http://www.recurrentmiscarriagecliniclondon.co.uk/

Recurrent Miscarriage Clinic London, 49 Marylebone High Street, High Street (2026)

11/02/2026

Polycystic o***y syndrome (PCOS) is a common endocrine disorder linked to insulin resistance, weight gain, and reproductive hormone imbalance. While dietary modification is a key part of management, the optimal approach to lifestyle interventions remains unclear and no one approach suits everyone. The recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic O***y Syndrome emphasise the role of healthy lifestyle behaviours encompassing healthy eating and/or physical activity for all women with PCOS to optimise general health, quality of life, body composition, and weight management (maintaining weight, preventing weight gain, and/or modest weight loss).
The guidelines recommend that lifestyle management goals and priorities should be co-developed in partnership with women with PCOS and value women's individualised preferences and that there are benefits to a healthy lifestyle even in the absence of weight loss. Healthcare professionals should be aware of weight stigma when discussing lifestyle management with women with PCOS.

When it comes to specific dietary interventions, the guidelines recommend that healthcare professionals and women should consider that there is no evidence to support any 1 type of diet composition over another for anthropometric, metabolic, hormonal, reproductive, or psychological outcomes.
Any diet composition consistent with population guidelines for healthy eating will have health benefits and, within this, healthcare professionals should advise sustainable healthy eating tailored to individual preferences and goals. The guidelines recommend that barriers and facilitators to optimise engagement and adherence to dietary change should be discussed, including psychological factors, physical limitations, socioeconomic and sociocultural factors, and personal motivators for change. The value of broader family engagement should be considered. Referral to suitably trained allied healthcare professionals needs to be considered when women with PCOS need support with optimising their diet.

https://doi.org/10.1210/clinem/dgad463

Here is an interesting study - ‘The effects of ketogenic diet on polycystic o***y syndrome: A systematic review and meta-analysis’ from Elisavet Arsenaki et al. This was a systematic search of five databases (inception-February 2025) identifying studies reporting outcomes in women with PCOS following a ketogenic diet. Meta-analyses compared pre- and post-ketogenic diet outcomes (primary analysis) and ketogenic diet versus other diets (secondary analysis). Fifteen studies were included in the review, of which ten met the criteria for inclusion in the meta-analysis. Most participants in the included studies had a body mass index BMI exceeding 25 kg/m2. In the primary analysis, ketogenic diet led to significant reductions in BMI (MD: -3.38 kg/m2, 95 % CI: 2.53 to 4.23, I2 = 0 %), weight (MD: -10.77 kg, 95 % CI: 8.73 to 12.81, I2 = 0 %), and waist circumference (MD: -8.93 cm, 95 % CI: 5.66 to 12.19; I2 = 44 %). In the secondary analysis, ketogenic diet showed superior effects on BMI (MD: -1.65, 95 % CI: -2.76 to -0.55, I2 = 0 %) and weight loss (MD: -4.98, 95 % CI: -9.05 to -0.91, I2 = 7 %) as well as LH levels (MD 1.68, 95 % CI: -3.18 to -0.19, I2 = 30 %) and insulin resistance (MD: -1.71, 95 % CI: -2.98 to -0.43, I2 = 90 %) compared to other diets, though results for androgen and lipid parameters were inconsistent. Heterogeneity was high for most of the studied outcomes.
The authors concluded that the ketogenic diet appears to be a promising dietary intervention for improving weight, insulin sensitivity, and reproductive hormone profiles in women with PCOS and a BMI exceeding 25. Nonetheless, the considerable heterogeneity among included studies and variations in study quality warrant cautious interpretation of these findings. Further high-quality, long-term randomised controlled trials are needed to more definitively establish the efficacy and safety of the ketogenic diet in women with PCOS.

Well done to Elisavet and team for their continued hard work in researching this important topic.

https://pubmed.ncbi.nlm.nih.gov/41483483/

09/02/2026

A powerful article in New Scientist by Deborah Cohen reminding us that we cannot deny that money shapes our health.

From pharmaceutical ads to research agendas, money has always been part of medicine. What’s new is the scale, speed and intimacy of it all. A wave of new players is nudging our everyday health choices, often stepping into the cracks left by overstretched healthcare systems. And as this is happening, our health is being commodified by a mash-up of tech, diagnostics and supplement brands.

As Deborah says - to combat this - we must stay evidence-based, safe and equitable while getting more responsive and grounded in lived experience.

https://www.newscientist.com/article/mg26935802-400-how-your-health-is-being-commodified-by-social-media/

04/02/2026

World Cancer Day is marked on 4th February to raise awareness of cancer and to encourage its prevention, detection, and treatment. There is increasing focus on long-term health and quality of life in cancer survivors. Effects of cancer treatment in women include fertility problems and hormone changes including menopause for many. The journey can be quite challenging for many. Early access to right information and support as well as proactive management of hormone changes can make a huge difference to quality of life and health.

This year, the theme of World Cancer Day —United by Unique — reminds us that while cancer is a global threat, each country, each community, and each person affected by cancer faces distinct realities. Effective responses must therefore be shaped collectively and implemented locally.

