34th Annual Scientific Conference,Chesford Grange,Kenilworth

¹UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland, donal.brennan@ucd.ie

²Liverpool Women’s Hospital, Liverpool, UK

³Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation and ABC Global Alliance, Lisbon, Portugal

⁴Department of Clinical Research for Women, Femicare VZW, Tienen, Belgium and Department of Obstetrics and Gynecology, University Hospital, University of Antwerp, Antwerp, Belgium

⁵Queen Charlotte’s & Chelsea Hospital, Imperial College London, UK

⁶Bayer plc, Reading, UK

⁷Bayer CC AG, Basel, Switzerland

⁸Bayer AG, Berlin, Germany

⁹Bayer Oy, Espoo, Finland

¹⁰Syneos Health LLC (providing service to Bayer), Morrisville, NC, USA

Objective: OASIS 4 is a 52-week, phase 3 trial in Europe and Canada evaluating elinzanetant, a dual neurokinin-targeted therapy, in women taking adjuvant endocrine therapy (AET) for treatment or prevention of hormone receptor positive (HR+) breast cancer. We present UK data through week 12, the placebo-controlled phase.

Methods: Women aged 18–70 years receiving AET for HR+ breast cancer treatment (no UK women were recruited for prevention) experiencing ≥35 moderate-to-severe VMS/week associated with AET, were randomized 2:1 to once-daily elinzanetant 120 mg for 52 weeks or placebo for 12 weeks followed by elinzanetant for 40 weeks. Primary endpoints were mean change in VMS frequency from baseline to weeks 4 and 12. Key secondary endpoints, tested hierarchically, were mean change from baseline to week 12 in Patient-Reported Outcomes Measurement Information System Sleep Disturbance short form (PROMIS SD SF) 8b total T-score and Menopause-specific quality of life questionnaire (MENQOL) total score. Additional secondary endpoints included mean change in VMS severity at weeks 4 and 12. Treatment-emergent adverse events (TEAEs) were monitored throughout.

Results: Twenty-one women were randomized to elinzanetant and 15 to placebo. Mean (SD) change from baseline in daily moderate-to-severe VMS frequency was -6.15 (4.17) for elinzanetant and -2.02 (2.58) for placebo at week 4, and -6.30 (4.81) and -1.78 (2.43) at week 12. Mean (SD) VMS severity reductions were -0.87 (0.47) and -0.44 (0.35) at week 4, and -0.84 (0.65) and -0.40 (0.36) at week 12 for elinzanetant and placebo, respectively. By week 12, mean (SD) PROMIS SD SF 8b total T-score reductions were -10.60 (8.59) with elinzanetant and -1.05 (4.43) with placebo; mean (SD) MENQOL total score reductions were -1.01 (1.13) and -0.37 (0.93), respectively. Greater score reductions reflect greater improvements in sleep/menopause-related quality of life (QOL). Through week 12, TEAEs occurred in 18 (85.7%) elinzanetant and 14 (93.3%) placebo participants; most common were headache, somnolence, and fatigue. No serious TEAEs were reported.

Conclusion: In UK women taking AET for HR+ breast cancer, elinzanetant demonstrated a favourable efficacy and safety profile, consistent with all OASIS trials. Elinzanetant reduced VMS frequency and severity, and improved sleep disturbances and menopause-related QOL.

Funding: Bayer.

¹SAS doctor and Menopause Specialist, Sexual and Reproductive Healthcare, Northern Health and Social Care Trust, jayne.creighton@northerntrust.hscni.net

²Clinical Lead Sexual and Reproductive Healthcare, Northern Health and Social Care Trust

³Consultant Obstetrician and Gynaecologist, Northern Health and Social Care Trust

Objective: There has been a substantial increase in referrals to the specialist menopause clinic within our Trust with resultant impact on waiting lists. Our objective was to reduce waiting times for our menopause clinic through a validation process of our waiting list and to implement a new digitalised electronic process for triaging of referrals improving GP access to specialist advice at the time of referral.

Method: A joint initiative between Gynaecology and Sexual and Reproductive Healthcare took place to validate all current patients on our waiting list from January to August 2024. Patients were allocated to one of three outcomes following review of their records and referral, to remain waiting list active, discharged back to GP with a letter of advice or to expedite/redirect the referral to a more appropriate service. We implemented a new electronic triaging system for GP referrals going forward placing focus on advice at the time of referral using Epic.

Results: 471 patients were validated – 338 (71.7%) discharged to their GP with advice, 16 (3.3%) upgraded to urgent or re-directed to general Gynaecology clinic, 117 patients remained waiting list active (24.8%). 19 patients (4%) were subsequently re-instated onto waiting list at the patient or GP’s request. Reasons for referral showed family history of breast cancer and VTE queries to be commonest (40%). Waiting times at the outset of the validation process were 159 weeks, following validation this was reduced to 13 weeks for routine and 1.5 weeks for urgent. Feedback sought from GP’s and patients has been positive.

Conclusion: This proved to be a very worthwhile and successful project with a resultant 91% reduction in waiting times alongside introduction of an efficient electronic triaging and advice system which has improved access for GP’s to specialist advice and helped to avoid unnecessary delays in initiation of treatment. It has ensured that patients in most need of being seen can be done so in a more timely manner.

¹Foundation Doctor, Shrewsbury and Telford Hospitals, k.meunier@nhs.net

²Obstetrics and Gynaecology Registrar, Shrewsbury and Telford Hospitals

Objective: Hormone replacement therapy (HRT) is often withheld before elective surgery due to perceived venous thromboembolism (VTE) risk. NICE guidelines recognise HRT as a VTE risk factor but do not specify the type, leading to ambiguity especially regarding oral, transdermal, and vaginal HRT. While estrogen-containing HRT is recommended to be stopped 4 weeks before surgery, transdermal and vaginal estrogen can be continued perioperatively. This study assessed doctors' knowledge of preoperative VTE assessment and HRT management across different training levels to determine if additional guidance is needed.

Method: Using a standardized VTE risk proforma, trainees from obstetrics & gynaecology (O&G), general practice (GP), and foundation year doctors completed three fictional patient scenarios involving different HRT preparations. Results were analysed by the audit department.

Results: Results (n = 144 responses) revealed variability across clinician groups.

Case 1 (transdermal HRT): O&G trainees correctly identified VTE risk (100%) but 84% recommended surgery continuation and 10% advised HRT omission. No GP trainees recommended omitting HRT, while 18% of foundation trainees did.

Case 2 (oral HRT): 77.8% of O&G trainees identified high VTE risk, with 66.7% recommending prophylaxis and 50% advising surgery continuation. Only 50% of GP trainees recognised the VTE risk, while 69.2% of foundation trainees allowed surgery despite identifying VTE risk.

Case 3 (vaginal estrogen): O&G and GP trainees identified VTE risk (100%) but only 75% and 85.7%, respectively, recommended surgery continuation. Foundation trainees advised omitting HRT in 12% of cases, with 80% recommending surgery continuation.

Conclusions: Significant knowledge gaps exist in assessing VTE risk related to different HRT preparations. Many doctors failed to recognise the VTE risk with oral HRT and the need for postoperative prophylaxis, increasing VTE event risk. Some trainees mistakenly advised omitting transdermal/vaginal HRT or cancelling surgery, leading to unnecessary delays.

¹GP with Women’s Health interest, Surrey, radhika.vohra@nhs.net

²Senior Surgical Care Practitioner, University Hospitals of Northamptonshire, Northampton

Objective: Given the plethora of evidence supporting replacing hormones using HRT (Hormone Replacement Therapy) as a first line pharmacological intervention for osteopenia and osteoporosis¹ it is important to understand whether this is offered to women in the UK as a treatment for failing bone health, especially with an ageing population and the increasing burden of bone disease in health economy. Moreover, we have recommendations to improve practice.

Methods: A Freedom of Information request was made to the Royal College of Physician’s Fracture Liaison Services (FLS) in England, Wales and Northern Ireland, requesting data (below) for all women who were seen with a fragility fracture (FF) between the years 2017–2023:

• Number of fractures 2017–2023

Results: A total of 356,229 women were referred to a FLS over the 7-year period. 71,449 (20%) sustained a hip fracture, 30,629 (9%) a spinal fracture, and 254,141 (71%) sustained ‘other’ fractures, with 19,065 (5%) sustaining multiple fractures.

There were 851 (0.2%) women taking HRT pre fracture, and only 169 (0.05%) were given HRT post fracture, despite many being of post-menopausal age. Findings show FLSs are not available in all areas due to lack of funding meaning that the number of women suffering fragility fractures are a significant underestimation.

Recommendations: These steps could help bone health:

• FLS funding needs investment and availability in all areas so accurate data can be collected and actioned.

Reference

1. Stevenson, J (2022) The British Menopause Society consensus statement on the prevention and treatment of osteoporosis in menopausal women on line https://thebms.org.uk/publications/consensus-statements/prevention-and-treatment-of-osteoporosis-in-women

¹Bay Medical Group, Morecambe UK

²Durham University, Durham UK, nelly.bencomo@durham.ac.uk

³Exeter University, Exeter UK

Background: Menopause care is deeply personal and often involves weighing potential benefits, risks, and individual preferences. While clinical guidelines and specialist input offer structure, women navigating perimenopause increasingly seek personalised, transparent, and participatory approaches. Machine Learning (ML) and Artificial Intelligence (AI) offer promising opportunities to support personalised and shared decision-making (PSDM) by combining clinical insights with individual values and priorities.

Objectives:

1. To propose an AI/ML-based clinical tool that supports PSDM for menopause treatment.

Methods:

Step 1: Exploration of AI/ML Techniques for Preference-Based Treatment Recommendations.

We conducted an initial study evaluating AI methods to support PSDM. Techniques prioritising explainability were selected, including logistic regression, decision trees, linear support vector machines, and multi-criteria decision-making (MCDM) methods.

Step 2: Design and Development of the weDecide Tool Prototype.

• Part 1: A recommender system that suggests treatments based on patients with similar symptoms. Emphasis was placed on explainability, enabling both patients and clinicians to understand the rationale behind recommendations.

