Menopause Clinic London

Thank you Shahara Aziz Ellahi, Jessica Wibisono, and Prof Aimee Spector for this important piece of work.
British South Asian women’s menopause experiences are shaped by intersecting cultural, relational, and healthcare factors. Improving culturally sensitive communication, menopause literacy, and inclusive, community-based support may help reduce inequities in menopause care and enhance engagement with services.

Link https://journals.sagepub.com/doi/10.1177/17455057261478338

Thank you, SunHee Park and Fiona Clark from the Menopause Research and Education Fund for the opportunity to talk to so many at the Simmons & Simmons offices at Citypoint in London. Lots of engagement, networking and questions at the end. Thank you Colette Harris for your support as always.

We discussed menopause experiences in East Asian women and the need for better symptom recognition, lifestyle modifications, access to clinical care and research into menopause and long-term health in specific populations. We also talked about the latest research from Professor Aimee Spector into cognition and menopause.

https://mref.uk/our-projects/

An interesting article from Amy McDermott for those with an interest in the evolutionary aspects of natural menopause.

It discusses the theories suggested so far and that perhaps menopause could even have multiple independent evolutionary origins at different time points over millions of years.

Which species experience menopause?
There are few animal species which experience menopause including humans, short-finned pilot whales, killer whales, belugas, narwhals and giraffes.

There is still plenty of research that is needed to understand the physiology and evolutionary mechanisms behind menopause.

https://www.pnas.org/doi/10.1073/pnas.2625473123

Thank you so much to everyone who has responded to our survey so far 🙏🏻.

A quick reminder about this survey from Menopause and Cancer CIC (not-for-profit) designed to gather insights from individuals (age 18-30) who have experienced both menopause and cancer with the aim to better understand the unique challenges faced by this community and to use these findings to enhance the support available for those affected.

All responses are completely anonymous. You must be aged 18-30 years old to take part in this survey. 
Please participate in the survey if you can or share with those who may be interested. Thank you for contributing to this research 🙏🏼.

Click to fill in or scan the QR code -
https://forms.cloud.microsoft/Pages/ResponsePage.aspx?id=8y1ywoOIqkup1ZOI4kKt2B5ITslOQvhElyTxa010jzlUNUgxWjYxOUtOU1NER0hJNEdDQzZEQ0dJTSQlQCN0PWcu

Here is a study published yesterday from Yohana M Kim and colleagues from the United States adding to the existing and fast evolving clinical evidence about effects of oestrogen on cognition in later life and the possible impact of hormone replacement therapy (HRT) on risk of cognitive problems.

Limbic-predominant age-related transactive response DNA-binding protein 43 (TDP-43) encephalopathy neuropathological change (LATE-NC) is a cause of dementia resembling Alzheimer’s disease (AD). The 90+ Study found women using hormone replacement therapy (HRT) two to three decades before death had lower odds of LATE-NC. The researchers attempted to replicate this finding in a different cohort.

Participants (n = 2056) included males (n = 640) and females (n = 1416) aged ≥65 and researchers examined the association between HRT and LATE-NC in males and females and between HRT-related and reproductive variables in relation to LATE-NC in females.

What was found?
HRT use within 5 years before or after menopause (odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.50 to 0.98, p = 0.03) or for 8 to 16 years (OR = 0.44, 95% CI = 0.24 to 0.79, p = 0.006) was associated with lower odds of LATE-NC. The authors concluded that this finding identifies a potential factor related to LATE risk and highlights the importance of HRT timing and duration for its possible potential neuroprotective effects.

The study strengths include good sample size, extensive demographic and clinical data including comorbidities and medications, and longitudinal nature of the data. But it also has several limitations which impact findings considerably - lack of data on type of HRT, possibility of recall bias due to use of self-reported information as one of its data sources, limited generalisability of the study due to nature of study cohort, body mass index/physical activity/environmental exposures/heart disease/nutritional factors not evaluated in the study and lack of ethnic diversity.

https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.71730

So, now we will have one more option to prescribe transdermal oestradiol gel to our patients.

We had the Sandrena (daily sachets of 0.5 mg or 1 mg strengths) and the Oestrogel (750 micrograms/actuation) and now it will be the Evorel gel (500 micrograms/actuation) that will be the new additional option.

1 g of Evorel gel contains 1.0325 mg of oestradiol hemihydrate, corresponding to 1.0000 mg of anhydrous oestradiol. Each metered dose delivers 0.5 g of gel, i.e. 0.5 mg of oestradiol (as 0.516 mg of oestradiol hemihydrate). Dose range - 1-6 pumps. The area of application should be at least 2 times the size of the hand. It is not necessary to rub Evorel Gel in, however, it should be allowed to dry for 2 minutes before covering the skin with clothing.

https://www.medicines.org.uk/emc/product/101998/smpc

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