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

Recurrent Miscarriage Clinic London, 49 Marylebone High Street, High Street (2025)

07/11/2025

It takes an effort from so many to keep the clinics running and deliver a service that patients deserve. Forever grateful to the team - Helen Delves, Soga Matthew, Sharon Kelly, Jessica Sutcliffe and Maya Rahman (from 10 Harley street, London Medical and LUNA clinics) who work tirelessly to keep us all moving in the right direction! Many thanks to you all for your help and support over the years 🙏

05/11/2025

is the national fertility awareness week in the UK and it is marked to raise awareness, challenge perceptions and support causes related to fertility awareness and help.

The world health organisation estimates that about one in six people worldwide are affected by subfertility. Despite all the medical and social advancements across the world in the last few decades, far too often, people struggle in silence with fertility issues.

Subfertility and the need for fertility treatments are often shrouded in shame and taboo, leading to feelings of inadequacy and social isolation for many who experience them across the world.

We all need to continue to strive hard in our roles to provide adequate support, information/guidance and good quality evidence based yet compassionate fertility care (not driven by commercial interests) to people who need it.

Every November, the fertility community comes together to put the focus firmly on fertility.
Here is a link from fertilitynetworkuk.
https://fertilitynetworkuk.org/national-fertility-awareness-week/

15/10/2025

As the authors of this study highlight, promotion of non-evidence-based health interventions to women on social media is a growing problem.

This interesting study aims to explore the use of social media to disseminate and promote health interventions that lack robust evidence and are of current interest and popularity.

The study will involve content analysis of posts on TikTok, Instagram, and Facebook about 5 health interventions targeted at women using participatory research methods with consumers. English-language posts that discuss boric acid suppositories, fertility testing, perimenopause and menopause testing, supplements and hormone treatments for menopause, and menopause hormone therapy for disease prevention will be included. Using keyword searches related to each health intervention, consumers will screen the top posts until 100 eligible posts on 2 different social media platforms are identified (1000 posts total across the 5 health interventions). Data from the post's caption, on-screen text, and audio and/or video will be included in the analysis. The analysis of these posts will take both a deductive approach using a prespecified framework and an inductive approach, generating key themes from the post content.
The findings will be disseminated via publications in peer-reviewed international medical journals and presentations at national and international conferences in 2025 and 2026.

We need studies like these, and more individuals and institutions to call out marketing strategies for interventions which do not have sufficient scientific evidence in certain areas and may actually cause potential harm.
The results from studies will be essential for developing strategies to mitigate potential harm and plan solutions, thus protecting women from the low-value interventions marketed to them, becoming patients unnecessarily, and taking finite resources away from the health care system.

https://pubmed.ncbi.nlm.nih.gov/41087009/

10/10/2025

It was a busy day for teaching today.

First, the teaching session for the Royal National Orthopaedic Hospital Rheumatology/Metabolic bone teams - we discussed physiological changes during menopause transition and impact on bones, muscles, cartilage, joints and the overlap between menopause symptoms and many chronic conditions including rheumatological diagnoses. It was great to see the interest from the team in how HRT or other interventions for menopause could potentially help their patients.

Second, NCEL Regional Obstetrics and Gynaecology Teaching day organised by Miss Neerujah Balachandren and team from Reproductive Medicine Unit, UCLH. Ovulation induction should be the first line treatment option for anovulatory subfertility when ovarian reserve is not compromised and no sperm/tubal pathology exists. The art of ovulation induction should be preserved.

Thank you both teams for the teaching opportunities.

08/10/2025

Following on from yesterday’s post about the study from Galica et al., here is a study from Ragnhild Johanne Tveit Sekse et al. trying to understand the lived experiences of long-term cancer survivors and how they experienced cancer care.
This was a qualitative study based on 32 in-depth interviews with 16 women declared as long-term survivors, aged 39–66. The first interview was made 5 years after treatment and the second a year later. The study has a phenomenological–hermeneutical approach.
The long-term surviving women experienced profound changes in their lives and had to adapt to new ways of living.

Three core themes were identified: living with tension between personal growth and fear of recurrence:the women spoke of a deep gratitude for being alive and of basic values that had become revitalised. They also lived with a preparedness for recurrence of cancer. Living in a changed female body: the removal of reproductive organs raised questions about sexual life and difficulties related to menopause. Feeling left alone – not receiving enough information and guidance after treatment: the process of sorting things out, handling anxiety, bodily changes and menopause were described as a lonesome journey, existentially and psycho-socially.

The authors write that surviving cancer entails living with profound life-changes, demanding as well as enriching. Additional follow-up programmes, focusing solely on the individual woman and her specific needs, are necessary.

This is a powerful paper and a compelling argument for us to do more to support individuals in such situations. Currently, there continue to be gaps in post-active treatment cancer care pathways where women tend to fall somewhere in between the primary care and specialist hospital teams with little access to long-term follow-up and support for late effects of cancer. We need to do better.

Link to paper - https://onlinelibrary.wiley.com/doi/10.1111/j.1471-6712.2010.00778.x

If you know someone who is looking for information or support - https://menopauseandcancer.org

07/10/2025

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.

Galica et al. conducted a scoping review to develop a model useful to guide clinical discussions and/or interventions. English, full length, and accessible primary studies describing the needs of Gynaecological cancer survivors were included. No restrictions on date or country of publication were applied. Seventy-one studies met the inclusion criteria. Results were thematically grouped into seven dimensions: physical needs, sexuality-related concerns, altered self-image, psychological wellbeing, social support needs, supporting the return to work, and healthcare challenges and preferences.