The tool uses both a synthetic dataset and anonymised data derived from audits of GP electronic health records. Patient privacy is strictly maintained through data masking techniques.

Results: Several proposed models achieved acceptable accuracy (75%+). The MCDM component was successfully integrated, providing recommendations aligned with both clinical reasoning and patient priorities. Outputs are presented in a user-friendly, interpretable format to support meaningful dialogue.

Conclusion: This research highlights how AI/ML can help enhance menopause care by supporting more personalised, explainable, and collaborative decision-making. By combining clinical expertise, patient preferences, and privacy-protected audit data, tools like weDecide can empower women and clinicians to make more informed treatment choices.

Future work will focus on expanding real-world datasets and refining the tool’s interface and communication strategies.

Website: https://wedecide.webspace.durham.ac.uk/

Funding: EPSRC IAA, Durham University

¹GP, Parkshot Medical Practice, Richmond upon Thames, f.cust@nhs.net

²Retired Consultant Gynaecologist

Objectives: With increasing discussion around menopause, many women are turning to social media (SM) platforms for their information. The reliability of advice on unverified platforms remains a concern, particularly when compared to evidence-based sources such as the NHS and the British Menopause Society (BMS). This study aimed to understand where patients accessed the majority of information and the accuracy of it.

Methods: A survey was conducted in a specialist menopause clinic, gathering responses from patients as to where, what and the perceived quality and reliability of information they watched. They were also asked if they had accessed reputable sources i.e. NHS or BMS websites. Tik Tok and Instagram were found to be the most used SM platforms, and so we analysed ‘influencers’ without medical or affiliated qualification. A new account was set up purporting to be a 52-year-old female, using search term ‘Menopause’ and the first 10 relevant views on each were analysed. The advice from the ‘influencer’ to the researcher was compared to evidence-based publications and given a percentage accuracy.

Results: The majority of respondents reported obtaining menopause information primarily from TikTok and Instagram videos. Over 50% of participants stated that they had never accessed information from either the NHS or BMS. Qualitative responses highlighted concerns about conflicting information, difficulties in distinguishing between credible and misleading advice, and a preference for engaging, accessible content. Analysis of the accuracy of the information on these platforms revealed that 63% was accurate and reflected evidence-based advice; 37% was inaccurate.

Conclusions: This study demonstrates that a significant proportion of menopause patients rely on SM as their primary source of information, often bypassing trusted sources such as the NHS and BMS. With misinformation commonplace in the menopause consultation (BMS 2024), SM is likely to be a significant contributing factor given 1/3rd was found to be inaccurate. Through this research, there is a need identified for authoritative bodies to consider new platforms for educational information. This would improve the visibility of evidence-based educational material on SM. Healthcare professionals are individually trying to bridge this gap, but professional bodies could also consider targeted educational campaigns to improve the reach of accredited advice.

¹GP and Menopause Specialist, Brompton PCN, anna_cantlay@hotmail.com

²GP and Menopause Specialist, Brompton PCN

Objectives: Brompton Primary Care Network (PCN) funded a GP-led community clinic to improve access to Women’s Health services in South Kensington and Chelsea. The clinic focuses on addressing unmet health needs related to Menopause and Premenstrual Dysphoric Disorder (PMDD). Brompton PCN supports 10000 patients across 12 practices

Methods: The Hub delivers two clinics a week across two different sites to support accessibility. Longer consultations are delivered by British Menopause Society-certified GPs. In addition to holistic menopause/PMDD care, all women have BP, BMI, smoking and alcohol status documented and NHS cancer screening prompted. A GP advice tasking system was also set-up as well as community education talks.

Results: From June 24-March 25 348 appointments were offered with 90% utilisation rate. A total of 200 women have attended, with 64 seen for at least one follow up. 30% of clinic appointments were follow ups. The clinic aims to provide a ‘one stop-shop’ and minimise the need for ongoing follow ups, thus reducing waiting times. A patient feedback survey has been overwhelmingly positive, 89% of 85 respondents were satisfied with the clinic and 95% on quality of GP advice. Referring GPs were surveyed and report improved patient outcomes and benefits to their own professional development. The clinic has served a diverse population, including women from African, Caribbean, Asian, Southeast Asian, and Eastern European backgrounds. SystmOne data shows 67.9% of patients are recorded as white, closely matching the areas 2021 census (63.7%). The average IMD decile rank of attendees is 6.05. The clinic has benefited women across a wide age range from 25–77, and from 90% of practices within the PCN. Referrals to the Chelsea and Westminster Menopause Service have fallen nearly 40%, demonstrating the initiative’s effectiveness in managing patients within primary care and reducing demand on secondary care.

Conclusion: Brompton PCN’s introduction of GP-led community clinics for Women’s Health has demonstrated a high demand for specialised care in the community, improved access to services, and reduced hospital referrals. Positive feedback and high utilisation suggest the model’s sustainability and potential expansion

Funding: Brompton PCN development funding

¹Consultant Physician, St Stephen’s Centre, Chelsea and Westminster Hospital, London, kimberley.forbes3@nhs.net

²Community Sexual & Reproductive Health Speciality Trainee, Chelsea and Westminster Hospital, London

³Clinical Fellow, St Stephen's Centre, Chelsea and Westminster Hospital, London

⁴Nurse Consultant, Chelsea and Westminster Hospital, London

Objective: To assess menopause clinic demographics, prescribing data pre and post specialist assessment and compliance with BMS Guidance on Progestogen dose for Endometrial Protection in HRT. Inform future work on enhancing the quality and efficiency of menopause services.

Methods: We randomly selected 100 patients attending attendances between December 2024 and February 2025; 50 attending HIV-led Menopause Clinic (HMC) and 50 to Gynaecology-led Menopause (GMC) Clinic. Patient and prescribing data were collected and analysed using Excel.

Results: 99% of all attendees identified as cis-female and 4% as neurodivergent. 7% were referred via the urgent suspected cancer pathway and 40% had a diagnosed mental health condition.

GMC attendees had a mean age of 47.6 years and 2% were re-referrals. 18% had anxiety alone. The main ethnicity was white British (54%) and diagnosis of early menopause affected 6%, whilst 22% had premature ovarian insufficiency. Prescriptions at referral were vaginal estrogen in 30%, transdermal estrogen 56%, estrogen implants 8%, and oral estrogen 8%. Estrogen doses were high for 26% and off-license in 2%. Testosterone 10%. Progesterone was not indicated in 16%. Mirena IUS used by 20%, and Jaydess by 4%.

Following consultation: transdermal estrogen 66%, implants 12%, oral estrogen 6%, testosterone 14%, high-dose estrogen 30%, and off-license 4%.

HMC (n = 99) attendees had a mean age of 52.8 years of and 10% were re-referrals. Anxiety & depression were present in 20%, depression alone in 16%, and anxiety alone in 6%. Most were Black African in ethnicity (42%), with early menopause affecting 14% and premature ovarian insufficiency 6%. The prescriptions following menopause review were vaginal estrogen 28%, transdermal estrogen 56%, estrogen implants 0%, and oral estrogen 0%. Estrogen doses: high 8%, off-license 0%. Testosterone 4%. Progesterone was not indicated in 20%. Mirena IUS used by 14%, and Jaydess by 0%. Progesterone dose was appropriate in all attendees.

Conclusion: This review highlights the diversity around menopause care. Women living with HIV (WLHIV) were likely to be older and identify as Black African. They also had HRT mostly initiated at the menopause service and less likely to be on oral estrogen. Transdermal estrogen use was prevalent and progesterone dose appropriate in all.

¹Division of Medicine, University College London, London, zchamf0@ucl.ac.uk

²Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London

³The National Hospital for Neurology and Neurosurgery, London

Objective: Migraine, a primary headache disorder, affects 1 in 5 women compared to 1 in 15 men. Up until puberty, migraine affects boys and girls equally; however, a female preponderance emerges after puberty, coinciding with significant hormonal changes. This systematic review explores the relationship between migraine frequency and hormonal influences, and the changes observed during the different stages of menopause. Despite existing evidence, we are yet to fully comprehend the mechanism behind the changes observed.

Methods: A systematic literature search was performed using PubMed, Cochrane Library, EMBASE, Ovid Medline, and ClinicalTrials.gov. Eligible studies were assessed for design, methodological quality, population and pathophysiological mechanisms. A risk of bias assessment was then performed using the ROBINS-I tool.

Results: 35 studies were eligible, seven of which were studies with original data which could be analysed. Results indicated a trend towards an increase in migraine frequency during the pre- and peri-menopausal stages and a decrease during the post-menopausal stage; however the mechanisms behind this were not conclusive. There were conflicting views regarding the benefit of hormone replacement therapy (HRT) for management of menopausal migraine, hence there are currently no standardised regimes to improve symptoms for this patient demographic. Furthermore, one study observed a lower migraine prevalence in women with spontaneous menopause who reported pre-menstrual symptoms (7%) compared to women with induced menopause (44%).

Conclusion: Our paper has demonstrated that both the cause of menopausal migraine and how they vary in intensity and frequency is still not fully understood. Although there is some evidence on the role of estrogen in the pathophysiology of menopausal migraine, our knowledge of how HRT could play a role in improving outcomes for patients is incomplete. Long term studies focused on this matter are required to improve outcomes for patients in our care.

¹Fourth year medical student, University of Manchester, isobel.blanksby@gmail.com

²APEP supervisor UoM, GP, menopause specialist, Newson Health, Education Lead, Newson Education

Objective: To systematically review the literature focused on the impact of menopausal symptoms on the NHS workforce.

Methods: I used a carefully constructed research question, involving Boolean operators to search the following four databases: OVID Medline, Web of Science, Scopus and ScienceDirect. I screened these results using specific inclusion/ exclusion criteria, which resulted in three studies being included in this review. Whilst undertaking background reading, I located and included two studies, one being grey literature. I reviewed five studies in total.

Results: All included studies were cross sectional studies. The population sizes studied varied from 14 to 6000. The studies were conducted in different countries within the UK and one was conducted on the whole of the UK. The studies used quantitative and qualitative measures to assess the impact of menopause on their participants.

