Menopause Clinic London

This recent large study by Vicente Arrarte and team analysed the association between premature (

The National Institute for Health and Care Excellence in the UK has published its updated guidance on ‘Osteoporosis: risk assessment’ last week.
Healthcare professionals use a combination of medical history, risk factors, fracture risk tools, and a bone density (DEXA) scan assessment (as needed) to understand someone’s bone health and advise on prevention or treatment of osteoporosis.
The updated guidance aims to make osteoporosis risk assessment more consistent and help with early identification of people at highest risk so that they can be offered the right care sooner.

There are several factors in medical history that are associated with increase risk of fragility factors. Two important ones to consider in the menopause clinic - history of premature or early menopause before 45 and long-term use of medicines associated with increased fracture risk (for example, glucocorticoids, anticonvulsants, selective serotonin reuptake inhibitors, thiazolidinediones, proton pump inhibitors and antiretroviral medicines).
https://www.nice.org.uk/guidance/ng259/chapter/Fragility-fracture-risk-assessment

There are plenty of useful resources on the Royal Osteoporosis Society website – the UK’s largest national charity dedicated to improving bone health and beating osteoporosis. It’s their 40th anniversary this year!
https://theros.org.uk

It’s time for yet another webinar!

Join us in the evening on coming Thursday 6th August at 6:30 pm for a free webinar on - ‘Genitourinary Health in Menopause’.

There have been several new publications in this area and updates about the use of vaginal oestrogen in bread cancer survivors.
Everyone and all questions welcome!

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

Thank you Payam Amini and team at the ‘Arthritis UK Research Consortium: Musculoskeletal Epidemiology’ for publishing this study protocol.
There is increasing interest and focus on musculoskeletal manifestations of the menopause and the need for good quality robust research has never been greater.

This will be a closed cohort study with nested repeat cross-sectional analyses using English national primary care electronic health records from the Clinical Practice Research Datalink Aurum, 2015–2024 in women aged 35–60 years. The study will provide national primary care estimates of menopause-related musculoskeletal burden and associated healthcare utilisation. Findings will inform clinical recognition, management strategies, and evaluation of potential inequalities in care.
https://bjgpopen.org/content/early/2026/06/30/BJGPO.2026.0106.long

Please join us at the world’s first Global Menopause and Cancer Conference on the 18th of September. 
 
This isn’t a traditional conference. 
 
It’s an opportunity for healthcare professionals from around the world to come together to discuss the questions that don’t yet have perfect answers, explore emerging evidence and help shape the future of menopause after cancer care. 

The program for the day will cover complex clinical case scenarios, patient perspectives, emerging therapies and their implications and establishing best practice in the area of menopause after cancer.

We would love you to join us in London or online. 
 
Register here: https://menopauseandcancer.org/menopause-and-cancer-conference/ 
 

It is good to see research teams producing valuable clinical evidence about use of vaginal oestrogen post-breast cancer treatment especially in breast cancer survivors receiving aromatase inhibitor (AI) therapy.

In a recent randomised, controlled, open-label clinical trial by Polly Niravath et al., ER+ breast cancer survivors receiving adjuvant AI therapy with symptomatic GSM were randomised to receive 24 weeks of a non-hormonal vaginal moisturiser or vaginal oestrogen therapy. The primary endpoint was change in vaginal dryness. Secondary endpoints included dyspareunia, s*xual functioning, vaginal pH, and serum estradiol values.

Twenty-three patients were enrolled. Vaginal pH decreased significantly with vaginal oestrogen compared to non-hormonal therapy (p = 0.0286). Other domains of s*xual function (libido, ability to achieve or**sm, s*xual satisfaction, and relationship with partner) were not significantly different between the 2 groups. Serum oestradiol levels remained low through the first 12 weeks of therapy. Two participants demonstrated estradiol elevations above threshold at 24 weeks (21.8 pg/mL and 16 pg/mL); both reported non-adherence to AI therapy preceding measurement.

In this randomised study, vaginal oestrogen provided greater improvement in vaginal dryness and dyspareunia than non-hormonal therapy in breast cancer survivors. These findings provide prospective evidence supporting symptomatic benefit with minimal systemic oestrogen exposure in most patients.

This study has limitations - small sample size and short follow up time. Nevertheless, the findings suggest that low-dose vaginal estrogen can meaningfully improve genitourinary symptoms while producing minimal systemic oestrogen exposure and supporting long-term adherence to aromatase inhibitor therapy in most patients receiving this treatment.
https://pubmed.ncbi.nlm.nih.gov/42530772/. Data like these are reassuring and are useful when counselling about benefits versus risks of vaginal oestrogen use in breast cancer survivors.

