Stress urinary incontinence (SUI) affects millions of women worldwide. Pelvic floor muscle training is the first-line treatment for SUI, and if this fails, midurethral sling surgery has become the gold-standard treatment. More recently, complications from midurethral mesh slings, particularly chronic pain and dyspareunia, have become a major concern. Although traditional SUI treatments, such as colposuspension and fascia slings, are used, the future of SUI treatment likely will rely on less invasive alternatives. Modern bulking agents could have the potential to become a first-line treatment for SUI, but further long-term studies are needed. Patients should be involved in decision-making prior to any surgery to ensure that they are aware of the risks and also any reasonable treatment alternatives. Furthermore, the effectiveness of a procedure should be balanced with its invasiveness and possible risks to provide women individually with the best possible treatment option.

Pelvic floor dysfunctions are a complex condition in elderly women; pelvic organ prolapse, urinary or fecal incontinence, constipation, pelvic pain, and sexual dysfunction are common problems. The goal of surgical treatment is functional reconstruction with symptom management and repair of anatomic defects. The recent advancements in surgical treatment of pelvic floor dysfunction allow several good options for choosing the best surgery for each patient. The vaginal procedure is traditionally the gold standard approach for elderly patients, but abdominal surgery is increasing as a mini-invasive approach and the robotic approach is gaining acceptance for treatment of pelvic floor dysfunctions. In elderly individuals, a multitude of factors affects the final result of any reconstructive surgery such as postmenopausal or aging-associated changes in muscle tone and nerve function or changes in the function of the bladder or of the rectum: an understanding of the underlining functional status of pelvic organs is very important in aging women before proceeding to surgery. In this context, pelvic floor dysfunction, particularly in elderly women, should be addressed in a multidisciplinary manner and, at the forefront, centers for surgical planning could be helpful to perform safer, patient-tailored surgery.

Successful human uterine transplantation followed by subsequent pregnancy and live birth in a woman for whom this would otherwise have been impossible is a laudable goal. Research programs have been developed in several countries aimed at achieving this goal. The pioneering Swedish program has reported live births in six women, two of whom had a second pregnancy and birth. Five other live births have been reported from other countries. Most transplants were from a live donor, although recently a live birth has been reported following transplant from a deceased donor. The surgical procedure on a live donor is highly invasive, complex, hazardous, and long and may decrease her quality of life. The use of a deceased donor would partly simplify this issue and is being explored in several centers. Also explored are technical modifications to simplify the procedure and shorten the operating times. The American Society for Reproductive Medicine (ASRM) reminds us of the full array of options available to patients: 'including gestational carriers (surrogacy), adoption and child-free living'. The ASRM also recommends 55 years as the upper age limit for transfer of donor oocytes and embryos in healthy women. Would it not be more practical and less onerous for the prospective live donor to carry the pregnancy instead? Uterine transplantation remains an experimental procedure that requires the study and resolution of ethical, technical, financial, and social issues, all very important.

The metabolic syndrome (METS) is an entity diagnosed by three or more of the following factors: abdominal obesity, low high-density lipoprotein cholesterol, and high serum triglycerides, fasting glucose, and/or blood pressure levels. Abdominal obesity is the most prevalent component of the syndrome that favors insulin resistance and a proinflammatory and prothrombotic status, and the risk of developing diabetes, hypertension, and other chronic conditions. During the menopausal transition, women tend to gain weight and this has been related to an increase in the prevalence of the METS. Rates have also been linked to hormonal status (perimenopausal vs. postmenopausal), changes in lifestyle, and endocrine adjustments. Abnormal cytokine secretion subsequently produces endothelial dysfunction, which will consequently increase cardiovascular risk and related morbidity and mortality. This document will review the various risks that arise as a consequence of the METS during female midlife.

The females of most species die soon after ceasing to reproduce, their purpose in life being to ensure survival of their kin. Human females may live more than one-third of their lives after they cease to reproduce, a property shared by few species, one of which is Orca whales. Orcas have been extensively studied because families live together in stable units or pods and individual whales have distinctive markings, enabling them to be identified. The females survive long after the menopause, one possible reason for this being that the older females provide a survival advantage since they are seen to lead the pods more often than younger females or males, thus providing a survival advantage in times of food shortage. The female lifespan is increasing in most countries worldwide, principally due to decreased infection and maternal mortality. Women are now more active through middle and into older age. Whatever sort of life they wish to lead, women need to be as fit as possible to facilitate healthy aging. Chronic diseases that affect millions of women are cardiovascular disease, osteoporosis, cancer, and dementia. The incidence of all these is increased by obesity, the prevention of which is a major challenge in our society. Hormone therapy may have a place for some women but for many others taking control of their health by lifestyle intervention is a major contributor to disease prevention. It is our duty as doctors to encourage this at every opportunity to help all women live a fruitful and healthy old age.

Over the past decades, progress in efforts to reduce cardiovascular morbidity and mortality has been achieved, although a disturbing trend for stagnation of cardiovascular mortality rates among younger women compared with those in younger men has been identified. While the menopause transition has traditionally offered an unequivocal opportunity to assess cardiovascular risk and counsel women to adopt preventive strategies, the veritable 'window of opportunity', usually applied to the concept of timing the initiation of menopausal hormone therapy, must be opened much wider to encompass younger women including those who have experienced adverse events during pregnancy, treatment for breast cancer, and premature menopause. Collaborative efforts by a number of expert medical groups provide encouragement and justification for an aggressive approach to identify and modify cardiovascular risk earlier in younger women, starting at age 20 years. Quantifying cardiovascular risk with country and population-specific risk calculators can be helpful to validate perception of risk and encourage preventive recommendations. Adherence to established guidelines for lifestyle measures (smoking cessation, healthful eating habits, enhanced physical activity, and weight control) along with treatment of traditional risk factors - hypertension, glucose intolerance, and dyslipidemia - provides a sound basis for prevention of cardiovascular disease in women.