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

Premature Menopause Clinic London, 10 Harley Street, London (2026)

17/01/2026

Looking forward to discussing some of the new papers/studies in the world of menopause and post-reproductive health with Fiona Clark on Monday.

Do join us on this learning journey with the Menopause Research and Education Fund (MREF).

We will aim to cover HRT after BRCA diagnosis; GSM, UTIs and vaginal oestrogen; Vaginal oestrogen and re**al cancer; Meningioma and HRT; Aging and HRT and Testosterone in menopause - the recent North American society guidelines.

Every piece of research matters - the aim is to understand the strengths and weaknesses of these studies/recommendations and how to make their best use in clinical practice.

Join us live on Monday 19th January at 6:45 pm or watch later on YouTube MREF channel.

16/01/2026

Some food for thought and future research -

Phosphodiesterase type 5 inhibitors (PDE5 inhibitors) share common characteristics and a similar mode of action. These medications work by blocking the action of the enzyme PDE5, which is responsible for breaking down cyclic GMP (cGMP) in the smooth muscle cells lining the blood vessels. By inhibiting PDE5, these drugs promote the accumulation of cGMP, leading to vasodilation in the smooth muscle cells of the blood vessels.
Initially developed as a potential intervention for cardiovascular disease, the drugs including sildenafil (Vi**ra) are today used for treatment of erectile dysfunction and pulmonary hypertension.

But can they have another role for women in menopause transition and beyond? We know that there is a lack of good quality female-specific research and preventative interventions when it comes to cardiovascular health in women and there is a need to develop this space more with better research into both lifestyle and medical treatments including hormonal (HRT) and non-hormonal strategies.

Here is a take on PDE5 inhibitors and their potential. A rationale for PDE5 inhibitors as a cardiovascular risk mitigation strategy in postmenopausal women. doi: https://doi.org/10.1093/jsxmed/qdaf397

14/01/2026

Menopause transition will potentially affect 50% or more of the population, however education on this topic for undergraduate medical students appears to be limited. We are conducting a short survey to gain better understanding of the extent of menopause education in medical schools in the UK so that we can use this information to advocate for a change in the current curriculum as needed.
Thank you Riya Philip from the University of Glasgow for taking this forward.
If you are able to participate, please click - https://forms.gle/J4BBPesijGX7g7SX6 or scan the QR code
or share with someone who may be interested.

13/01/2026

On behalf of Reproduction and Fertility, I invite you to contribute to the recently launched collection “Evolving Perspectives in Management of Menopause Transition”. The collection is being led by myself as Collection Editor alongside Hisham AlAhwany.

Reproduction and Fertility has a global readership and an Impact Factor of 3.4 (Q1 journal).
Co-Editors in Chief -
Andrew Horne, PhD FRCOG FRCP Edin FRCSEd FRSE
Professor of Gynaecology and Reproductive
Sciences,
MRC Centre for Reproductive Health,
University of Edinburgh, UK
and
Norah Spears, D Phil
Professor of Reproductive Physiology,
Centre for Integrative Physiology,
University of Edinburgh, UK

Key areas we will aim to cover -
* Management of menopause symptoms with non-hormonal therapies and the advent of novel therapies like NK-3 receptor antagonists
* Hormone replacement therapy for menopause - where are we now?
* Cardiovascular and bone health in menopause
* Premature ovarian insufficiency and early menopause
* Menopause and Cognitive health
* Testosterone therapy during menopause
* Managing menopause after cancer - what do we know and how is it different?
* Addressing global inequalities in menopause care and support - how do we overcome barriers and challenges that lie ahead?

You can find out more about article submission at -
raf@bioscientifica.com

Or click

https://raf.bioscientifica.com/page/menopause-transition/evolving-perspectives-in-management-of-menopause-transition-

11/01/2026

A big thank you to all staff and colleagues at London Medical (49 Marylebone High Street) for all the help and support over the past 6 years. Forever grateful to the admin team - Soga Matthew, Sahra Munye and Ruzi Hamid and all the healthcare assistants for the wonderful support with reproductive endocrine and menopause clinics 🙏🏼.
And finally not to forget all the patients who have been an amazing source of learning in this journey. - thank you!

Here are some of the free patient information resources we created at London Medical -

https://londonmedical.co.uk/gp-services/menopause-and-hormone-replacement-therapy-hrt/

https://londonmedical.co.uk/news-and-events/recurrent-miscarriage-questions/

https://londonmedical.co.uk/news-and-events/what-is-pcos/

10/01/2026

Vaginal oestrogens (pessaries, gel, cream or ring) are a safe and effective treatment for genitourinary symptoms (dryness, pain, irritation, bladder issues, UTIs) of menopause (GSM). There is minimal (clinically non-significant) systemic absorption of oestrogen from low dose vaginal products.
Although basic principles of management of GSM in breast cancer survivors remain similar, there are some differences in how various guidelines approach or recommend the use of different non-hormonal and hormonal preparations based on the type of cancer.

