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

Premature Menopause Clinic London, 10 Harley Street, London (2025)

07/12/2025

Here is an interesting study from Siitonen et al. who assessed the impact of vaginal oestradiol (VE) on the risk of re**al cancer (RC). This was a nationwide case-control study of primary re**al cancer cases with five age-matched control cases in 1994–2019 from a dataset of 1.1 million Finnish postmenopausal women. Users of systemic hormone replacement therapy were excluded. Users of vaginal oestradiol (10–25 μg twice a week) were traced from 1994–2013.
Odds ratios with 95 % confidence intervals were calculated for re**al cancer risk with adjusted logistic regression models separately for vaginal oestradiol users in 1994–2013 and for the whole study period of 1994–2019 (2853 cases, 13865 controls).

Results
During follow-up, 494 re**al cancer patients (17 %) and 2826 controls (20 %) used vaginal oestradiol (p < 0.001). Users were diagnosed with re**al cancer on average nine years later than non-users (73.9 vs 65.1 years, p < 0.001). Use for ≥3 years was associated with a reduced risk of re**al cancer (OR 0.79, 95 % CI 0.63–0.97) in the 1994–2013 cohort. In the extended 1994–2019 follow-up, risk reductions were similar (0.79, 0.68–0.92), appeared already with less than 3 years' use (0.85, 0.74–0.97), and persisted for up to 5 years after cessation of vaginal oestradiol (0.80, 0.71–0.91).

The authors concluded that vaginal oestradiol use may be associated with a reduced risk of re**al cancer - perhaps due to oestradiol infiltration into the re**al mucosa. This possible protecting effect could be an important additional health benefit of vaginal oestradiol.
Vaginal estradiol use was associated with 12 to 23 % reductions in RC risk.

The study has its strengths and limitations. Strengths - large numbers, five comparative control women for each case, data were collected from government-controlled registries, exclusion of all women with systemic hormonal use and follow up for a long period of 25 years.
Limitations - not able to control several confounders such as diet, smoking, family history, and obesity (authors emphasise that Finnish patients with colore**al cancer do not differ from the background population concerning the socioeconomic factors) and potential bias of generally healthier lifestyle in VE users. The authors also could not address the use of biologically weaker oestrogens, such as oestriol and most of VE exposures consisted of 25 μg vaginal tablets, and therefore, data should be applied with caution to women using 10 μg VE tablets.

These data certainly have future research (randomised controlled trials) and clinical implications. Vaginal oestrogens have a large number of genitourinary benefits with minimal to no risks and any added benefits such as above would be an important part of counselling and consideration about this treatment.

https://www.sciencedirect.com/science/article/pii/S0378512225006103

05/12/2025

It was wonderful to see three of our research posters presented at the EGA Institute for Women’s Health ‘20th’ Annual Conference today at the Senate House, University of London.

Amazing work from Telma Martins Viveiros and Riya Philip on their systematic review and survey projects (on Spironolactone for Treatment of Hyperandrogenic Symptoms of Polycystic O***y Syndrome and Menopause in Medical Education). We found that current evidence does not show any significant differences in symptoms with the use of low dose 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 in PCOS management.

The majority of medical students in our small survey felt that they needed more education on menopause. These results indicate a need for bigger studies looking into student’s and healthcare professional’s views on current teaching about menopause and a review of medical school curricula.

We also submitted a poster on the results of the big Menopause and Cancer survey conducted by Dani Binnington and team from the Menopause and Cancer CIC earlier this year. A strong call to action for better information, support and clinical care for cancer survivors. We must continue campaigning until change happens.

Over 1200 women participated in the survey over a period of 12 weeks making it one of the biggest surveys focussing on this topic. 3 out of 4 women did not receive adequate information about menopause resulting from cancer treatment as part of their pre-treatment discussions with the healthcare team. 9 out of 10 participants said that menopause related symptoms which followed cancer treatment, had a significant impact on their quality of life. More than 3 out of 4 women felt that they did not receive adequate support from their healthcare professionals for menopause resulting from cancer treatment. 3 out of 4 women felt that their healthcare professionals team did not have up-to-date knowledge of menopause management. There is certainly more that needs to be done in this space to support individuals better.

Thank you team UCL EGA Institute for Women’s Health for this opportunity 🙏.

04/12/2025

It’s time for yet another meeting! We started these short webinars during the COVID pandemic and it will be 6 years next March!

Join us in the evening today for a free webinar on - ‘Gynaecological cancers and hormones’.

