https://www.prematuremenopausecliniclondon.co.uk/

Premature Menopause Clinic London, London (2025)

26/07/2025

Menopause is an important moment in a woman’s bone health journey. As hormones change and oestrogen levels decline - bone mineral density (BMD) decreases. With this loss of bone density comes reduced bone strength and a greater risk of fractures. Risk is greater, the earlier menopause happens in life. There are various interventions which are recommended for prevention or treatment of osteopenia or osteoporosis - lifestyle, non-hormonal therapies/medications and of course hormone replacement therapy (HRT). The best approach depends on woman’s age, age at menopause, medical/family history, lifestyle, medications use and balance of benefits versus risks. Exercise is good for bones but what type is preferred? Weight-bearing exercise is crucial for building and maintaining bone strength and involves activities where body’s weight is supported by feet and legs for example walking, jogging, dancing, and even jumping, with the intensity adjusted based on individual needs and abilities.
Progressive muscle resistance training is the best type of muscle-strengthening exercise for bones. It involves using weights or resistance bands to build up the work for muscles over time - gradually increasing the weight lifted in a slow and controlled way.
It’s important to build up gradually based on fitness level and muscle strength and having a trainer/qualified supervisor is ideal.

Here is an information leaflet which provides a brief overview of many lifestyle interventions that can help during menopause transition -
https://www.rdp-int.com/index.php?&pgid=506
What does the Cochrane review suggest? It looked at 43 randomised trials with 4320 participants. The results suggest a relatively small statistically significant, but possibly important, effect of exercise on bone density compared with control groups without exercise. Exercise has the potential to be a safe and effective way to avert bone loss in postmenopausal women.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000333.pub2/full

25/07/2025

Premature ovarian insufficiency (POI) is defined by amenorrhoea due to loss of ovarian function before 40 years of age - it can occur spontaneously or is secondary to medical or surgical treatments.

Spontaneous POI can be associated with chromosomal and genetic causes, environmental factors, metabolic or autoimmune conditions (most commonly adrenal and thyroid) and certain infections, but is unexplained or idiopathic in majority of cases.

POI is associated with reduced fertility and can have a major long-term impact on cardiovascular, bone/muscle, cognitive, psychological and metabolic health.

Biochemical diagnosis of POI requires follicle-stimulating hormone (FSH) levels in the menopausal range on two occasions, at least four to six weeks apart in a woman

23/07/2025

‘Navigating menopause after cancer’ - a must read for anyone experiencing this journey or supporting someone through menopause after cancer treatment. Thank you Dani Binnington and team at Menopause and Cancer charity for all that you do.

21/07/2025

Do join us on this Webinar tomorrow Tuesday 22nd July 2025 at 6.30pm where we will discuss ‘Thalassaemia - Menopause, POI and HRT’. Please DM for the teams link.

21/07/2025

Cardiovascular disease (CVD) is a leading cause of death in women, worldwide, however this is under-recognised.
Menopause transition with reduction in s*x hormone levels is associated with certain metabolic changes such as central body fat accumulation, decreased energy expenditure, weight gain, insulin resistance and an altered lipid profile which can all have an adverse effect on blood vessel walls/atherosclerosis and raise CVD risk.
Women with premature ovarian insufficiency certainly have heightened CVD risk (lifestyle interventions and HRT at least until age of 51 recommended) and those with severe menopausal symptoms may have a more adverse cardiometabolic profile.

Eating healthy balanced diet with portion control, regular physical activity, weight management, quitting smoking/reducing alcohol consumption and treating high blood pressure/diabetes/abnormal lipid profile adequately - these are the main steps to prevent CVD. Hormone replacement therapy (HRT) when prescribed for treatment of menopausal symptoms or prevention of osteoporosis has a beneficial effect on cardiometabolic risk factors when started early within 10 years of onset of natural menopause in healthy women.

Here is an interesting paper from Bertomeu-Gonzalez et al. whose study aimed to assess the risk factors for incidence of major adverse cardiovascular events (MACE) exclusive to postmenopausal women.
It was a prospective cohort study in postmenopausal women 40 years and above.who were included in the UK Biobank cohort between 2006 and 2010 and followed to 2021 (12 years). A total of 156,787 women were followed for a median of 12.5 years and MACE risk was assessed using risk models.
Postmenopausal women had significant, female-specific risks for cardiovascular morbidity and mortality. Findings suggested that not having taken contraceptive pills, nulliparity, and early menarche (≤12 years) were independently associated with cardiovascular morbidity and mortality. This association was independent of classic cardiovascular risk factors. (look for possible explanation for this in the comments)

20/07/2025

Late effects of cancer treatment on fertility, hormones, and reproductive health vary between women. Age at diagnosis, type/grade/stage of cancer, nature/duration of treatments and many background medical factors determine the final outcome.