Some guidelines including the British Menopause Society recommend vaginal moisturisers and lubricants as the first-line treatment for GSM following breast cancer. The guidelines recommend that low-dose vaginal oestrogen can be considered in women who have oestrogen receptor negative tumours or who are taking tamoxifen and have not found non-hormonal treatments effective for GSM. Oestrogen therapy should be discussed with the woman’s oncology team. Low-dose vaginal oestrogens are not recommended for women taking aromatase inhibitors although not absolutely contraindicated. Guidelines emphasise the need for collaborative decision making, including the
patient’s breast oncology team, if non-hormonal treatments are unsuccessful and vaginal oestrogen therapy is being considered.
In most guidelines, medications for GSM such as the oral Ospemifene (Selective Estrogen Receptor Modulator) and vaginal dehydroepiandrosterone (DHEA) are currently not recommended for this group of women as there is a lack of evidence about long-term safety. Recent BMS guidance on GSM suggests that Ospemifene can
be offered to women with a history of breast and endometrial cancer, who have completed
treatment.

The American College of Obstetricians and Gynecologists also recommends non-hormonal methods as the first-line treatment. These include silicone-, polycarbophil-, and water-based lubricants, hyaluronic acid, polyacrylic acid, and vitamin E and D vaginal suppositories. It advises that when non-hormonal treatments fail to address symptoms, low-dose vaginal oestrogen may be used as the next treatment option including for those individuals who take tamoxifen. For individuals taking aromatase inhibitors, ACOG suggests that low-dose vaginal oestrogen can be used after shared decision making between the patient, Gynaecologist, and Oncologist. The guidelines go on to advise that if vaginal oestrogen is not an option, vaginal DHEA or testosterone may help with painful s*x and improve vaginal tissue health and that oral Ospemifene may be considered yet another treatment option.

Decision making can be tricky for patients and they need as much information as possible to make an informed choice. There is also a need for good quality RCTs on this topic. We summarise the evidence and talk about the decision making process in Dani Binnington’s book on ‘Navigating Menopause After Cancer’.

https://menopauseandcancer.org/book/

https://thebms.org.uk/wp-content/uploads/2025/11/09-NEW-BMS-ConsensusStatement-Genitourinary-Syndrome-of-Menopause-GSM-NOV2025-B.pdf

https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2021/12/treatment-of-urogenital-symptoms-in-individuals-with-a-history-of-estrogen-dependent-breast-cancer

https://thebms.org.uk/publications/consensus-statements/risks-and-benefits-of-hrt-before-and-after-a-breast-cancer-diagnosis/

https://journals.sagepub.com/doi/10.1177/20533691231208473?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

09/01/2026

Join us for a case based discussion on menopause transition and HRT. Thank you Assimilate for the opportunity 🙏🏼.

🗓 January 12th Monday
⏰ 𝟏𝟏:𝟎𝟎 𝐀𝐌 – 𝟏𝟐:𝟎𝟎 𝐏𝐌 (𝐔𝐊 𝐓𝐢𝐦𝐞)
⏰ 𝟒:𝟑𝟎 𝐏𝐌 – 𝟓:𝟑𝟎 𝐏𝐌 (𝐈𝐒𝐓)

https://assimilate.one/case-discussion/menopause-transition-and-hormone-replacement-therapy/

07/01/2026

Learn and connect: menopause and cardiovascular health

Menopause transition is associated with several hormone changes that impact long-term health including cardiovascular function. Since the publication of landmark studies such as the WHI and the Million Women’s study, we have learned so much regarding the benefits and risks of modern hormone replacement therapy that is highly relevant to all physicians who care for women at risk for or those with established cardiovascular disease (CVD).

This meeting will focus on the cardiovascular changes during menopause and the management (lifestyle, hormonal and non-hormonal) of symptomatic women, including those with risk factors for CVD as well as those with stable CVD.

Join us for this exciting RCGP session at 30 Euston Square, London chaired by North and West London Faculty’s Dr Alba Soares-Pereira.