Thank you Roger Prentis and Katie Day at Midlife Matters for this opportunity as always.

To join us - search for Midlife Matters Menopause Meetings on tickettailor.com website or click
https://www.tickettailor.com/events/rdpi/1033447

03/12/2025

It was lovely to do a teaching session at Arachne Greek Cypriot Women's Group on Monday on the topic of menopause and HRT.

Attendees shared their experiences of perimenopause and menopause and some of the challenges they had encountered getting right help, information and support. We had a discussion about all things lifestyle and medical interventions that could help.

It is in sessions like these in the community is where I feel we make the most difference.

A big thanks to Maria Gonzalez at Healthwatch and Dr Charlotte Phillips, Women's Health Hub lead, Islington and Haringey for putting these sessions together.

02/12/2025

Thank you for the opportunity, Dee diaryofakidneywarrior. I hope the podcast will be useful to many with CKD and menopause. Watch or listen on YouTube, Apple or Spotify.

30/11/2025

We invite you to complete or share this survey with friends and colleagues from Cyprus.

MITRA, in partnership with Dr Vikram Sinai Talaulikar is conducting the MENOWISE-CY: Study of Knowledge & Attitudes Towards Menopause Among Women in Cyprus Above the Age of 35.

Why does this matter?
-To inform health education & research
-To help shape better healthcare policies for women
-To create a future where every woman feels supported during menopause

📊 It’s a quick 8-minute survey in Greek, Turkish & English, approved by the Cyprus National Bioethics Committee.

👉 Take the survey here - https://docs.google.com/forms/d/e/1FAIpQLScOtDYisKoRwmLOAPMkndE3EjXfPBVAdy08xRbtvGziH37xeA/viewform.

We need your help!
💡 Share this far & wide; tag friends, sisters, mums & colleagues.
🏢 Workplaces: Share via Teams, Slack, Skype, or email lists.
📣 Employers & organizations: Support by sharing it internally & on social media.

We want to make sure every woman in Cyprus has the chance to participate! Thank you 🙏

29/11/2025

This week was full of teaching and learning.

A big thanks to Exeltis and Mediconf for the webinar on Menopause, Cardiovascular health and HRT. The key message is that nothing replaces healthy lifestyle for prevention of cardiovascular (CVS) disease. HRT started within 10 years of onset of menopause has some CVS benefits but largely neutral effect after that.

Thank you Mr Bassel Wattar for the second South London Menopause meeting. It was great to catch up with colleagues, talk about ‘autoimmunity and menopause’ and listen to amazing talks on GLP-1 agents and new hormone therapies on the horizon. Key message here - ovarian activity can fluctuate with immune causes.

Thank you Menopause and Cancer charity for all the incredible hard work that went into putting together the ‘Menopause care after Gynaecological cancer’ course for healthcare professionals. We discussed various cases and scenarios and emphasised the need for better and individualised post-cancer care. Thank you Dani Binnington and Phoebe Cardew for everything.

Next, it was the live patient webinar for National Rheumatoid Arthritis Society - we discussed complex interplay and overlap of hormones, immunity and symptoms and the role of adequately addressing menopause symptoms alongside rheumatological care. Thank you so much Tracy Dias and Donagh Stenson.

Finally, we held our 6th Menopause Research and Education Fund teaching course for HCPs with attendees mostly from the UK but also from Italy, Belgium, The Netherlands, Singapore, Canada, Malta, Portugal, Ireland and Australia. Amazing hard work behind the scenes from Fiona Clark and Diane Danzebrink. So far, we have trained over 1200 healthcare and allied healthcare professionals.

Together, we will continue to strive hard to spread the message of evidence based menopause healthcare and more patient involvement in treatment decision making.

I am grateful to all the organisers for the opportunities I have had. A big thank you to all the amazing co-speakers on these events from whom I keep learning new things almost every day 🙏.

25/11/2025

Please participate in or share/support this research from Laura Naysmith from King’s College London - a study about POI and the brain 🧠

Using online cognitive tasks ("Cognitron"), this study will examine POI symptoms and cognitive ability. For example, do specific symptoms impact certain cognitive abilities? How do symptoms cluster/occur together, and does this burden affect cognitive performance? Are cognitive symptoms (like brain fog) associated with measurable cognitive change? In addition, it will assess if factors like hormone therapy, age of diagnosis, or POI type influence different aspects of cognition.

This research is funded by the Early Career Research Award from the Institute of Psychiatry, Psychology & Neuroscience.

For more information- pm_cog@kcl.ac.uk

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

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