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GP and women's health professionals study day, UCLH, London (2025)

24/11/2025

Polycystic o***y syndrome (PCOS) is a common condition, that manifests as menstrual irregularities, subfertility, or symptoms of hyperandrogenism – including hirsutism, adult acne, and alopecia. Current pharmacological treatment of the hyperandrogenic symptoms includes the option of combined oral contraceptive pills. However, there are contraindications and side-effects, which limit their use. Anti-androgens, such as spironolactone, are commonly prescribed off-label but their long-term safety and efficacy in PCOS women is uncertain. This review aimed to evaluate the efficacy and safety of spironolactone, when compared to other nonhormonal medications in the management of PCOS hyperandrogenic symptoms.

Comprehensive literature searches were conducted across MEDLINE, EMBASES, PUBMED and SCOPUS. RCTs published in English assessing the use of spironolactone for hyperandrogenism in PCOS were included. The quality of papers was assessed using Cochrane RoB 2.0 tool. Meta-analysis was conducted using a random-effects model, reporting as standardised mean differences and 95% confidence intervals.

Of 3378 studies identified, five open-label RCTs met the inclusion criteria, three of which were included in the meta-analysis. Spironolactone, monotherapy or combination with metformin, showed no statistically significant difference in reducing Ferriman-Gallwey scores, total testosterone levels or BMI compared to metformin monotherapy. Side effects of spironolactone included menstrual irregularities, polyuria, and gastrointestinal symptoms.

Current limited evidence does not show any significant difference in the use of spironolactone when compared to metformin. Given its widespread use and limited safety concerns, spironolactone remains an off-label option, especially for those unable to take hormonal contraceptives. However, larger, better quality studies are needed to establish its efficacy specifically in PCOS management.

Thank you Telma and team for all the hardwork that went into writing this paper.
Link: http://doi.org/10.1111/cen.70062

22/11/2025

While women with high body mass index (BMI) and hypogonadism (presenting with lack of periods) are often labelled as having polycystic o***y syndrome (PCOS), there appear to be mechanistic differences causing the increased activation of hypothalamic GnRH neurons observed in PCOS, as opposed to the reduction in GnRH neuronal activity in high BMI-related secondary hypogonadism.

Here is an excellent review from Pei Chia Eng et al. highlighting features which are more associated with high BMI-related secondary hypogonadism than PCOS.

The authors note that high BMI is associated with an increase in leptin levels, which can result in hypothalamic leptin resistance and a reduction in GnRH pulsatility and LH levels. Lower LH levels can occur due to increased clearance of endogenous LH in women with high BMI as well as reduced pituitary response to GnRH. AMH levels are reduced in some women with high BMI, and theoretically a reduction in AMH levels could lead to reduced stimulation of GnRH neurons and thus LH levels. Androgens are increased in women with high BMI, and markedly elevated levels could contribute to a reduction in LH levels. An increase in inflammatory markers can also contribute to the reduction in LH levels and hypogonadism observed.

A thorough evaluation of reproduction endocrine function in women with high BMI and hypogonadism is needed to differentiate those with PCOS from those with BMI-related secondary hypogonadism as it will shape the clinical advice and management offered to them.

https://academic.oup.com/edrv/article/45/2/171/7240177

21/11/2025

I am always amazed by how well the Scandinavian countries collect healthcare data and analyse their registries to present research findings on not so common topics which usually need large numbers to be screened over a long duration.

On the background of some clinical cases we encountered this month where individuals had surgical menopause following rare forms of ovarian cancer - a review of literature produced this extremely useful paper detailing the type/histology and stage of ovarian cancer and patient’s hormone journeys thereafter which could be factored in while carefully assessing benefits versus risks of HRT in individual scenarios.