Register at RCGP website (search in events) or
https://royalcollegeofgeneralpractitioners.my.site.com/event/a2kWS000000TUbN/ev05943?recordId=a2kWS000000TUbN&utm_campaign=3012298_London%20%26%20South%20England%20Faculty%20Fortnightly%206%20January&utm_medium=email&utm_source=Dotmailer&dm_i=49LX,1SKAY,JUZQT,8H927,1

06/01/2026

This is such an interesting and thought provoking article from Kerr and Rodgers.

Whenever we discuss PCOS, we discuss about the above average number of ovarian follicles and when we are discussing premature ovarian insufficiency or early menopause, we talk about low ovarian follicle numbers in women. The number of follicles or ovarian reserve at birth seems to determine the reproductive health and hormone journeys for women across the lifespan.

How sure are we about what happens to oocytes and follicles during foetal life and at birth? Here is what this paper discovered.

The ovarian reserve is the quantity of non-growing primordial follicles (NGF) in paired ovaries. In textbooks, published papers, and internet modalities, a recurring theme is that for human females, on average, mid-gestation marks the peak supply of 7 million germ cells/NGF followed by large-scale depletion to about 1–2 million in paired ovaries at birth. A massive 70–85% die-off among germ cells in foetal ovaries is reported during the second half of gestation. Although germ cell degeneration is a reality, the authors reviewed the evidence for the timing and extent of germ cell death in foetal/newborn human ovaries. Searches to September 2025 were performed using PubMed, Google Scholar, and DOIs/URLs from published papers, textbooks, and webpages.

The authors found that germ cell number estimates (oogonia, oocytes, NGF) in human embryonic, foetal, and newborn ovaries (n = 139) in seven studies from 1953 until 2011 used three different quantitation methods: (i) volumetric/model-based with correction factors, (ii) volumetric/modified stereology, and (iii) fractionator/optical dissector. In a 1963 study, germ cells in paired foetal ovaries at 20 weeks (n = 2) reported 6.8 million in total with 20% atretic, and at birth (n = 2), 2 million in total with 50% atretic, leading to the narrative that the mid-gestation human female foetus has 7 million germ cells/NGF that are subsequently depleted to 1–2 million by birth.

In the six decades since, the calculations in the above study have not been confirmed. Alternative estimates of germ cell numbers are at variance with these accounts reporting numbers that in general are substantially lower, often by a factor of 10. Based upon these data for ovaries in newborns, mathematical modelling predicts that only about 1% have ≥1 million germ cells in the ovarian reserve. In adult women, ovarian volume is strongly correlated with the numbers of NGF but an equivalent correlation between germ cell supply and ovarian volume during foetal life up to birth has not been investigated.

The authors concluded that the narrative whereby human foetal ovaries develop millions of germ cells followed by most degenerating up to birth has not been verified. Systematic analysis of total numbers and estimates of viable versus degenerating germ cells across gestation is needed.

Based on these findings the authors suggest that for fertility counselling and for women electing to delay pregnancy, it is suggested that clinicians and health professionals be aware that the age-related ovarian reserve in adults may not necessarily be in the expected range if the NGF reserve at birth was significantly lower than the narrative of 1–2 million at that time. This would be especially important for women from different ethnicities and geographical backgrounds.

The statement that "science grows by keeping questioning" is a fundamental principle of the scientific method and intellectual progress. Science is not about accepting a fixed set of "facts" but is an ongoing process of observation, skepticism, and inquiry that constantly challenges and refines our understanding of the world. We need to question what we know and push for good quality research when things do not add up or cannot be explained. This paper certainly does that.

https://academic.oup.com/humupd/advance-article/doi/10.1093/humupd/dmaf031/8405518?login=false

04/01/2026

The first issue of New Scientist for 2026 brings a sharp focus on to GLP-1 weight loss medications.
It suggests that weight-loss medications should get cheaper and more accessible (with expiry of semaglutide patents in many countries) and the approval of orforglipron which can be taken in a pill form. Also, there are more promising drugs on the horizon that could produce greater benefits (with more than 100 weight-loss drugs in development).

As the article notes, there are still many unanswered questions about long-term effects, what happens when you stop and the access to these agents.

The world health organisation guidelines conclude that medications alone cannot solve the global obesity burden. The availability of GLP-1 therapies should galvanise the global community to build a fair, integrated, and sustainable obesity ecosystem. Countries must ensure equitable access not only to comprehensive disease management, but also to health promotion and prevention policies and interventions targeting the general population and those at high risk.

As health professionals, we are already seeing more of our patients use GLP-1 agents and the numbers are only set to rise on future. We will have to be prepared and informed about what comes next.

https://www.newscientist.com/article/mg26935761-800-2026-is-set-to-be-an-even-bigger-year-for-weight-loss-drugs/

https://jamanetwork.com/journals/jama/fullarticle/2842199

03/01/2026

Wonderful news to start the year.

