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There are limited nonhormonal treatments for women seeking relief from hot flushes. Perimenopausal and postmenopausal women may not wish to take estrogens and selective serotonin reuptake inhibitors offer a reasonably good option for decreasing the frequency, severity or bothersome effects of hot flushes. A report by Freeman et al. (JAMA 2011;305:267–74) indicates that the selective serotonin reuptake inhibitor escitalopram is effective in controlling flushes in healthy menopausal women. As usual in controlled trials for flushes, about one-third of volunteers had a 50% reduction in symptoms on the placebo but more than half had a similar beneficial effect from taking 10–20 mg/day of escitalopram over 8 weeks. The active substance had few adverse effects and it was convincing that 3 weeks after the trial ended those who had taken the escitalopram had the return of more hot flushes than those ‘coming off’ the placebo. For the record, the participants had at least four flushes or night sweats a day before treatment and there were no racial differences between groups with African-American and white women being equally represented in the sample population. Estrogens are the treatment of choice for menopausal symptoms but escitalopram appears to be an option in reducing the frequency, severity and bother of menopausal vasomotor symptoms. There are numerous nonsurgical options available to women suffering from heavy menstrual bleeding. In the spectrum between drugs and minimally invasive resection techniques are the endometrial ablation procedures that can be carried out as outpatient manoeuvres without general anaesthetic or conscious sedation. Two well-recognised methods are bipolar radiofrequency and thermal balloon applications. Clark et al. (Obstet Gynecol 2011;117:109–18) compared these two techniques in terms of their achievement of amenorrhoea after 6 months, acceptability and quality of life. The radiofrequency worked better than the thermal balloon method in complete surface ablation and took less time. It also produced better rates of amenorrhoea, although not statistically significantly so, and both improved the woman’s quality of life. Where there is no intracavity pathology, office-based procedures have much to offer to those who wish to avoid surgery or for whom anaesthesia is inadvisable. Contraception in HIV-positive women presents a challenge in that condom usage is unreliable, expensive and may be difficult to negotiate. Where sure but reversible methods are required there is little research to inform decision-making and the hormonal effects in immunodeficient women are largely unknown both in their effects on cytological changes and their role in infections. A study on a small group of HIV-positive women using the levonorgestrel-releasing intrauterine system now adds to the evidence about safety and efficacy of contraception in this high-risk group (Heikinheimo AJOG 2011;204:126. e1–4). It was found that 80% of the users continued with the method for at least 5 years and their CD4 counts were similar to comparable HIV-positive controls. No pregnancies occurred and haemoglobin levels remained higher in the user group, although both cohorts had high levels of exfoliative cervical cytology atypia. There were no episodes of pelvic inflammatory disease so it is postulated that levonorgestrel-releasing intrauterine system plus condoms may be the best form of contraception in HIV-positive women. The management of preterm labour involves the acute suppression of uterine contractions. By inhibiting the end-organ response it is presumed that the initial stimulus will not remain operative or that the incident producing it has passed. It is a conveniently uninvestigated aspect of preterm labour research—randomised trials using placebo controls are scarce and nifedipine has never been subjected to this gold-standard form of investigation (Caritis AJOG 2011;204:95–6). Most trials of uterine activity suppression test one drug against another and look at relative efficacy and adverse effects rather than neonatal outcomes. However, in the present ethical climate it may be that comparative efficiency is the best that can be hoped for and the best evidence comes from a meta-analysis by Conde-Agudelo et al. (AJOG 2011;204:134. e1–20). Their work shows nifedipine to be superior to β-adrenergics and magnesium sulphate for tocolysis of women in preterm labour, so if a decision is made on clinical grounds to suppress the myometrium then there is guidance in favour of nifedipine for the person in charge of management. Pre-eclampsia and its complications are a leading cause of maternal morbidity and mortality. The lack of screening markers for the disease does not allow for its prediction and even when it declares itself the speed of its progression is difficult to prognosticate. Because interventions, other than blood pressure control, are largely ineffective in preventing deterioration, the timing of the delivery becomes the critical factor in its management and the prediction of maternal and fetal jeopardy is critical. In a quest to seek clarity of factors that could predict adverse outcomes, an international group developed a model that estimated such risk. It was called the fullPIERS model (Pre-eclampsia Integrated Estimate of RiSk) by von Dadelszen et al. (Lancet 2011;377:219–27). After using the Delphi technique to consolidate expert opinion on variables the group then selected tests to be used in the prediction of which mothers would become ‘at risk’ after admission to hospital. They found that the more remote from term the disease becomes clinically detectable, the higher the maternal mortality—20 times the term risk if it manifested before 32 weeks of gestation. Factors that allowed risk to be predicted with accuracy were gestational age, chest pain or dyspnoea, oxygen saturation by pulse oximetry (SpO2), platelet count, serum creatinine and aspartate transaminase levels. The close monitoring of these parameters will allow more objective decisions to be made about patient transfers, immediate delivery or ongoing conservative management provided the fetal risks remain acceptable. Scandinavian countries are highly developed with enviable socio-economic status. They have had data-gathering systems in place for decades allowing population trends to be followed that may be indicators of what other nations and groups can anticipate as they too become more socially sophisticated. In Norway over the last three decades the maternal age has risen steadily, with women having their first child at the age of nearly 30 years and the birth rate for women aged 20 to 24 years decreasing dramatically from 115 per 1000 to 60 per 1000. At the same time, there has been access to legal termination of pregnancy (TOP) and these rates have been relatively stable within age groups over the same time period—suggesting that terminations do not play a major role in postponing childbearing (Vlietman et al. Acta Obstet Gynaecol Scand 2010;89:1564–70). The practicalities of TOP are also being explored with medical procedures using mifepristone plus misoprostol shown to be effective in Finland (Joensuu-Manninen et al. Acta Obstet Gynaecol Scand 2010;89:1552–6). Their mid-trimester TOP statistics show that 94% of women abort within 24 hours in the hospital environment. Clearly these TOPs are less satisfactory than early medical management with social and psychological factors making interventions more complicated. These complexities are reflected in the American data about women having recurrent TOPs (Bliel AJOG 2011;204:122. e1–6). There is an association between repeated TOPs and adverse events in a woman’s childhood, like abuse, family disruptions and lack of personal safety. It seems that these self-reported experiences lead to a tendency to make use of serial TOPs in later life. As circumcision has been shown to decrease rates of HIV transmission, it is possible that it reduces rates of human papillomavirus (HPV) transmission as well. This would be in keeping with the low prevalence of cervical cancer in Jewish women whose husbands have been circumcised. A group of researchers looking at HIV transmission rates in Uganda also investigated whether circumcision would reduce HPV transmission rates (Wawer et al. Lancet 2011;377:209–18). The men in the trial either underwent immediate circumcision or had the procedure delayed by 2 years, during which time their partners were screened for HPV infections. In the immediate intervention group the HPV infection rate in partners was nearly 30% whereas in the delayed intervention group it was nearer 40%—a statistically significant difference. Although not providing extensive protection from oncogenic HPV strains, circumcision does reduce their transmission and by extrapolation could reduce the risk of cervical cancer. These data should strengthen the case for circumcision in developing countries to protect women from HPV and HIV infections.