The authors concluded that far too few premenopausal women receive HRT after surgical menopause for ovarian cancer. To avoid morbidity and improve quality of life, HRT can be recommended up to average age of menopause for most. There is a need to increase and follow-up the use of HRT especially in younger women since they are at risk of developing significant morbidity and having a poorer quality of life.

https://www.sciencedirect.com/science/article/pii/S0090825822018558

There are also recent BGCS and BMS guidelines which can aid decision making -

https://www.bgcs.org.uk/wp-content/uploads/2024/08/BGCS-BMS-Guidelines-on-Management-of-Menopausal-Symptoms-after-Gynaecological-Cancer.pdf

20/11/2025

It is good to see a condition like ‘premature ovarian insufficiency’ (POI) getting the much deserved attention and awareness in the past few years.

Many women have traditionally suffered from delayed diagnosis, poor standards of care, lack of access to timely hormone replacement therapy (HRT) or non-HRT treatments depending on the cause/medical history and long-term health monitoring for POI. Research into the condition has been little and healthcare professional training and education has been limited.
Fortunately this is changing although there is a long way to go……

But in the meantime, we are starting to have another battle on our hands - a rise of non-scientific and non-evidence based treatments or claims being made about various supplements, hormones or other therapies/trials/interventions promising a host of fertility and long-term health benefits. Some of them with potential health risks long-term that have not been discussed or explained.

We must fight these trends together so that everyone sticks to science and we do not allow exploitation of the vulnerable with misleading claims with no robust evidence or cherry picked weak evidence.

Here are useful resources -

https://www.eshre.eu/-/media/sitecore-files/Guidelines/POI/2024/INTERNATIONAL-GUIDELINE-ON-POI_2024_2.pdf

https://www.sciencedirect.com/science/article/abs/pii/S152169342100167X?via%3Dihub

https://academic.oup.com/ejendo/article/190/6/G53/7674241

18/11/2025

Menopause following cancer treatment presents unique challenges for many. Whether it is surgery, radiotherapy, chemotherapy or endocrine treatments - impact on fertility and hormones can be significant and life-changing. Both childhood and adult cancer cure rates have improved vastly and it is now time to intensify focus on late effects of treatment and long-term physical/psychological health and quality of life.
There remain multiple gaps in current care pathways - lack of specialist clinics, long waiting times for existing clinics, lack of consistent fertility/hormone advice prior to or during treatment, lack of pre-operative planning, lack of healthcare professionals training or education on up to date advice regarding fertility/hormones post cancer, no structured follow-up plan for late effects and lack of research funding focussing on this area. Standards of care vary across different regions and populations. There is a lot to be done.

Thank you Carolyn Harris MP for the Menopause APPG round table meeting at the Portcullis House today to discuss some of these issues. We must all come together to change things for better.
Thank you Dani Binnington for continuing to support cancer survivors across the country through Menopause and Cancer charity. Your work is vital.
https://menopauseandcancer.org

18/11/2025

Management of menopause with hormone replacement therapy following surgery for endometriosis can be challenging. Striking a balance between replacing sufficient hormones for treatment of symptoms/long-term health benefits versus reactivation/recurrence of the disease can be tricky in those with severe or residual disease. Use of adequate progestogen/progesterone dose to balance the oestrogen in HRT is a key consideration.

Endometriosis can still be active/symptomatic after menopause (reported in women both with or without HRT use). Although the absolute risk of disease recurrence and malignant transformation remains low, accurate counselling remains difficult due to lack of high-quality studies. Women with a history of severe endometriosis should be carefully counselled about the possibility of disease recurrence after menopause and use of HRT weighing up individual benefits and risks. Although the absolute risk is unclear and is likely low, women should be advised to seek help if they experience recurrence of endometriosis-like symptoms so that these can be promptly investigated.

Here are a couple of helpful reviews on the topic -
https://www.eshre.eu/guideline/endometriosis
and
https://academic.oup.com/humupd/article/23/4/481/3814217?login=false

16/11/2025

Looking forward to joining the South London Menopause Meeting next week to discuss the overlap between menopause and autoimmunity.

We have always known that autoimmune diseases have a strong association with premature ovarian insufficiency or early menopause suggesting that immunological mechanisms play a pivotal role in pathophysiology.

What is also interesting is that ovarian function often fluctuates when POI is associated with immune diagnoses or positive antibody markers.