Conclusion: Each study highlighted that menopausal women are negatively impacted by menopausal symptoms at work and that many women make occupational changes as a result. The degree to which women were affected varied. Recommendations to address this problem include flexible working hours, increased support, uniform and workplace adjustments. As a consequence of menopause being a unique experience for each person, individualised management and support for staff is required.

Strengths and Limitations: This systematic review was conducted in an organised manner, and this was well displayed using the PRISMA flow diagram. The limitations include the lack of research focused on this topic and the inability to access the full text of three articles.

¹O&G ST2, Aneurin Bevan UHB, Wales, alexandra.buckle@doctors.org.uk

²O&G ST1, Cwm Taf Morgannwg UHB, Wales

³O&G Consultant, Cwm Taf Morgannwg UHB, Wales

Objective: To assess the extent of inappropriate referrals of postmenopausal bleeding (PMB) following new or change in hormone replacement therapy (HRT) regime on the urgent suspected cancer pathway (USCP).

Methods: The British menopause society (BMS) advises referral on the USCP for endometrial assessment if 1 major or 3 minor risk factors present. (1) Otherwise, referral if unscheduled bleeding more than 6 months since starting HRT or 6 months following optimisation of change in regime.

This was a prospective audit, running May 2023 to December 2024, in Gynaecology Rapid Access Service, Royal Glamorgan Hospital, Wales. Patients with PMB on HRT referred from General Practice (GP) to USCP were included. A percentage was calculated of those who were referred having started on HRT, or had a change in regime of existing treatment, within the last 6 months. Additionally, the percentage of patients who were referred and received a neoplastic diagnosis.

After preliminary data collected, two interventions were delivered to improve referrals to the service. First, an education letter via the GP working group with updated BMS guidelines. Second, referral rejection letter in response to inappropriate referrals. A repeat round of data collection and analysis as above was done to assess change and complete the audit cycle.

Results: Pre-intervention, 16% (6/37) referrals did not meet BMS guidelines and therefore were inappropriate. Post intervention, 8% (3/37) referrals did not meet BMS guidelines and therefore were inappropriate. None of the patients referred received a neoplastic diagnosis. Overall, there was a 50% improvement in referrals.

Conclusion: The results show that there was an improvement in referrals for PMB in women on HRT following our intervention. This suggests that enhanced communication and guidance with primary care colleagues was useful. The impact of this change will be more effective use of resources and improved patient care. There would be benefit in repeating the audit in 6–12 months to assess whether this change is sustained. Additionally, to perform the audit in other units.

Reference

1. Management of unscheduled bleeding on hormone replacement therapy (HRT), BMS, 2024. https://thebms.org.uk/wp-content/uploads/2024/12/01-BMS-GUIDELINE-Management-of-unscheduled-bleeding-HRT-NOVEMBER2024-A.pdf

¹Menopause Specialist and GPwSI in Gynaecology, Fordhouses Medical Centre, Wolverhampton, r.kharwadkar@nhs.net

Objective: Menopausal symptoms are common in women treated for breast cancer, yet their management is often inadequate. This clinical audit aimed to assess the prevalence of menopausal symptoms, evaluate current management strategies, and determine whether patients received sufficient information and support from their healthcare teams.

Methods: Women diagnosed with breast cancer in the past ten years were identified by running a search on the EMIS clinical system. Patients were contacted and introduced to the audit process before completing a menopause symptom questionnaire sent via the accuRx messaging system. They were then booked for a 30-minute consultation with the in-house menopause specialist GP. Additionally, DEXA scan referrals for patients on aromatase inhibitors were reviewed, and the level of menopause-related information and support provided by secondary care was explored by contacting the breast care team and also during individual consultations.

Results: Among 25 patients identified:

52.9% experienced joint pain.

Regarding menopause-related information, most patients reported receiving only the booklet from Breast Cancer Now, with no structured guidance or follow up. The local breast cancer team confirmed that no dedicated menopause service existed, and discussions were previously conducted during annual review appointments – now discontinued due to the Patient-Initiated Follow Up (PIFU) pathway. Staff acknowledged a lack of formal training and primarily relied on distributing the Breast Cancer Now booklet and an in-house leaflet on vaginal dryness management.

Conclusion: Menopausal symptoms are prevalent but often poorly managed in breast cancer patients. This audit highlights a significant gap in support and symptom management, emphasizing the need for structured menopause services within oncology care. Findings suggest that multidisciplinary team (MDT) integration and enhanced training for healthcare providers could improve patient outcomes.

¹Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea, r.churm@swansea.ac.uk

²Diabetes Research Group, Faculty of Medicine, Health and Life Science, Swansea

Objectives: The menopause is a significant part of a women’s life and can have life changing implications in relation to both physiological and mental health. Evidence supports an intrinsic relationship between glycaemia and menopause, primarily assessing menopause related metabolic changes and dysglycaemia. However, there is a paucity in our understanding on the relationship between dysglycaemia and menopause symptoms. This study aims to evaluate menopause symptoms in postmenopausal women with and without dysglycaemia.

Methods: A cross-sectional analysis of 44 overweight women [age: 57 ± 3.8 years, BMI: 30.44 ± 4.8 kg/m²], post menopause [since final menstrual period (FMP) 7 ± 4.6 years] was conducted. Menopause symptoms were collected using the Balance App Menopause Symptom Questionnaire. Fasting plasma glucose (FG) and insulin (Fins) were collected and Homeostasis model assessment-insulin resistance (HOMA-IR) assessed via HOMA-2 model. Subgroup analyses were conducted according to American Diabetes Association FG values for impaired glucose regulation (NFG: < 5.6 mmol/L, and impaired FG (IFG): ≥ 5.6 mmol/L). Variables were analysed using a two-sided t-test for FG grouping. Linear regression was used to investigate the effects of FG on menopause symptoms and weighted for time since final menstrual period (FMP). Significance was set at p <0.05.

Results: There was a higher menopause symptom score for individuals with IFG when compared to NFG (IFG vs NFG; 28.8 ± 16.5 vs 21.0 ± 10.3 mmol/L, p = 0.038). Linear regression of total cohort was significant (R2 = 0.10, p < 0.05), indicating FG was related to menopause symptom score (β = 4.3, p < 0.05), when weighted for years since FMP. Overall cohort and sub-group analysis indicated no association with insulin resistance models (HOMA-IR p > 0.05).

Conclusion: Women with IFG experienced a greater number of menopause symptoms after their FMP, when compared to women with normoglycaemia. Thus, FG may be associated with menopause symptoms independent of years since menopause onset. However, it is vital to gain a better understand through larger studies, the interplay between menopause symptoms and glycaemia, especially for the experience of women with impaired glycaemia.

¹Post CCT Fellow, Sussex and Surrey NHS Foundation Trust, dr83_manju@yahoo.com

Background: Increased HRT prescription over the decade has increased attendance in the hysteroscopy clinic with unscheduled bleeding, impacting on service capacity and anxiety in the patients.

The objective was to compare hysteroscopy outcomes with national standard, and explore effectiveness of hysteroscopy in diagnosing abnormalities.

Method: A retrospective audit was carried out among 100 patients attending the hysteroscopy service between October to November 2024. Parameters were compared to ensure compliance with the BMS and RCOG guidelines.

Results: Most of the women were in their fifties, 70% of women were multiparous with 22 women having a caesarean birth. There was no significant difference in pain, which demonstrates suitability of hysteroscopy is not based on multiparty or menopausal status. Intraoperative (macroscopic evaluation) and postoperative (histopathological evaluation) endings were recorded. Hysteroscopic evaluation is the gold standard method for endometrial evaluation. Hysteroscopy endings – the most common ending was an atrophied endometrium, a polyp was seen in 12% of patients, thickened endometrium in 2% and submucous ebroid in 8%. Among the cohort 98% had benign histopathological endings, while 2% were diagnosed with cancer. Over 75% of patients did not report any pain during the procedure, of the remaining women who did experience discomfort, it was reported as slight.

Conclusions: Unscheduled bleeding on HRT should be investigated meticulously. Managing women on appropriate pathways ensure increased patient satisfaction and reduced variation in services delivery. The recommendations were to foster collaboration with gynaecologists and General practitioners for integrated patient care and reduce the rate of referrals which didn’t meet the threshold for diagnostic evaluation.

¹Registered Dietitian, Your Menopause by Harley Street at Hom, nigel@harleystathome.com

²Registered Dietitian, South Tees Community Dietetics

³Senior Lecturer in Dietetics, School of Health & Life Sciences, Teesside University

Objective: This study aimed to explore the prevalence and progression of digestive health issues, including Irritable Bowel Syndrome (IBS), among peri-menopausal and menopausal women. It also sought to understand current management strategies and the impact of symptoms on health-related quality of life (HRQoL).

Methods: A cross-sectional online survey was disseminated via a menopause support platform to a sample of self- or formally diagnosed peri-menopausal and menopausal women. The survey gathered data on digestive symptoms, IBS diagnoses, symptom progression, management strategies, and HRQoL impact. Descriptive statistics and Chi-Square tests were used to analyse responses from 564 participants aged 44–73.

Results: A striking 94% of participants reported experiencing digestive health symptoms, with bloating (77%), constipation (54%), stomach pain (50%) and acid reflux (49%) being most common. Despite the high symptom burden, only 33% had received a formal IBS diagnosis. The majority (82%) reported either the onset or worsening of symptoms at peri-menopause or menopause. Statistically significant associations were found between menopausal groupings and specific symptoms, particularly bloating and stomach pain. While 53% had sought professional support, 58% of them found it inadequate. Most (89%) tried self-management strategies, including dietary changes, stress management, and supplements. Over half experienced daily or weekly symptoms, with 55% reporting a significant or regular impact on their quality of life.

Conclusion: Digestive health issues are highly prevalent among peri-menopausal and menopausal women, with many reporting the onset or exacerbation of symptoms during this life stage. Despite the symptom burden, formal diagnoses and effective professional support remain limited. The findings underscore the need for increased clinical awareness, targeted support strategies, and further research into the intersection between digestive health and menopause. Improving healthcare provider education and broadening research efforts could enhance diagnosis, management, and ultimately, quality of life for women navigating menopause.

