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

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

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

01/12/2025

A common question asked in fertility clinics is about safety of taking selective serotonin-reuptake inhibitors (SSRIs/anti-depressants) during pregnancy. What do current datasets say?

This article from The New England Journal of Medicine dives into the complexities of trying to answer this question based on observational and database studies. The findings described in the paper underscore how powerful confounding by indication and related factors can be in evaluations of the association between SSRIs and adverse pregnancy outcomes and make it clear that incomplete control for confounders has fueled decades of conflicting results.

The authors state that the current data from studies that explicitly address confounding by indication should reassure women and their families, clinicians, and regulators that treatment with SSRIs carries little or no risk for the most serious adverse outcomes. They believe the FDA must adhere to its commitment to evidence-based recommendations and communicate this conclusion and the nuanced evidence supporting it.

https://www.nejm.org/doi/full/10.1056/NEJMp2511434?query=obstetrics-gynecology

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

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 s*xual 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, s*xuality-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 s*xual 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

06/10/2025

It is the SAS week!
Join the British Medical Association (BMA) for a week-long celebration of SAS (specialist, associate specialist, and specialty) doctors. In partnership with NHS employers, SAS week is all about recognising and celebrating the incredible work and expertise of SAS doctors.
Each day, they will shine a spotlight on the vital contributions of SAS doctors to inform, inspire, and engage.

https://www.bma.org.uk/advice-and-support/career-progression/sas-development/sas-week

https://www.nhsemployers.org/articles/sas-week-2025

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.

Recurrent Miscarriage Clinic London

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