Let’s catch up and discuss what we know so far (a lot remains unknown) and recent guideline recommendations on the 26th!

Thank you Mr Bassel Wattar for putting together this educational event.

14/11/2025

📣 We want to hear from YOU!

Diary of a Kidney Warrior Podcast is planning a special listener-led episode exploring everything about menopause and chronic kidney disease (CKD).

Got a question you’ve always wanted to ask about menopause and CKD? 🌸💭

👉🏽👉 Click the link to send in your question.
🗓️ Deadline: Sunday 16 November

https://diaryofakidneywarrior.getform.com/ymy2y

13/11/2025

The National Rheumatoid Arthritis Society (NRAS) provides information and support services for those affected by rheumatoid arthritis (RA), their families, friends, carers and health professionals.
Join on Wednesday 26th November at 7pm for information about menopause, the commonalities between menopause and RA, ways to manage it and much, much more.
https://nras.org.uk/event/nras-live-menopause-ra/

10/11/2025

Bone and muscle health are always very important but even more so when menopause transition begins. About one in two women in the UK will suffer a fracture after the age of 50 and a 50-year-old woman has about 2.8% risk of death related
to hip fracture during her lifetime.

Osteoporosis does not cause symptoms and may only be discovered after a fracture happens. Prevention is key! From healthcare professionals point of view, all women should be offered lifestyle advice including balanced diet, adequate protein, calcium and vitamin D intake, regular exercise (resistance and weight bearing), quitting smoking and limiting alcohol intake.

Individual risk assessment should be carried out regarding risk of developing osteoporosis and osteoporosis related fractures. Bone mineral density assessment should be offered on an individualised basis following risk assessment.

HRT has a protective effect against osteoporosis and bone fragility fractures. It stimulates osteoblastic action and inhibits osteoclast activity. Many clinical guidelines recommend that HRT should be considered one of the first-line medical treatment options for prevention and treatment of osteoporosis in women with premature ovarian insufficiency or early menopause and menopausal women below the age of 60 years.

The national osteoporosis guidelines group (NOGG), UK also recommends that for patients in whom treatment is indicated, offer antiresorptive therapy with oral
bisphosphonates (alendronate or risedronate) or intravenous zoledronate, or in postmenopausal women age ≤60 years - hormone replacement therapy.

Discussing benefits versus side effects/risks of each treatment option is important so that women can make an informed choice.

https://ecronicon.net/assets/ecgy/pdf/ECGY-11-00784.pdf

https://www.nogg.org.uk/sites/nogg/download/NOGG-Summary-of-main-recommendations-2024.pdf?v4

09/11/2025

Our next Menopause Research and Education Fund (MREF) menopause management course is on Nov 27.�It has been updated and covers everything from the basics to managing complex cases.�It is presented by British Menopause Society registered menopause specialists and a pelvic floor physiotherapist.�It’s online but you can watch later, is worth 8 CPD points and costs just £20 to help support the charity.

At MREF, our aim is to provide evidence based good quality menopause management education to as many as we can at very affordable fees. Please share with any healthcare professional who may benefit from joining 🙏

Simply register on eventbrite.co.uk or
Links -
https://www.eventbrite.co.uk/e/1574218643339?aff=oddtdtcreator

https://mref.uk

08/11/2025

Here is a research study from University College London - A multimodal study of menopausal ageing focusing on hormones, health and habits. The study will involve group discussion sessions at UCL.
Please do take part or share with someone who may wish to take part 🙏.
Scan the QR code or link - https://forms.office.com/Pages/ResponsePage.aspx?id=_oivH5ipW0yTySEKEdmlwoTflfXjTTVHg99cZbAd9thUNk5WQ1JLNzNBM1owOVRGSVhZRFRHTEtLVi4u&origin=QRCode
For more information contact - f.ronca@ucl.ac.uk

GP and women's health professionals study day

24/11/2025

22/11/2025

21/11/2025

20/11/2025

18/11/2025

18/11/2025

16/11/2025

14/11/2025

13/11/2025

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08/11/2025

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