¹IMT1 Resident Doctor and Academic Clinical Fellow in Diabetes and Endocrinology, Diabetes & Endocrinology Research, Institute of Life Course and Medical Sciences, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, and Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, manson1@liverpool.ac.uk

²Consultant Endocrinologist, Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford

³Consultant Endocrinologist and Reader in Cardiovascular & Metabolic Medicine, Diabetes & Endocrinology Research, Institute of Life Course and Medical Sciences, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool

⁴Consultant Endocrinologist, Centre for Intelligent Healthcare, Coventry University, Coventry and Department of Endocrinology, Spire Manchester Hospital, Manchester

Objective: To assess cardiovascular and estrogen-related cancer risk in women with type 2 diabetes (T2D) using HRT.

Methods: We performed an active comparator new user design, retrospective cohort study using electronic health records. Cohort 1: Impact of T2D in users of HRT with transdermal estrogen. Cohort 2: Impact of transdermal HRT versus non-users in individuals with T2D. Cohort 3: Impact of oral versus transdermal HRT in individuals with T2D. Cohort 1 was 1:1 propensity score matched (PSM) for age and ethnicity. Cohorts 2 and 3 were PSM for age, ethnicity, HbA1c, BMI and history of essential hypertension. Outcomes: pulmonary embolism (PE), deep vein thrombosis (DVT), ischaemic heart disease (IHD), cerebral infarction, and breast, ovarian and endometrial carcinoma. Analysis started from initiation of HRT or a statin for controls. Follow up: 5 years.

Results: Study population (n = 7600, Cohort 1: n = 2650; Cohort 2: n = 2298; Cohort 3: n= 2652). Mean ages (58.3 ± 9.9 to 59.0 ± 10.8 years). Cohort 1: Compared to HRT users without T2D, transdermal HRT in women with T2D was associated with a greater risk of PE (HR 2.70, 95% CI 1.14–6.42, p = 0.019), DVT (HR 1.95, 95% CI 1.13–3.33, p = 0.014), IHD (HR 2.13, 95% CI 1.74-2.60, p < 0.001) and cerebral infarction (HR 1.88, 95% CI 1.17–3.03, p = 0.008), but no differences in rates of breast, ovarian or endometrial carcinoma. Cohort 2: For individuals with T2D, use of transdermal HRT, compared to non-users, was associated with a reduced risk of IHD (HR 0.78, 95% CI 0.61–0.99, p = 0.047), and no difference in risk of PE, DVT, cerebral infarction, breast, ovarian or endometrial carcinoma. Cohort 3: Oral, compared with transdermal HRT in individuals with T2D, was associated with an increased risk of IHD (HR 1.34, 95% CI 1.08–1.66, p = 0.008) and cerebral infarction (HR 1.59, 95% CI 1.07–2.39, p = 0.022), but no difference in risk of: PE, DVT, breast, ovarian or endometrial carcinoma.

Conclusion: Up to five years of regulator approved doses of transdermal HRT appears safe in a large cohort of midlife women with T2D, whereas we propose that women with T2D should not be prescribed oral estrogen therapy.

¹Department of Psychiatry, Queen’s University School of Medicine, Kingston, Ontario, Canada, Claudio.Soares@kingstonhsc.ca

²Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, Research Center for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy

³George Washington University, IntimMedicine Specialists, Washington, DC, United States

⁴Bayer CC AG, Basel, Switzerland

⁵Bayer AG, Berlin, Germany

⁶Syneos Health LLC (providing service to Bayer), Morrisville, NC, USA

⁷Queen Charlotte’s & Chelsea Hospital, Imperial College London

Objective: OASIS 1 and 2 are double-blind, placebo-controlled, randomised Phase 3 trials evaluating the efficacy and safety of elinzanetant over 26 weeks for treatment of moderate-to-severe VMS (hot flashes) associated with menopause in the United States, Israel, and Europe.

Methods: Postmenopausal women aged 40–65 years and experiencing at least 50 moderate-to-severe VMS per week were randomised to once daily elinzanetant 120 mg for 26 weeks or 12 weeks placebo followed by 14 weeks elinzanetant. Pooled OASIS-1 and -2 region Europe and Israel data were analysed using descriptive statistics. Endpoints included mean change in frequency and severity of moderate-to-severe VMS (collected by Hot Flash Daily Diary) from baseline to weeks 4 and 12 and mean change in sleep disturbances and menopause-related quality of life (assessed with the Patient Reported Outcome Measurement Information System Sleep Disturbance Short Form [PROMIS SD SF] 8 total T score and the Menopause-specific Quality of Life Questionnaire [MENQOL] total score). Safety over 26 weeks was also assessed.

Results: In the pooled Europe/Israel data set, 180 women were randomised to elinzanetant 120 mg and 179 placebo. Mean (SD) change from baseline in daily moderate-to-severe VMS frequency for elinzanetant vs placebo was -8.0 (6.3) vs -5.7 (6.6) at week 4 and -9.4 (6.9) vs -7.4 (7.1) at week 12, respectively. Mean (SD) change from baseline in daily moderate-to-severe VMS severity for elinzanetant vs placebo was -0.8 (0.7) vs -0.5 (0.6) at week 4 and -1.0 (0.8) vs -0.7 (0.7) at week 12, respectively. At week 12, PROMIS SD SF 8 total T-score mean change (SD) from baseline was -11.3 (8.3) and -5.4 (7.0) for elinzanetant and placebo, and -1.3 (1.2) and -1.0 (1.2) for the MENQOL total score, respectively. Regarding safety, 49.2% (n = 89) receiving elinzanetant and 45.5% (n = 81) receiving placebo experienced at least one TEAE by week 12. Serious TEAEs were experienced by 1.1% (n = 2) receiving elinzanetant and 0.6% (n = 1) receiving placebo up to week 12.

Conclusions: Elinzanetant reduced VMS frequency, severity, and sleep disturbances, and improved menopause-related QoL. Findings for the Europe/Israel region were consistent with those of OASIS 1 and 2 overall.

Funding: Bayer AG.

¹Obstetrician and Gynaecologist, Queen Charlotte’s & Chelsea Hospital, Imperial College London, London, nickpanay@msn.com

²Obstetrician and Gynaecologist, University of Pavia, and Research Center for Reproductive Medicine, Italy

³Psychiatrist, Queen’s University School of Medicine, Kingston, Ontario, Canada

⁴Bayer CC AG, Basel, Switzerland

⁵Bayer AG, Berlin, Germany

⁶Bayer plc, Reading

⁷Bayer Oy, Espoo, Finland

⁸Syneos Health LLC (providing service to Bayer), Morrisville, USA

⁹Obstetrician and Gynaecologist, George Washington University, USA and IntimMedicine Specialists, Washington, USA

Objective: There is an unmet need for long-term, safe, effective treatments for disruptive menopausal symptoms including vasomotor symptoms (VMS; i.e., hot flashes). Elinzanetant, a dual neurokinin-targeted therapy, could address this need. OASIS-3 is a double-blind, placebo-controlled, randomized 52-week Phase 3 trial evaluating elinzanetant’s efficacy and safety for treatment of moderate-to-severe VMS associated with natural or surgical menopause, conducted in North America and Europe; here, we present the European data.

Methods: European postmenopausal women aged 40–65 years seeking treatment for moderate-to-severe VMS (with no requirement for a minimum number of VMS) were randomized to once-daily oral elinzanetant 120 mg or matching placebo for 52 weeks. Results were analyzed with descriptive statistics and included mean change over time in frequency of daily moderate-to-severe VMS (assessed to week 50), Patient-reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b [PROMIS SD SF 8b] total T-score, and Menopause Specific Quality of Life [MENQOL] total score. Safety over 52 weeks was also assessed.

Results: Overall, 176 European women were randomized to elinzanetant and 175 to placebo. Mean baseline moderate-to-severe daily VMS frequency was 7.0 (8.5) for elinzanetant and 7.3 (5.9) for placebo. Mean change (SD) from baseline in daily VMS frequency for elinzanetant vs placebo was -5.8 (9.0) vs -3.7 (5.2) at week 12 and -6.2 (9.8) vs -3.6 (5.9) at week 50, respectively. Elinzanetant also improved sleep disturbances and menopause-related quality of life. Mean change (SD) in PROMIS SD SF 8b total T-scores from baseline to week 52 was -9.4 (8.7) for elinzanetant and -6.2 (8.5) for placebo. Mean change (SD) in MENQOL total scores from baseline to week 52 was -1.2 (1.3) for elinzanetant and -1.1 (1.3) for placebo. Regarding safety, 74.0% (n = 131) receiving elinzanetant and 62.1% (n = 108) receiving placebo experienced at least one treatment-emergent adverse event (TEAE); most common were headache, nasopharyngitis, fatigue, and COVID-19. There were no serious treatment-related TEAEs, no hepatotoxicity signal, and no endometrial neoplasms/hyperplasia.

Conclusions: Elinzanetant demonstrated a favourable efficacy and safety profile in European women, consistent over the OASIS trials. Elinzanetant has the potential to be an effective treatment for moderate-to-severe VMS associated with menopause.

Funding: Bayer CC AG, Switzerland. Medical writing assistance was provided by Elizabeth Sandham of Highfield, Oxford, UK with sponsorship from Bayer.

¹Registrar In Obstetrics and Gynaecology (East Midlands Trainee ST5); Menopause Specialist Trainee, Chesterfield Royal Hospital NHS Trust, sharvarikasture@gmail.com

²Lead for Gynae Cancer Services & Menopause Specialist, Consultant Gynaecologist, Chesterfield Royal Hospitals NHS Trust, UK

³GP trainee, Chesterfield Royal Hospitals NHS Trust

Objective: To assess endometrial pathology in women with postmenopausal bleeding (PMB) attending the PMB clinic at Chesterfield Royal Hospital (CRH) and evaluate the impact of hormone replacement therapy (HRT) as a contributor.