Results of the study demonstrated the diverse needs of Gynaecological cancer survivors as they complete primary cancer treatment. The needs reported appeared to be dependent upon demographic and clinical characteristics (those who were younger and had more advanced disease had most needs, whereas those residing in rural or remote regions reported fewer needs) or treatment received (those receiving radiotherapy reported more sexual problems and those receiving chemotherapy reported lower quality of life). Very few clinical/post-treatment pathways currently address all these issues.

Link to paper - https://www.sciencedirect.com/science/article/pii/S0738399121007667

Access to non-biased information about help and support available as well as interventions which can help - lifestyle, alternative therapies, non-hormonal treatments and hormones is key for these women. No ‘one approach fits all’. Decisions about treatments can be difficult. Careful consideration of benefits versus risks of each approach and shared decision making between the woman and her health professional are important.

If you know someone who is looking for information or support - https://menopauseandcancer.org

04/10/2025

Thank you Stuart McGunnigle and team from The Red Cell Network for inviting me to talk and be part of the Thalassaemia Family Fun Day today at The Royal College of Physicians in London. It was amazing to hear thalassaemia patient stories and experiences and learn about how they would like us provide to them with the care and support they deserve. The panel discussion was full of learning (Dr Emma Drasar, Chris Dean, Remis Osman, Neelam Thapar and Haifa Ungapen).
It was so wonderful to interact with patients and families with little ones in person - teaches you so much about strength and resilience!
We need much more awareness, education and research into impact of thalassaemia on hormones, fertility and menopause.

10/09/2025

Are you a UK healthcare professional who supports people living with Polycystic Ovary Syndrome (PCOS)? We'd love your help to create a short list of questions for future research to focus on 🙏.

A team from Cardiff University and Verity (PCOS UK) are working in collaboration with the James Lind Alliance to identify the priorities for future research.

After consulting with the community of people living with PCOS in the UK, their loved ones and families, and the healthcare professionals who work along side them, they have a long list of questions for future research to consider.

Now they want to create a shortlist that will be taken to a workshop being help on October 17th, 2025. There, a group of people living with PCOS, their loved ones and families, and the healthcare professionals who work along side them, will participate in a series of discussions to reach a consensus on the Top 10 research priorities for PCOS in the UK.

To help them identify the shortlist, please let them know (by September 14th, 2025) which questions from the longlist YOU think are most important.

Don’t miss out on the opportunity to have your say. Take the survey here: www.verity-pcos.org.uk/jlapcos
⏱ Estimated time: 10 minutes

28/07/2025

Metformin, an oral antihyperglycemic drug, acts as an insulin sensitiser and is used in certain clinical situations related to polycystic ovary syndrome (PCOS) and gestational diabetes mellitus. Although many studies and randomised clinical trials have not been able to clearly establish its superiority over alternative treatments for PCOS, metformin continues to be a useful and effective treatment option in specific subgroups of women either alone or as an adjunct with other therapies in management of PCOS.

It will be nearly 10 years since we wrote a narrative review on the role of metformin in management of clinical conditions related to women’s health. It still appears relevant and in my opinion, metformin remains underutilised in clinical settings related to PCOS.
What are the practical uses of metformin in the clinic? It appears to be a useful medical option which often improves regularity of menstrual bleeds and ovulations in women with PCOS (especially high BMI and wishing to conceive). Metformin also forms one of the management options in women who need anti-androgen therapy without the need for contraception at the same time (mild effect though). Women with PCOS undergoing in vitro fertilisation are likely to benefit from metformin therapy to reduce their risk of ovarian hyperstimulation syndrome. Metformin alone or in combination with insulin has been reported to have similar safety and efficacy to insulin for the treatment of GDM. There is ongoing research whether long-term metformin may be associated with a decreased risk of developing cancers like endometrial cancer in certain groups of patients but we need to wait for data to emerge.
https://journals.lww.com/obgynsurvey/abstract/2016/05000/role_of_metformin_in_women_s_health__review_of_its.20.aspx

What about metformin and risk of miscarriage in women with PCOS?
Here is a useful recent systematic review and meta-analysis from Cheshire et al. which explored the effects of preconception and first-trimester metformin use on pregnancy outcomes in women PCOS.
A total of 12 trustworthy studies (involving 1708 women) were included in the meta-analysis, all of which were graded low to moderate quality. Women who received preconception metformin that was continued throughout the first trimester of pregnancy showed higher clinical pregnancy rates (odds ratio, 1.57 [95% confidence interval, 1.11–2.23]), a possible reduction in miscarriage (odds ratio, 0.64 [95% confidence interval, 0.32–1.25]), and possible increase in live birth (odds ratio, 1.24 [95% confidence interval, 0.59–2.61]) than women who received either a placebo or no treatment.
Women who stopped metformin once pregnant not only had an increase in clinical pregnancy rate (odds ratio, 1.35 [95% confidence interval, 1.01–1.80]) but also had an indication of an increase in miscarriage rate (odds ratio, 1.46 [95% confidence interval, 0.73–2.90]) compared with those who received a placebo or no treatment.

The strengths of this review included the inclusion of RCTs, several of which were multi-centre. The main limitation of this review was the heterogeneous nature of the population studied and overall low quality of evidence with some results not reaching statistical certainty.
The authors concluded that continuing metformin treatment throughout the first trimester of pregnancy may reduce the risk of miscarriage and increase live birth rates in women with PCOS and highlighted the need for further high-quality research.
https://www.ajog.org/article/S0002-9378(25)00365-5/fulltext

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