Menopause and Cancer are a not-for-profit organisation who support everyone affected by menopause after cancer. If you know someone who would benefit from the support they provide - please sign post them to their website. Please also support them by donating or sharing information about them.

https://menopauseandcancer.org

https://www.who.int/southeastasia/news/detail/04-02-2026-world-cancer-day

30/01/2026

There has been a drug safety update from
Medicines and Healthcare products Regulatory Agency (MHRA) for healthcare professionals - ‘Drug Safety Update: GLP-1 receptor agonists and dual GLP-1/GIP receptor agonists: strengthened warnings’.

The product information for all Glucagon-Like Peptide-1 (GLP-1) receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists (dulaglutide, exenatide, liraglutide, semaglutide and tirzepatide) has been further updated to highlight the potential risk of severe acute pancreatitis with these products, including rare reports of necrotising and fatal pancreatitis. Healthcare professionals should remain vigilant for signs and symptoms of acute pancreatitis in patients treated with GLP-1 and GLP-1/GIP receptor agonists.

In the UK between 2007 and October 2025, the MHRA has received 1,296 Yellow Card reports of pancreatitis (including acute, autoimmune, chronic, haemorrhagic, necrotising, subacute and obstructive forms of pancreatitis) associated with GLP-1 receptor agonists or dual GLP-1/GIP receptor agonists. Of these, 19 reports were fatal and 24 were reported as necrotising pancreatitis. For context, in the past 5 years, it is estimated that roughly 25.4 million packs of the GLP-1 receptor agonists have been dispensed.

Advice for Healthcare Professionals to Provide to Patients:
* pancreatitis (inflammation of the pancreas) is a possible side effect with GLP-1 receptor agonists and dual GLP-1/ GIP receptor agonists. In rare reports this can have serious or fatal outcomes
* seek urgent medical attention if you experience severe, persistent abdominal pain, that may radiate to your back and may be accompanied by nausea and vomiting, as this may be a sign of pancreatitis
* do not restart GLP-1 receptor agonist or GLP-1/GIP receptor agonist treatment if pancreatitis is confirmed
* report suspected side effects through the Yellow Card scheme.

https://www.gov.uk/drug-safety-update/glp-1-receptor-agonists-and-dual-glp-1-slash-gip-receptor-agonists-strengthened-warnings-on-acute-pancreatitis-including-necrotising-and-fatal-cases?utm_source=e-shot&utm_medium=email&utm_campaign=DSU+(January+2026)+-+GLP-1+receptor+Main+2&es_c=9F07D01E72E4AE738ACF58FA29868971&es_cl=CE8E48F88E252E1A07D4DB0D616D7ECD&es_id=y77£o2

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/

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

31/12/2025

Wishing everyone a very happy, healthy and productive new year!

27/12/2025

Some fascinating laboratory science here that may reveal novel targets and pathways for designing future clinical interventions that may change the outlook for age related changes to ovarian reserve, fertility and hormone activity.

The more you study about the human o***y - the more you realise what an amazing, incredible and dynamic endocrine organ it is! 🙌

Orchestrating myriad of functions and processes from head to toe of the female body - it produces an incredible variety of hormones, steroids and proteins including the largest cell in the human body - female egg cell (o**m).

But it’s not just the egg/o**m in isolation that is important - research is accumulating that it’s all the surrounding follicular cells, stromal cells, blood vessels and even the connective tissue matrix that seem to be key to ovarian function and reserve as age advances.

The more one learns and gets to know - the more one realises how little we really know.

https://www.nytimes.com/2025/12/27/health/eggs-ovaries-fertility-aging.html

18/12/2025

Perimenopause, menopause, POI and common women’s health conditions such as PCOS are being talked about more and there is greater awareness about health during mid-life and after. This is a wonderful development.

Menopause experiences vary and every individual has a right to non-biased scientific evidence based information and high quality clinical care/support as needed during this phase.

Unfortunately, despite progress in the recent years, we still have a long way to go as not everyone has universal access to such support and gaps/barriers remain due to geographical, financial, socio-cultural and health professional education related factors.

Patient support groups and charities play a vital role in getting closer to the goal of reaching everyone who need us and helping them by providing them with resources or signposting and also providing educational and scientific updates or research funds to relevant healthcare professionals. A big shoutout to four charities who worked flat out tirelessly this year to do exactly that. I was lucky to get involved with some of what they do.

Please support these charities or not for profit organisations by donating or sharing information about them with people who may need them or could support their work.

Menopause and Cancer
https://menopauseandcancer.org

Menopause Research and Education Fund
https://mref.uk

Menopause Support
https://menopausesupport.co.uk

Verity PCOS
https://www.verity-pcos.org.uk

10/12/2025

S*x Therapy London (STL) is a free and confidential online service for people who are experiencing s*xual difficulties and/or who want to make changes to their s*x life. STL contains a range of self-help information, advice and resources to help improve your s*x life. It also has interactive online programmes that are available to patients of CNWL S*xual Health Services.

STL has been developed by a team of experienced clinical psychologists, with input from specialist medical doctors, working in CNWL S*xual Health Services. The S*xual Problems Assessment and Treatment Service (SPATS) provides both medical and psychological assessment, advice and treatment for people experiencing s*xual difficulties.

STL is intended for use by people aged 16 or above living in England.
For more information about accessing the service or referrals, please visit -
https://www.s*xtherapylondon.nhs.uk/about-us

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