Methods: This study included 203 consecutive women presenting with PMB at CRH for 6 months from November 2023 to April 2024. Patients were categorised into 2 groups depending on HRT use at time of presentation. 107 women were on HRT, and 96 women were not using HRT. Endometrial biopsies were performed, and histopathology reports were analysed.

Results: In the HRT users (107) 93 women had normal biopsies, while 14 had abnormalities. which were endometrial hyperplasia and one case of endometrial cancer. The rate of endometrial cancer (EC) in the HRT cohort was 0.94%.

In the non-HRT users (96) 74 women had normal biopsies, while 22 had abnormalities. Among the abnormal biopsies 12 were diagnosed with cancer (9 underwent surgery and 3 were in advanced stage and were inoperable). Four cases had atypical hyperplasia who underwent surgery but had no cancer, while six cases had complex hyperplasia without atypia and remain under surveillance. The rate of diagnosis of EC in the non-HRT group was 12.5%.

The endometrial thickness (ET) >10 mm was nearly 50% lower in the HRT group compared to the non-HRT group. As expected, the study showed cancer increased with age. The average BMI in the carcinoma group was higher than in the non-carcinoma group (36 vs. 31).

Conclusion: A structured pathway as suggested by the BMS guideline is to be followed for women with abnormal bleeding on HRT incorporating dose management, persistence of symptom, endometrial thickness and risk stratification to optimise healthcare resources and improve patient outcome. Future research should refine referral criteria and explore AI-driven tools for better risk assessment in PMB management.

Funding: Chesterfield Royal Hospital

¹Consultant Obstetrician and Gynaecologist, St George's Hospital, London

²ST5 Obstetrics and Gynaecology, St George's Hospital, London, nicole.ryan2@nhs.net

³ST7 Obstetrics and Gynaecology, St George's Hospital, London

Objective: To assess current practice in pre-operative counselling regarding surgical menopause and the provision of hormone replacement therapy (HRT) following bilateral oophorectomy in a single tertiary centre.

Methods: Retrospective notes review for all patients over a 3-month period January to March 2024, who underwent either bilateral oophorectomy inducing surgical menopause or who underwent ovarian conservation at the time of bilateral salpingectomy +/- hysterectomy. Outcomes: evidence of documented pre-operative discussion regarding ovarian conservation or HRT; as well as provision of HRT prior to discharge.

Results: Fourty-five patients were identified. 20 underwent bilateral salpingectomy +/- hysterectomy with ovarian conservation and 25 underwent bilateral oophorectomy inducing surgical menopause. Four patients (9%) had no evidence of documented pre-operative discussion regarding ovarian conservation. Of those with bilateral oophorectomy, 6 (24%) were <51 years, and 7 (28%) were 51–55 years. 40% of bilateral oophorectomies were undertaken for fibroids, 36% for oncological concerns, 20% as genetic risk-reducing surgery and 4% for dysfunctional bleeding. Excluding cases with potential malignancy or aged >60 years, all cases were counselled pre-operatively regarding the benefits and risks of HRT. Following oophorectomy, 36% (n = 9) received HRT on discharge. Two-thirds received implants (n = 6), whilst one-third started a transdermal HRT patch (n = 3). One patient was advised to see their GP post-operatively for HRT prescription. Of those with ovarian conservation, 18 (90%) were below the average age of natural menopause in the UK (51 years), and 2 (10%) were aged 51–55 years.

Conclusion: This project highlights the need for education regarding pre-operative surgical menopause counselling and HRT provision. There is increased morbidity following an early surgical menopause. Menopausal symptoms can be severe due to the sudden drop in hormones after oophorectomy, so HRT should be arranged prior to hospital discharge. HRT implants are unlicensed in the UK, are not recommended first-line therapy and have associated supply issues. In response, we have designed a checklist for clinicians to aid pre-operative counselling and facilitate HRT prescribing. This includes patient information signposting and a stepwise decision-making aid for all levels of gynaecologist regarding first-line HRT prescribing. We intend to evaluate the impact of this tool following implementation.

¹Obstetrics and Gynaecology Registrar, Salisbury District Hospital, Salisbury, camillelaure@doctors.net.uk

²Consultant Obstetrician and Gynaecologist, Salisbury District Hospital, Salisbury

Objective: Analysis of referral patterns and types of patients. Update from 2022 data set for a District General Hospital Menopause clinic

The number of consultations regarding menopause and hormone replacement therapy (HRT) has risen over the last 5 years. This has been seen with an increase in referrals and an increase in HRT prescriptions by 130% from 2018–19 to 2023–24.

Method: Clinic opened in Sept 2018. Data is from 2023–2024. Data collection was prospective. Analysis was done using Excel.

Results: 310 new referrals were seen, 19% for menopausal symptoms, 12% for perimenopausal symptoms, 28% for ineffective HRT, 4% for premature ovarian insufficiency, 4% for premenstrual syndrome, 5% for other endocrine issues, and 28% were for reduced sexual interest. 26 were for psychological and other issues (excluded from analysis, n = 284).

Of those referred for menopausal symptoms, 37% had a previous diagnosis of cancer, 6% a family history of breast cancer, and 33% had a medical issue, all indicating that secondary care support was needed in 76% of these women.

96% were GP referrals, 1% from gynaecologists within the department, and 3% from other consultants within the Trust.

16% of referrals were from outside the catchment area for this trust.

Conclusion: This clinic was set up to offer support to the local population of GPs and patients. Referral criteria were circulated. This data shows that most women referred fit these criteria.

There has been a change in referral pattern, with women being referred increasingly with perimenopausal symptoms, inadequate HRT and reduced sexual interest. This may be a reflection of increased awareness of menopause, uncertainty of diagnosis, lack of experience/confidence with prescribing/adjusting HRT.

Secondary care menopause services are valued by GPs and patients, as shown by the high number of referrals. Effective education and support programmes in primary care has been shown to reduce referrals to secondary care.

Specialist services can be set up in a way that they can serve both a local and regional population as both a secondary service level provider and tertiary sub-specialist service. This aligns with our Trust values of providing good local general care, with niche specialist services.

¹SHE (Sport, Health and Exercise) Research Centre, Technological University of the Shannon, Athlone, Ireland, patricia.heavey@tus.ie

²Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle Upon Tyne

³Department of Health Sciences, Sport and Exercise Science, South East Technological University, Waterford, Ireland

⁴Waterford Sports Partnership, Waterford, Ireland

⁵Department of Health Sciences, Sport and Exercise Science, South East Technological University, Waterford, Ireland

⁶UPMC Sports Medicine and UPMC Institute for Health, UPMC, Ireland

⁷UPMC Sports Medicine and UPMC Institute for Health, UPMC, Ireland

⁸SHE (Sport, Health, and Exercise) Research Centre, Technological University of the Shannon, Athlone, Ireland

Objective: The transitional time between experiencing regular menses to menopause typically takes place over several years and is commonly referred to as ‘perimenopause’. While menopausal hormone therapy (MHT) remains the most effective treatment for menopause symptoms, there is growing evidence to support the benefits of lifestyle adjustments for managing symptoms and optimising health outcomes during perimenopause and beyond. The aim of this study was to assess the feasibility and acceptability of a lifestyle programme for perimenopausal women, and to evaluate the programme’s preliminary effectiveness on symptoms, physical activity and menopause-specific health literacy.

Methods: A lifestyle intervention incorporating physical activity and menopause-specific health education (including basics of menopause, benefits of physical activity and diet, mental health and well-being, sleep, pelvic floor health, sexual health, hormonal replacement therapy and health after menopause) was implemented over six-weeks. Feasibility was assessed through recruitment, retention and adherence rates, as well as safety measures. Acceptability was evaluated using weekly questionnaires and a focus group with a subset of participants. Secondary outcomes included self-reported perimenopausal symptoms (Menopause Rating Scale [MRS]), physical activity (International Physical Activity Questionnaire [IPAQ]) and menopause-specific health literacy. Ethical approval was granted from the Technological University of the Shannon ethics committee. Written, informed consent was obtained from all participants prior to participation.

Results: Of 38 eligible participants, 21 enrolled (55% recruitment rate), of which 17 completed pre- and post-intervention assessments (81% retention rate). On average, participants attended 83% of group sessions either in person or online. No safety concerns were reported. Participants found the programme acceptable, with focus group interviews revealing positive feedback regarding its relevance and efficacy. Total MRS score decreased over time (pre-intervention: 16.82 ± 7.74 Au; post-intervention: 8.53 ± 5.72 Au, p = <0.001). Total physical activity increased from pre (869.53 ± 873.73 MET-min/week, p = <0.001) to post-intervention (1909.29 ± 1261.44 MET-min/week). Menopause-specific health literacy largely improved from pre- to post-intervention (p < 0.013).

Conclusion: This pilot study supports the feasibility and acceptability of a lifestyle programme for perimenopausal women with additional support for a positive impact of the programme on perimenopause-related symptoms, physical activity and menopause-specific health literacy.

Funding: UPMC Sports Medicine and UPMC Institute for Health, UPMC, Ireland.

¹Medical Student, University of Leeds

²Lecturer in Medical Education, Leeds Institute of Medical Education, School of Medicine, University of Leeds, n.d.quinton@leeds.ac.uk

³Associate Professor in Clinical Education, Leeds Institute of Medical Education, School of Medicine, University of Leeds

Objective: Healthcare plays a crucial role in a person’s menopausal journey and providing high-quality menopause care begins with medical education. This study focuses on medical students’ experiences of menopause education. We consider, how well they perceive it prepares them to support patients through menopause as future doctors

Methods: A qualitative study with a constructivist approach was designed using focus groups for data collection. These consisted of fourth- and fifth-year medal students. After transcription, Reflexive Thematic Analysis (Braun and Clarke, 2019) was used to analyse and interpret the data.