There is a significant symptom overlap between long COVID (LC) and perimenopause/menopause.

Our experience in the clinic has been that dissecting out which symptoms belong to one or the other and working out a holistic management plan can be tricky at times and often needs multidisciplinary team input utilising several lifestyle, non-hormonal and hormonal interventions.

A phase 3, cluster-randomised, multicenter clinical trial investigated the effectiveness of integrated care pathways (ICPs) interventions for LC. In this largest interventional LC trial to date, the researchers reported an overall decrease in reported fatigue with specialist LC care.
https://www.nature.com/articles/s41591-026-04552-x

More about symptoms Long COVID symptoms and overlap-
https://www.nhs.uk/conditions/long-covid/

Another useful resource about COVID and menopause -https://www.rcn.org.uk/-/media/Royal-College-Of-Nursing/Documents/Publications/2026/January/012-346.pdf

Join us on this event for an in-depth exploration of how exercise, physical activity and rehabilitation can transform outcomes for people living with musculoskeletal and chronic diseases.

The event will examine the growing evidence and clinical importance of movement, exercise and rehabilitation across rheumatology, chronic musculoskeletal disease, and sports and exercise medicine (SEM).

It aims to equip attendees with practical clinical strategies for integrating rehabilitation and exercise principles into patient care to improve function, outcomes, and quality of life and to develop confidence in applying interdisciplinary approaches from sports and exercise medicine, rehabilitation, and rheumatology within clinical practice.

We will be discussing - ‘Menopause, HRT and its implications for musculoskeletal health and rheumatology’.

Thank you Su-Ann Yeoh and team 🙏🏼 at the Rheumatology and Rehabilitation Section for the invitation to speak.

https://www.rsm.ac.uk/events/rheumatology-and-rehabilitation/2025-26/rru02/

We often have to offer the best practice evidence-based advice on nutrition and exercise to women in menopause clinics. It becomes even more important to know ‘what the current science says’ when advising women pursuing competitive professional sports. What should be our advice?

Here is a well balanced informative editorial from Kristina Fagher and team which points to the lack of good quality evidence to guide exercise for health and performance in this population.

The authors summarise the current knowledge in relation to hormone changes at menopause, various forms of exercise and their impact on performance, bones, muscles and heart while also discussing the various actions of oestrogen in the body as well as the role of HRT and testosterone replacement and the anti-doping regulations.

They call for a multidisciplinary approach to improve understanding of menopause and to screen for and optimise training load, musculoskeletal health, pelvic floor health, cardiovascular health, gynaecological health and mental health.

Article link -
https://bjsm.bmj.com/content/early/2026/07/27/bjsports-2026-111836

A comprehensive and thought provoking piece of work from Abigail Shore and team on Granulosa cell tumors and menopausal hormone replacement therapy (HRT) especially in women with premature menopause.

Adult granulosa cell tumors (GCT) are rare s*x cord stromal tumours of the o***y. Although GCT have a favorable prognosis compared to other ovarian tumours, recurrences typically occur later; usually between 4–8 years after initial diagnosis. GCT are hormonally active tumours, with many secreting oestrogen. Progesterone and oestrogen receptors are often expressed in these tumors.

In GCT patients, most guidelines caution against HRT use, due to perceived risk associated with the hormonally and endocrinologically active nature of these tumors.

This narrative review outlines the hormonal nature of GCT and summarises the evidence (including current British and European society guidelines) relating to possible safety and risk of HRT use in GCT patients. The authors argue that there is no direct evidence suggesting that HRT is safe or unsafe for GCT patients.

Despite this lack of evidence, almost all current recommendations warn against HRT use in these patients. While health and quality of life benefits associated with HRT use in individuals experiencing premature menopause cannot be discounted, it is important to acknowledge that there are also real potential harms associated with HRT, especially given the proliferative effects through ERα and ERβ activation. Overall, there is a paucity of evidence surrounding HRT and GCT, and although these tumors are rare, there are women who could greatly benefit from HRT if it was shown to be safe.

Individualisation of clinical treatments and shared decision making are key parts of clinical care for these tumours.
A big thank you to the authors for all the work in this review 🙏🏼
Article link -
https://pmc.ncbi.nlm.nih.gov/articles/PMC13254716/

Menopause and Cancer CIC offer a wide range of free, practical support services and resources to women who are looking for support for menopause after cancer. Here is a link for signposting -
https://menopauseandcancer.org/support-for-you/