What do specialist late effects cancer clinics have to offer to these women? For many, what is most important is the fertility discussion post-cancer. Accurately interpreting ovarian reserve tests/menstrual cycle patterns and establishing the potential impact of given treatments is crucial. No one size fits all.
Contraception is a key element of discussion and the choice of contraceptive needs careful consideration as many have medical issues related to treatments for example history of blood clots.
For other women, it is about effectively managing perimenopause/menopause symptoms and the impact of hormone changes on bones, heart, metabolism and cognition (lifestyle, non-HRT, HRT). Hormone replacement therapy decisions following some forms of cancers can be straightforward but tricky in other situations.
Still others need input for effects of radiation, vulvo-vaginal problems including stenosis/graft versus host issues and other genitourinary symptoms.
And not to forget the psychological support and quick access to advice for any subsequent questions or queries. This perhaps makes the biggest difference of all.
Patient journeys vary and as you follow up women over 5, 10 or some times even longer number of years due to their evolving medical needs - you get to see how individuals show a remarkable difference in their recovery patterns, expectations and achievement of the outcomes that are relevant and important to them.
That is the real essence of the late effects service - helping women navigate the challenging post-cancer treatment phase with non-biased medical advice/support letting them make the informed choice.

Thank you Prof Melanie Davies and Dr Panagiotis Kottaridis at University College London Hospital for setting up and providing such an amazing service over the years and allowing many of us to be part of it.

20/07/2025

Late effects of cancer treatment on fertility, hormones, and reproductive health vary between women. Age at diagnosis, type/grade/stage of cancer, nature/duration of treatments and many background medical factors determine the final outcome.

What do specialist late effects cancer clinics have to offer to these women? For many, what is most important is the fertility discussion post-cancer. Accurately interpreting ovarian reserve tests/menstrual cycle patterns and establishing the potential impact of given treatments is crucial. No one size fits all with women considering options form natural conception to assisted reproduction/IVF to donor conception to egg/embryo freezing to surrogacy/adoption. All this while balancing the risks of cancer recurrence and impact of treatments on maternal and fetal health during pregnancy.

Contraception is a key element of discussion and the choice of contraceptive needs careful consideration as many have medical issues related to treatments for example history of blood clots.

For other women, it is about effectively managing perimenopause/menopause symptoms and the impact of hormone changes on bones, heart, metabolism and cognition (lifestyle, non-HRT, HRT). Hormone replacement therapy decisions following some forms of cancers can be straightforward but tricky in other situations and can be challenging or life changing both for patients and healthcare professionals.

Still others need input for effects of radiation, vulvo-vaginal problems including stenosis/graft versus host issues and other genitourinary symptoms needing advice about lubricants, moisturisers, dilators and hormones/topical anti-inflammatory medications.

And not to forget the psychological support and quick access to advice for any subsequent questions or queries. This perhaps makes the biggest difference of all.

Patient journeys vary and as you follow up women over 5, 10 or some times even longer number of years due to their evolving medical needs - you get to see how individuals show a remarkable difference in their recovery patterns, expectations and achievement of the outcomes that are relevant and important to them.

That is the real essence of the late effects service - helping women navigate the challenging post-cancer treatment phase with non-biased medical advice/support letting them make the informed choice. We have to keep working hard to make these services available to as many women as we can in the future.

Thank you Prof Melanie Davies and Dr Panagiotis Kottaridis at University College London Hospital for setting up and providing such an amazing service over the years and allowing many of us to be part of it.

17/07/2025

Managing cancer induced menopause can be challenging due to the nature of menopause and concerns related to safety of HRT following certain cancers. Supported by a BGCS grant, MENO.pause, a web-based/app decision-aid based on international guidelines was developed to personalise natural and complex menopause treatment including management of HRT complications and guidance for high-risk gene carriers. MENOpause launched in May 2025 and includes guidance that simplifies the BMS-BGCS unscheduled bleeding (USB) guideline, helping clinicians and NHS England to implement this national pathway. MENO.pause is free for use by NHS healthcare professionals. Initial feedback on MENO.pause has been overwhelmingly positive. Despite only launching in May, 1% of users are using it daily and 8% weekly, and this is likely to increase with time. Thank you Gabriella Yongue from University College London Hospital for all the hard work with the app and presenting this poster at the recent British Gynaecological Cancer Society meeting in London.

14/07/2025

Join us at Menopause Research and Education Fund (MREF) on 17th July at 7 pm on You Tube, Linked in or Instagram as we try and learn form 5 research papers related to menopause and understand what the findings mean for healthcare professionals and women.
We will be covering muscle mass in early menopause, NK3 receptor antagonists following breast cancer, links between hormones and melanomas or meningiomas and use of SSRIs during menopause transition.

13/07/2025

Thank you Mr Bassel Wattar as always for this video. Basic science research often does not get the headlines or the attention it deserves in today’s world where cherry picked sensational research findings make it to the social media.
https://youtu.be/U4B2GdDPJVw?si=niPT8r6LWOnB819B

Here is a study that examined whether early menopause, hysterectomy (with removal of ovaries or through its functional impact on conserved ovaries) or the combination of both are related to accelerated aging with adverse impact on long-term health and how early menopause with and without hysterectomy is associated with a higher risk of accelerated biological aging as measured by both epigenetic and physiological indicators.