Results: The following four themes were considered:

(1) The mismatch between feelings and knowledge,

Students clearly recognise the importance of menopause education but feel uncomfortable with their current knowledge base. They find the teaching too exam focused and would like a more holistic approach. Students believe the current teaching is crammed into a busy week of gynaecological and obstetrics teaching and as a consequence feel it has been labelled as a ‘woman’s problem’ with the multidisciplinary aspect not being recognised. Additionally, students feel that the medical school have a duty to include all genders into the discussion and to address the social biases that fuel misconceptions around menopause.

Conclusion: Students feel confused around menopause due to the superficial teaching that does not reflect a bio-social understanding of menopause. Consequently, students are not being adequately equipped to manage it as future doctors. A shift towards a more holistic approach is needed, this could involve including a spiral curriculum where various aspects of menopause are more clearly included and signposted throughout the years of medical school. In earlier years the focus could be on patients’ narratives and the multidisciplinary approach which could be built upon in later year with further clinical knowledge and management.

¹Consultant Gynaecologist Rotunda and Beaumont Hospitals, Dublin and Medical Director, The Menopause Hub, Dublin, conorharrity@rcsi.ie

²Menopause Specialist and Deputy Medical Director, The Menopause Hub

³Nurse and Practice Manager, The Menopause Hub

Objective: During menopause, hormonal changes can lead to heightened sensitivity to histamine, which is stored or inactivated by its primary degradative enzymes; diamine oxidase (DAO) in the gastrointestinal tract, and HNMT in the CNS and lungs, with degradation altered by genetic and environmental factors. Symptoms of histamine intolerance (HIT) and menopause can overlap, including headaches, skin irritation, digestive problems, vasomotor, and mood changes, making diagnosis challenging. Supplemental estrogen therapy may stimulate mast cell histamine release while simultaneously inhibiting DAO resulting in reduced clearance, potentially creating a self-perpetuating cycle in at-risk patients. Whether HRT induced HIT truly exists, how to diagnose it, and what treatment options are appropriate, are all subject to debate, with research needed in this area.

Methods: A prospective observational pilot study was designed and approved by the clinic ethics committee. To diagnose potential histamine intolerance, HNMT and DAO testing was offered to patients with worsening symptoms suggestive of HIT developing after commencement of HRT. Abnormal results provisionally diagnosed HIT, and were treated by a stepwise algorithm, and symptom monitoring to assess for resolution. Initial therapy was dietary/lifestyle modification combined with type 1 and 2 antihistamines. If this was unsuccessful, a trial of mast cell stabilisers (Montelukast 10mg, Ketotifen 1mg, Sodium Chromoglycate 100 mg TID) was considered if no contraindications.

Results: Thirteen patients developed suspected HIT after initiation of HRT, and agreed to testing during the study period. 2/13 cases (15.4%) had normal results despite clinical suspicion, and symptoms unsurprisingly did not respond to an empirical trial of type 1/2 antihistamine therapy. Of 11 patients with abnormal results, 5 had reduction in both HNMT and DAO activity, with 6 having lower DAO activity alone. Clinical response to therapy was noted in 5/6 patients with reduced DAO activity (83.3%) and 4/5 patients with combined lower activity (80%).

Conclusion: Measurement of HNMT and DAO activity can be useful for diagnosis of potential HRT induced HIT. Combination antihistamine therapy or mast cell stabilisers alongside dietary modification appear to be useful treatment options for these patients. Larger studies with longer term follow up will be valuable to validate these findings.

¹GP and Menopause Specialist, Bioconnect Clinic, Barbados, dr.toby@bioconnectmedical.com

²Gynaecologist and Menopause Specialist, Bioconnect Clinic, Barbados

³Data Manager, Bioconnect Clinic, Barbados

⁴Data Co-ordinator, Bioconnect Clinic, Barbados

Introduction: The decision to initiate hormone replacement therapy (HRT) among Black women is influenced by a combination of cultural beliefs, healthcare access, and historical medical mistrust. Research indicates that Black women in the US and UK are less likely than white women to use HRT, often due to concerns about safety, lack of culturally competent healthcare guidance, and preferences for natural or non-pharmaceutical treatments (Harris et al., 1999). However, there is limited data on the attitudes towards HRT among Black women in the Caribbean.

Objective: This study aims to assess the uptake of HRT in perimenopausal and menopausal Black women attending a newly established menopause clinic in Barbados and compare it to the uptake among their white counterparts.

Method: Data was retrospectively collected from 112 women who attended the clinic between October 2024 and March 2025 for an initial menopause appointment. Information on age, ethnicity, menopausal status, surgical menopause, and choice of HRT was collected.

Results: Among the 112 women, 54 (48%) were perimenopausal and 58 (52%) were postmenopausal. Of the participants, 44 (39%) were Black, 42 (37.5%) were White, 16 (14%) were Mixed, 8 (7%) were South East Asian, and 2 (2%) were Hispanic. A total of 28 (63.6%) Black women started HRT, with 19 (68%) being postmenopausal and 9 (32%) perimenopausal. Among the 42 White women, 29 (69%) started HRT, with 16 (55%) postmenopausal and 13 (45%) perimenopausal. Nineteen (73%) women from non-Black ethnic groups (excluding Black) started HRT, with 7 (37%) postmenopausal and 12 (63%) perimenopausal.

Conclusion: The data suggests that Black women in Barbados do not differ significantly from their White counterparts in their decision to start HRT. This could indicate that historical medical mistrust is less prevalent, as many physicians on the island are of Black or non-white racial backgrounds. The findings highlight the need for further research into the cultural and healthcare factors influencing HRT uptake in diverse populations.

Reference

1. Harris, T.J., Cook, D.G., Wicks, P.D., & Cappuccio, F.P. (1999). Ethnic differences in use of hormone replacement therapy: community-based survey. BMJ, 319(7210), 610-611

¹Medical student, ScotGEM, University of St Andrews and University of Dundee, jade.coupland@nhs.scot

Objective: The Women’s Health Plan: A plan for 2021–2024 places increased focus on the recognition and treatment of cardiovascular disease (CVD) in women (Scottish Government, 2021). This is important in respect to menopause, where the prevalence of hypertension – one of the most significant risk factors for CVD – more than doubles in post-menopausal women (Newson, 2017; Staessen et al, 1989). The aim of this quality improvement (QI) project was to improve primary care follow up for women attending menopause clinics at the Dumfries and Galloway Royal Infirmary (DGRI) who are found to have raised blood pressure (BP).

Methods: After analysing the current procedures using QI tools, the team utilised the plan-do-study-act (PDSA) methodology to implement, track and assess the effectiveness of change ideas. Patient education was supplemented through the design of an informative leaflet and assessed through distribution rates. Sheets for recording home blood pressure monitoring (HBPM), were developed to allow for the distribution of HBPM kits once obtained. Clinic letter templates were assessed and altered to improve communication between primary and secondary care. During the project, the proportion of GP follow up of high clinic BP was recorded as an outcome measure.

Results: Patient information leaflet distribution increased in the duration of the project and HBPM kit funding was obtained as a future continuation of this project. However, due to the time required for follow up no significant improvement in outcome measures was seen.

Conclusion: Although no significant improvement was recorded within the 6 weeks this project ran for, it laid the foundation for improving GP follow up of high clinic BP readings.

References

1. Newson, L., (2017) ‘Menopause and cardiovascular disease’ Post Reproductive Health, 24(1). Available at: https://doi.org/10.1177/2053369117749675 (Accessed 29 February 2024).

2. NICE (2023). ‘Hypertension in adults: diagnosis and management’.

3. Scottish Government (2021) Women’s health plan. A plan for 2021–2024. Available online at: https://www.gov.scot/binaries/content/documents/govscot/publications/strategyplan/2021/08/womens-health-plan/documents/womens-health-plan-plan-2021-2024/womens-health-plan-plan-2021-2024/govscot%3Adocument/womens-health-plan-plan2021-2024.pdf (Accessed 25 February 2024).

4. Staessen, J., Bulpitt C.J., Fagard R., Lijnen, A., and Amery, A, (1989) ‘The influence of menopause on blood pressure’, Journal of Human Hypertension, 3, 427–433.

¹GP Registrar, Duncan Street Primary Care Centre, Wolverhampton, a.thompson27@nhs.net

²Consultant in Community Sexual and Reproductive Health, Royal Wolverhampton NHS Trust

Objective: This quality improvement project (QIP) aimed to enhance patient safety and appropriateness of hormone replacement therapy (HRT) prescribing in primary care by ensuring that all non-hysterectomised women receiving HRT are prescribed an adequate progestogen for endometrial protection.

Unopposed estrogen increases the risk of endometrial hyperplasia and cancer, making progestogen co-prescription essential in non-hysterectomised women. The progestogen dose must be proportionate to the estrogen dose for adequate protection. However, complexities of HRT formulations, variable dosing regimens, and recent supply shortages can contribute to inconsistencies in prescribing, highlighting the need for this project.

Methods: This QIP used the Model for Improvement framework with Plan-Do-Study-Act (PDSA) cycles to test and implement changes.

A 12-month retrospective audit of estrogen-only HRT prescriptions was conducted to assess compliance with endometrial protection guidelines.

A driver diagram analysis identified key contributing factors, including prescriber knowledge gaps, patient adherence challenges, high prescribing volumes, and challenges accessing key clinical information, such as hysterectomy status or levonorgestrel-releasing intrauterine device (LNG-IUD) use.

PDSA Cycle 1: Electronic prescribing records were updated to explicitly indicate progestogen status within the estrogen prescription (whether required and which preparation), allowing prescribers to assess co-prescription needs efficiently.

PDSA Cycle 2: A clinician-facing infographic summarising progestogen requirements was introduced, including dosage recommendations based on estrogen dose. Audit findings were disseminated via an educational session for prescribers.

Prescribing data were re-audited following each intervention.

Results: Baseline analysis identified 34 women prescribed an estrogen-only preparation; 16 (47.1%) had an intact uterus. Five of those women had an LNG-IUD in situ, leaving 11 requiring a separate progestogen. Of these, four (36.4%) received inadequate endometrial protection: two were prescribed estrogen-only preparations without a progestogen; two received insufficient progestogen doses.

Following both PDSA cycles, all patients requiring progestogen received an appropriate prescription.