A UCLH patient with beta thalassaemia has spent her first ever Christmas without needing to plan her life around blood transfusions after a gene-editing therapy has left her able to produce her own red blood cells.

Last year the NHS became one of the first health systems in the world to use the therapy called Casgevy, for beta thalassaemia, which mainly affects people of Asian, Mediterranean, and Middle Eastern descent.

Casgevy uses the patient's own stem cells which are removed, edited over a six-month period so they produce haemoglobin, then reintroduced into the body via infusion. In international clinical trials the technique removed the need for blood transfusions for at least a year in 98% of patients.

The treatment of beta thalassaemia major (BTM) usually consists of long-term blood transfusions and iron chelation therapy. Iron overload can cause multiple organopathy with significant morbidity such as liver damage, cardiac complications and multiple endocrine problems.

From a reproductive perspective, the commonest abnormality is hypogonadotropic hypogonadism (HH) which affects 70–80% of thalassaemic patients and is usually considered irreversible. In women, HH can present as primary amenorrhoea, delayed puberty or secondary amenorrhoea with consequent subfertility. Hormone replacement therapy is recommended for HH for quality of life and bone/heart health protection.

The hope is that this ground breaking treatment will provide a cure for many patients with transfusion dependent thalassaemia preventing life-threatening complications and improving their quality of life.

https://www.uclh.nhs.uk/news/hope-patients-beta-thalassaemia-new-gene-editing-therapy-rolled-out-uclh

02/01/2026

Thank you Vindya Pathiraja, Om Kurmi, and Gayathri Delanerolle from the MARIE WP2a project for the opportunity to contribute to this paper which explores the availability and acceptability of hormone replacement therapy (HRT) in low- and middle-income countries (LMICs) using insights of pharmacists.

HRT remains underutilised and under-researched in LMICs despite its potential to alleviate menopausal symptoms for many. This study explored pharmacists’ perspectives on the use, cost, and availability of HRT across six LMICs. A cross-sectional survey was conducted from January 1 to March 31, 2025, as part of the Global Menopause Project. Pharmacists working in community, hospital, and private sector settings in Malaysia, Sri Lanka, Nepal, Nigeria, Ghana, and Tanzania were recruited. Participants completed an anonymous online questionnaire. The questionnaire was piloted prior to dissemination and assessed HRT availability, pricing, and perceived barriers to use.

Here is what we found -
A total of 331 pharmacists responded: Ghana (18·4%), Sri Lanka (17·5%), Tanzania (16·9%), Nepal (16·6%), Malaysia (15·4%), and Nigeria (15·1%). The respondents were almost equally distributed between s*xes (50·8% were female), and most were aged 26–35 years (49·0%). The majority worked in private community pharmacies (41·7%) or government hospitals (32·6%), and 57·4% were based in urban areas. From the sample, 68·9% of pharmacists reported that HRTs were available for dispensing in their respective countries (highest proportion was reported in Nepal, 92·7% and lowest in Nigeria, 42%). HRT costs varied widely, with Sri Lanka reporting the highest prices and Malaysia the lowest. Key barriers identified included low health literacy, economic constraints, and limited healthcare access. Significant disparities exist in HRT access, availability and affordability across LMICs, with urban-rural gaps further compounding inequities. Pharmacists’ insights underscore the urgent need for inclusive, equitable strategies in menopausal care and women’s health policy in resource-limited settings.

We identified a need to incorporate updated and evidence-based content on menopause and HRT into pharmacy education and ongoing healthcare professional development programs. This will help ensure pharmacists are equipped with accurate knowledge about the indications, formulations, and dosing of HRT. Second, public health authorities should implement awareness campaigns to clarify widespread misconceptions, particularly the confusion between HRT and contraceptives, which were notably prevalent in some regions. Third, there is a need to improve access and reduce disparities in availability and cost of HRT - governments and healthcare systems should explore ways to regulate HRT pricing and consider subsidy mechanisms to make preparations more affordable. Finally, establishing standardised, country-specific guidelines for pharmacists on HRT use can promote consistent counselling and dispensing practices. Together, these recommendations support safer, more equitable, and better-informed use of HRT in diverse healthcare settings.

We must make sure that the benefits of growing awareness and education about menopause and HRT (benefits versus risks) should reach everyone across the world and they should have a choice of all lifestyle, non-HRT and HRT interventions to manage their symptoms and quality of life.

https://www.nature.com/articles/s41598-025-18083-x

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