The researchers ensured good participant numbers and sociodemographic factors including education, race/ethnicity, and lifetime smoking pack years were controlled for in the analysis.

Results -
Hysterectomy, whether following normal-aged or early menopause, or in younger ages, was significantly associated with markers of accelerated biological aging. Women with early menopause or hysterectomy showed accelerated epigenetic aging. Women who experienced normal-aged menopause without hysterectomy demonstrated lower levels of accelerated biological aging. Later menopause and/or no hysterectomy was associated with a reduced risk of accelerated aging potentially due to prolonged exposure to oestrogens.

Of course, the study has major limitations such as - it does not distinguish between hysterectomy with ovarian conservation and hysterectomy with oophorectomy and does not account for original indications for hysterectomy or comorbidities (Gynaecological or metabolic problems) which may influence the results. There is reliance on self-reported data for menopause and hysterectomy and it is unable to differentiate between early menopause and primary ovarian insufficiency (POI). It cannot establish any causal relationships.
Future studies with clinical and hormonal data are needed to provide more targeted insights into findings like these.

Why does this matter?
Studies like these point to long-term health implications of early or surgical menopause so benefits/risks discussion of hysterectomy needs to be robust before surgery is performed. Women with early/surgical menopause or hysterectomy need to be made aware of targeted peri and post-operative early interventions —such as lifestyle adjustments, non-hormonal therapies, hormone replacement therapies and possible long-term monitoring of health markers (bone/heart/cognitive/metabolic) to prevent long-term health problems.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12236146/

Thank you Diane Danzebrink for giving up your time and discussing the findings of a survey (of more than 500 women) from Menopause Support which show an urgent need for better support and clinical services for women following surgical menopause.
https://menopausesupport.co.uk

11/07/2025

It has been a while since I shared some of the recent clinical experiences. Lots of observations and learnings in the clinics.

Unscheduled bleeding on HRT remains a problem in the menopause world. Increased HRT prescribing is contributing to increasing referrals for management of abnormal uterine bleeding including pelvic ultrasound scans and where needed hysteroscopies. Off license HRT regimens complicate the picture further. While clinics are quick on prescribing or changing HRT doses or types - many women still do not seem to be given some of the most basic information about how to use patches or gels or capsules effectively and what can happen with non-compliance. Missed HRT doses leading to bleeding remains a common reason for unnecessary investigations for bleeding on HRT but very little attention is paid when instructing women about problems or dangers of skipping HRT doses or how to take the prescribed medications.

There remains a massive push for testosterone as an add on to oestrogen and progesterone HRT even when there are no symptoms or problems attributable to it and on background of healthy musculoskeletal health. Normal blood test results are being disregarded and side effects of prescription are often not explained. Just like HRT, Testosterone is a medication and has its indications, side effects and risks - these need to discussed before prescribing.

Some more observations in the comments 👇

HRT is a medication. It has a number of benefits, can cause some side effects and also has associated long-term risks. Balancing benefits versus risks is important. Most crucial is discussing these all before a prescription is handed out. As the Hippocratic oath says - “primum non nocere,” - first do no harm.

09/07/2025

Clinibee have launched MENO.pause, a clinician-designed platform built using Clinibee tools to transform national menopause guidelines into clear, step-by-step decision-making support.

MENO.pause app for healthcare professionals is built on national guidelines (NICE, BGCS, BMS) to support evidence-based menopause care for -
Natural and induced/complex menopause (including post-cancer)
Premature ovarian insufficiency
High-risk populations (e.g., BRCA carriers)

It covers HRT decision-making and rational/responsible prescribing for management of complex menopause scenarios including unscheduled bleeding on HRT.
It has been developed by specialists from across primary, secondary, and tertiary care medical teams.

Meno.pause is available on the Clinibee platform using their iOS, Android and Web apps. You only need to register once to use it seamlessly across both mobile and web. The app can be accessed free for NHS users in the UK via the link:
https://www.menopause-app.com/

The app has been developed by Clinical Leads and Specialists 🔹 Dr. Shibani Nicum 🔹 Miss Gabriella Yongue
Contributors 🔹 Prof. Rebecca Bowen 🔹 Dr. Kristin Manley 🔹 Dr. Vikram Talaulikar 🔹 Prof. Adam Rosenthal 🔹 Dr. Louise Price

We hope you will find the app useful in your clinic and help us to develop it further into a comprehensive evidence-based clinical support tool. Feel free to reach out to team@clinibee.com with any queries.

Premature Menopause Clinic London

26/07/2025

25/07/2025

23/07/2025

21/07/2025

21/07/2025

20/07/2025

20/07/2025

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14/07/2025

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11/07/2025

09/07/2025

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