Conclusion: Targeted educational and prescribing interventions led to a marked improvement in compliance with endometrial protection prescribing standards.

Prescribers reported that changes streamlined the prescribing process, improving efficiency, accuracy while enhancing patient safety. Ensuring quick identification of progestogen co-prescription needs and appropriate progestogen dosing is essential for best practice. Future efforts should focus on sustaining these improvements and expanding best-practice implementation.

¹GP Principal, Willow Bank Surgery, BMS Menopause Specialist and BMS Trainer, bala.sankarasubbu@stoke.nhs.uk

²Medical Student

Objectives: To identify how many patients were diagnosed with Essential Hypertension in menopause clinic.

Methods: Audit of all patients who attended menopause clinic in the last 6 months.

We identified patients who were started on anti-hypertensives or coded as essential hypertension during the menopause consultations.

Results: Total of 40 patients seen.

10 of them have been diagnosed with hypertension.

Conclusions: We have diagnosed new hypertensive cases in our menopause clinic.

Lifestyle advice is a major component in menopause management. It is important to address lifestyle issues like smoking, BP and BMI, strength training during menopause consultation. We have commenced health care clinic alongside menopause clinic so that patients receive lifestyle advice after seeing menopause specialist.

¹GP, Saxmundham Health, Suffolk, stephanieparnell@hotmail.co.uk

Objective: The experience of menopause varies for each woman. HRT is the treatment of choice for many but there are lifestyle changes that can be used to reduce symptoms and risks associated with the menopause. A cross-sectional study, completed in primary care, demonstrated the most common symptoms experienced by women in the menopause and perimenopause, and the treatment they had received. It highlighted the discrepancies between the information provided in primary care and the information women had hoped to receive.

Methods: This study conducted non-systematic literature reviews on four topics to summarise evidence that could be used to inform patients. The topics included dietary advice, supplements, exercise recommendations and lifestyle advice for Genitourinary Syndrome of the Menopause (GSM). The recommendations from British professional bodies on these topics were also reviewed.

Results: The results described the evidence available on the benefits of lifestyle interventions on menopause symptoms and the risk of cardiovascular disease and osteoporosis.

This study showed the advantages of a balanced and mixed diet, with the importance of adequate carbohydrate and protein intake to prevent the loss of lean muscle. It supported the use of isoflavones and Black Cohosh for the relief of vasomotor symptoms and probiotics to improve GSM and bone health. It presented the evidence on regular and varied exercise, where aerobic exercise improved cardiovascular health, strength-based exercise improved muscle mass and bone health and low-intensity, balance-based exercise improved vasomotor and psychological symptoms. It described the benefits of vaginal moisturisers and lubricants for GSM, but that vaginal estrogen should be promoted as first line where appropriate. It further detailed the benefits of smoking cessation and regular sexual activity to prevent the progression of GSM, while the use of laser should not be recommended.

Conclusion: This review summarised important evidence on lifestyle changes that can improve menopausal women's symptoms, quality of life and risks such as osteoporosis and cardiovascular disease. The discussions were summarised, so they could be used to create a patient information leaflet for distribution in primary care consultations. Providing women with the information they need without extending the duration of a time-constrained consultation.

¹Consultant Gynaecologist, Menopause Clinic, University Hospitals Dorset, Poole, tim.hillard1@gmail.com

²GP and Menopause Specialist, Menopause Clinic, University Hospitals Dorset

³Innovation and Adoption Programme Manager, Health Innovation Wessex

⁴Programme Manager – Transformation Delivery, NHS Dorset

Introduction: The increasing public awareness and discussion around the perimenopause, menopause and HRT in recent years has resulted in a corresponding increase in demand for menopause appointments which an already over-stretched health care system has struggled to provide. Consequently, innovative approaches are needed.

As part of the Women’s Health Strategy, the Dorset Women’s Health Programme was established aiming to provide education and support for women through Women’s Health Hubs. Within Dorset, menopause was identified by patients as one of their 6 priority topics. We established a hub and spoke model from our specialist menopause clinic providing group training through a series of themed Webinars. An audit of our referrals identified the top 3 problems as: Bleeding on HRT, Testosterone and Prescribing issues with HRT. Our aim was that these webinars would empower clinicians in primary care to manage these problems themselves and reduce referrals to secondary care.

Methods: The 3 Webinars were conducted live at lunchtime and were open to all clinicians working in women’s health in Dorset. They were divided into 2 sections; a 20 minute overview and a 40 minute Q&A session. The Webinars were recorded and subsequently made available online. All attendees were asked to complete a questionnaire on pre and post webinar expectations and feedback.

Results: In total 218 people attended the three webinars. (95, 72, 51)

How confident are you with your knowledge of this topic?

OPEN IN VIEWER

Level of Confidence	Pre-Webinar Feedback (n = 86)	Post-Webinar Feedback (n = 85)
Extremely not confident	12%	0%
Somewhat not confident	21%	1%
Neutral	33%	7%
Somewhat confident	34%	60%
Extremely confident	0%	32%

Additional Comments: Most clinicians identified time as the biggest barrier to achieving their learning goals; the webinars met their expectations. 96% wanted further webinars; 96% believe this training would reduce secondary care referrals; all attendees found the format useful felt they would positively impact and support women throughout Dorset.

Conclusion: By providing targeted and interactive webinars it is possible to improve knowledge and confidence in primary care which will be beneficial to patients and reduce referrals to secondary care. This initiative was accompanied by an online educational patient resource.

Funding: Women's Health Strategy central funding to support the Dorset Women's Health programme

¹Medical Director and Lead Trainer at Facial Aesthetics Ltd, Essex, facial_aesthetics@hotmail.com

Objective:

1. Primary-Objective: Assess the impact of BTX on mild depressive and anxiety symptoms in perimenopausal/postmenopausal women.

2. Secondary-Objective:

• Evaluate changes in self-perceived confidence and well-being at 2-week and 3-month intervals.

Methods:

• Study Design: Prospective observational study in a menopause-focused clinical setting.

Results:

• 2-week review: 98% reported some positive impact; 87% indicated “Moderate” to ‘Very Significant’ improvements.

Conclusions: Initial data suggests BTX may confer psychological benefits for menopausal women with mild depressive symptoms. These improvements, maintained at 3-month follow up, position BTX as a potential adjunctive treatment for mental well-being. In conjunction with study findings, a Menopause Support Group was established (facialaesthetics.co.uk/menopause-support-group/) highlighting the value of a holistic support framework. Further large-scale controlled studies are needed to confirm efficacy, durability, and best practices for integrative mid-life care.

References

1. Freeman, E.W. et.al. (2014) ‘Association of hormones and menopausal status with depressed mood in women with no history of depression’. Archives of General Psychiatry, 61(9).

2. Finzi, E and Rosenthal, N.E. (2014) ‘Treatment of depression with onabotulinumtoxin :A randomized double-blind, placebo-controlled trial’. Journal of Psychiatric Research, 52.

3. Lewis, M.B. and Bowler, P.J. (2009) ‘Botulinum toxin cosmetic therapy correlates with a more positive mood’. Journal of Cosmetic Dermatology, 8(1).

¹GP, DrShoCares Clinic, Hertfordshire, itunu.johnson1@nhs.net

Objectives: Most women will spend at least one-third of their lives in menopause, a natural and transformative stage that can reshape their biopsychosocial identity. Recognising that every element of this profound experience warrants exploration, this review focuses on the often under-examined mental load: the continuous cognitive and emotional effort required to manage daily responsibilities, and its bidirectional relationship with menopause. It aims to assess how menopause interacts with mental load, and to evaluate current assessment and intervention therapies while identifying strategies to enhance their effectiveness.

Methods: This study employs a systematic literature review to explore the bidirectional relationship between mental load and menopause. A comprehensive search was undertaken across global databases including PubMed, Scopus, ScienceDirect as well as other relevant literature, to identify peer-reviewed articles and authoritative sources in order to examine the multifaceted interactions between the mental load and menopause.

Results: The reviewed studies indicate that the menopausal transition is linked to an increased mental load, as reflected by both subjective reports of cognitive fatigue and measurable declines in cognitive domains such as attention and working memory. This relationship is bidirectional; while menopausal symptoms and hormonal changes heighten cognitive and psychological stress, the burden of a heavy mental load can further exacerbate menopausal symptoms. Socio-cultural pressures of work and home life disproportionately impacts midlife women. Sometimes described as the ‘squeezed middle’ or ‘sandwich generation’ supporting the young, old and vulnerable whilst often also active members of the workforce. These demands contribute significantly to this cognitive strain, and even women on HRT sometimes continue to struggle, suggesting that symptoms are not always hormonally driven.

Conclusion: The literature suggests that menopause is associated with a heightened mental load in midlife women, driven by biological changes and amplified by socio-cultural pressures. These findings underscore the need for a comprehensive, biopsychosocial approach to menopause care that incorporates strategies for assessing and mitigating mental load. In particular, for women who fail to respond appropriately to treatment, the impact of a heavy mental load on symptoms should be explored in order to improve outcomes and enhance overall quality of life for women.

¹Specialised Foundation Year 2 Doctor, Keele University, Stoke-on-Trent, a.chew@keele.ac.uk

²Junior Clinical Fellow in Obstetrics and Gynaecology, Chelsea and Westminster Hospital

³GP, Wolstanton Medical Practice, Stoke-on-Trent

⁴Junior Clinical Fellow, Royal Stoke University Hospital, Stoke-on-Trent

⁵ST2 in Obstetrics and Gynaecology, King’s College Hospital, London

⁶Junior Clinical Fellow in Infectious Diseases, North Manchester General Hospital, Manchester

⁷PDRA Biostatistics/Epidemiology, Keele University, Stoke-on-Trent

⁸Senior Lecturer, Keele University, Stoke-on-Trent

⁹Research Associate in Epidemiology & Biostatistics, Keele University, Stoke-on-Trent

¹⁰Professor of Primary Care Epidemiology, Keele University, Stoke-on-Trent

¹¹NIHR Clinical Lecturer in Primary Care, Keele University, Stoke-on-Trent

Objective: This study aims to systematically evaluate the association between menopause and musculoskeletal (MSK) pain, with a focus on Patient-Reported Outcome Measures (PROMs). Given the clinical significance of MSK pain in the menopausal population, understanding how PROMs capture this experience is crucial to enhance clinical care.

