt to confirm the late Dr Lee's generous claims about its efficacy on the heart and skeleton. Unfortunately it does not seem to work and it is hardly absorbed. Previously, the same team showed that progesterone cream does not protect the endometrium, so this would seem to be inadequate within a safe HRT preparation.

Simon Brown in his news and views revisits the 2002 women's health initiative (WHI) study and those later more relevant and reassuring publications and adds to the discussion about the risks or otherwise of heart attacks and breast cancer with age and timing of treatment. It is a very up-to-date critique of the literature and should not be missed.

Dr Aittokallio and colleagues from Turku, Finland, have studied the effects of estrogen therapy on sleep patterns and carbon dioxide levels during sleep. The hypothesis was that estrogens should help sleep disorders and reduce nocturnal TcCO₂ levels. This was not the result of the study, which needs further time to determine the effect of HRT on various sleep problems such as sleep apnoea.

Patient compliance for the treatment of postmenopausal osteoporosis is important; Professor Palacios and colleagues have studied this issue, noting that the more knowledgeable women are about their condition, the more likely they are to continue therapy. However, it does seem a pity that in Spain, as in the rest of the Western world, the most common treatment is bisphosphonates even in women below the age of 60 years. Somehow, and sometime, we must correct that. Calleja–Agius and colleagues (from Malta) have produced an important review showing how intervertebral discs are protected by estrogens and not by bisphosphonates. As the discs make up 25% of the length of the vertebral column, this is information that should find its way to the consciousness of bone physicians. It seems almost an insult to suggest that gynaecologists are not confident at addressing sexual issues, but Cordingley and her colleagues question how good we are in their review. Although most gynaecologists spend their lives talking about sex no doubt we do have a lot to learn. Twenty years before the scares of the WHI studies, there was the report of increased endometrial carcinoma with unopposed estrogens. Dr Daayana and Holland review the history and the prevention of this excess risk. What we need to know now are the different physical and emotional side-effects of various progestogens used to prevent endometrial pathology. That is a much more difficult task.

The American Association of Psychiatrists have already changed the name of premenstrual syndrome to PMDD and there is a move to include the somatic components of this condition within a new definition and name. Professor Dennerstein and her colleagues have clearly shown that the physical symptoms of PMS are more common than the emotional symptoms. It is important to understand this, because PMDD or PMS is clearly an endocrine condition caused by ovarian cyclicity rather than a psychiatric condition treatable with the usual collection of selective serotonin uptake inhibitor drugs. If we are able to agree on a name stressing the importance of ovarian activity such as the ovarian cycle syndrome, we are half way to understanding the causation of the condition and the realization that treatment should usually be based on hormonal manipulation and not on antidepressant therapy. Most gynaecologists involved in the treatment of this condition will be aware of how often women labelled with bipolar depression are cured with the appropriate hormone therapy, which suppresses ovulation and thus removes the cyclical symptoms of PMS.