Methods: We conducted an extensive literature review across seven databases from inception until October 2024. This review was run in parallel with a related review on menopause hormone replacement therapy (mHRT). Two independent reviewers performed screening, data extraction, and critical appraisal using Joanna Briggs Institute (JBI) tools. Data were synthesized through narrative synthesis and meta-analysis where feasible. The protocol is registered on PROSPERO (CRD42023472009).

Results: From an initial 30,748 articles, 88 studies met the inclusion criteria, with 23,238 screened for eligibility. The inclusion criteria included (i) perimenopausal or menopausal women, (ii) outcomes including mention of chronic MSK pain (prevalence, incidence, experience), and (iii) usage of PROMs any measure of pain severity or function, quality of life. HRT-related studies or trials were considered up to full-text review, but were excluded thereafter.

The pooled prevalence of MSK pain in menopausal individuals was 48% (95% CI: 44%–51%), with substantial heterogeneity observed (p < 0.001). Subgroup analysis based on studies using different PROMs revealed variability in prevalence estimates:

• MENQOL (n = 7): 67.6% (95% CI: 44.5%–84.4%)

Despite high heterogeneity albeit slightly reduced from pooled estimates, these findings underscore that MSK pain is highly prevalent among menopausal individuals.

Conclusion: Our findings highlights the widespread nature of MSK pain in the menopausal population and emphasize the usage of consistent and validated PROMs to capture this, as suggested by the high heterogeneity. This study advocates for increased clinical awareness, tailored treatment pathways, and an integrated approach to managing MSK pain during menopause, to improve menopausal healthcare.

¹GP, Highgate Group Practice, sue.dickie@nhs.net

²Advanced Nurse Practitioner, Highgate Group Practice

Objective: To investigate if perimenopause is considered when women consult GPs with anxiety or depressive symptoms age 40–50; and to answer the question:

Are women being treated with antidepressants when HRT might have been an alternative or additional option?

Methodology: The EMIS search function was used to define a cohort of women aged 40–50 newly prescribed antidepressants for mood or anxiety symptoms in the last year, who were not taking hormone replacement therapy. These women’s records were assessed to check whether hormones, perimenopause, or the relationship between mental health symptoms and their menstrual cycle were discussed.

If no discussion had been recorded women were invited to complete a modified Greene questionnaire; consisting of 11 questions scored on a scale of 0–3, with 0 experiencing the symptom ‘not at all’ and 3 experiencing it ‘extremely’. The results were then analysed.

Results: There are 1274 women aged 40–50 at Highgate Group Practice, North London. Of these 58 (5%) were identified with a new code of depression or anxiety (or allied codes) in the 12 months preceding the search. Of these, 16 women already prescribed HRT were excluded, along with those with longstanding symptoms, who had been wrongly coded (5), leaving a cohort of 22.

8 (36%) of these had been asked about perimenopausal symptoms. The remaining 14 women were sent questionnaires.

Of these 14 women, 8 (57%) responded and a range of symptoms were reported. The symptom scores reported were between 3–29/33 with a mean score of 15/33 and median 13/33.

Conclusion: Just over one third of women presenting to the GPs with new symptoms of depressed mood or anxiety in the year preceding the study had been asked about perimenopausal symptoms. When the remaining two thirds were asked about their symptoms over half responded to a climacteric symptom scorer with significant symptoms.

This supports routine enquiry regarding perimenopausal symptoms in women aged 40–50 presenting with mental health symptoms; to ensure that the choice of hormonal treatment alongside, or in place of, antidepressants is discussed.

¹Advanced Clinical Pharmacist in Menopause and Mental Health Specialist, Primary Care, North East London and Essex, vsandhupharmacist@gmail.com

Objective: To evaluate the prevalence of misdiagnosed mental health conditions in perimenopausal and menopausal women and assess the impact of hormone replacement therapy (HRT) compared to standard psychiatric treatments. Many midlife women experience mood disturbances that are mistakenly diagnosed as primary psychiatric disorders, leading to prolonged distress and unnecessary psychotropic medication use. This study highlights the need for menopause-informed mental health assessments to improve diagnostic accuracy and patient outcomes.

Methods: A retrospective analysis was conducted on 120 women aged 45–60 booked in mental health clinic in Primary care (2022–2024) with symptoms including anxiety, depression, emotional instability, paranoia, anger, and excessive worry.

• 80 women (66.7%) developed psychiatric symptoms after age 40, coinciding with hormonal fluctuations.

Symptoms were evaluated at three and six months post-intervention.

Results: Among the 50 misdiagnosed women:

• 25 (50%) experienced significant symptom resolution within three months of starting HRT.

Statistical analysis confirmed a strong correlation between hormonal fluctuations and mood disorders, reinforcing the need for menopause screening in psychiatric evaluations.

Conclusion: A substantial proportion of midlife women presenting with psychiatric symptoms may have undiagnosed menopause-related mood disturbances. Women over 40 with new-onset or treatment-resistant psychiatric symptoms should undergo dual evaluation for mental health and hormonal imbalances. Misdiagnosis leads to delayed treatment, unnecessary medication use, and prolonged suffering. Integrating menopause screening into psychiatric assessments could improve diagnostic precision, treatment outcomes, and overall patient care. Further research is needed to establish standardized menopause-aware psychiatric evaluation protocols, clinician training programs, and formulary development to guide treatment choices.

¹Reproductive Medicine Unit, University College London Hospital, vikram.talaulikar@nhs.net

²Menopause and Cancer Charity

³Epsom and St Helier Hospitals

Objective: Menopause following treatment of cancer can be difficult for many due to significant menopause symptoms (systemic and/or genitourinary) which adversely impact quality of life and limitations to the treatment options available on background of cancer history. Careful consideration of benefits versus risks of each approach (lifestyle, non-hormonal, and hormonal) and shared decision making between the woman and her health professional are important aspects of long-term care. Women need access to evidence-based information and support so that they can make informed choices about menopause management. We conducted an online survey of cancer survivors asking them about their views on availability of information and support for menopause following cancer.

Methods: Individuals who had experienced menopause because of cancer treatment were offered to take part in a short anonymous online survey to answer 7 questions including – Have you had satisfactory access to information resources regarding menopause following cancer treatment? Have you had satisfactory access to support, and treatment related to menopause following cancer treatment? Have you had satisfactory access to discussions regarding benefits versus risks of HRT in your situation? The survey was open to individuals across the UK and participants were invited through various online/social media platforms over a period of 8 weeks between June and August 2023.

Results: 287 women participated in the survey over a period of 8 weeks. Over half of the participants (55%) said that they did not receive satisfactory access to support and treatment related to menopause symptoms management. 42% of women were dissatisfied with the discussion and information they received about menopause because of cancer treatment, and 77% of the participants found it difficult to access reliable HRT advice and information on using HRT post cancer treatment.

Conclusion: Majority of cancer survivors in our survey were not satisfied with the information and long-term care/support that was offered to them for menopause management following cancer treatment. There is certainly more that needs to be done in this space to support individuals better. Larger surveys across multiple clinics or health communication platforms will be needed to generalise the findings we observed in our survey.

¹GP, Greenfield Medical Centre, London, saloni.kapoor@nhs.net

²GP, North West London

Objectives: The perimenopausal and menopausal transition is a critical period for preventative healthcare as physiological changes increase long-term cardiometabolic risks. Clinicians play a vital role in identifying these risks and providing lifestyle advice. This audit evaluates whether first-contact consultations for perimenopausal and menopausal women in primary care cover cardiovascular risk and lifestyle measures per current BMS guidelines.

Methods: A retrospective audit was conducted on 40 women attending their first-contact GP appointment for menopause-related concerns. Consultations were assessed for key health parameters: BMI, pre-existing diabetes, blood tests (Hba1c, non-HDL cholesterol) within 12 months, diabetes risk, QRISK, pre-existing hypertension, recent blood pressure readings, and hypertension risk. Consultations were also evaluated for whether lifestyle factors of diet, sleep, exercise, stress, mental health, smoking, and alcohol were addressed.

Results: Data assessing metabolic risks show that 63% of patients had no HbA1c recorded and did not receive diabetes risk counselling. Although 59% of patients had no pre-existing high cholesterol, they lacked recent recorded bloods of non-HDL cholesterol or documented QRISK assessments and subsequently lacked any cholesterol risk discussions. Additionally, 80% had no discussion of BMI risk and 30% had no blood pressure risk assessment. 50% of all consultations lacked any documented discussion of lifestyle factors. Among those where lifestyle was addressed, 70% did not include risk discussions regarding alcohol and smoking, and 80% omitted exercise counselling. Notably, 67% of perimenopausal women had none of the lifestyle factors discussed, compared with 25% of postmenopausal women. Systemic HRT was prescribed in 75% of consultations.

Conclusions: These findings underscore significant gaps in cardiometabolic risk and lifestyle counselling assessment during initial menopause-related consultations. Given the risks associated with initiating HRT, it is imperative to screen and counsel on HbA1c, cholesterol, blood pressure, and lifestyle factors. Potentially systemic HRT was prescribed in most patients without a full cardiometabolic and lifestyle risk assessment. Perimenopause is identified as the most prevalent time to discuss cardiometabolic risk factors to improve long term health outcomes. We recommend the implementation of structured consultation checklists, enhanced GP training, and modifications to the templates for menopause to include prompts for cardiovascular and lifestyle risk counselling.

Reference

1. https://thebms.org.uk/wp-content/uploads/2023/06/19-BMS-TfC-Menopause-Nutrition-and-Weight-Gain-JUNE2023-A.pdf

¹GP and BMS Menopause Specialist, Liberty Menopause Care, Derbyshire, eward1@nhs.net

Objective: To establish the significance of osteosarcopenia in post-reproductive life.

Methods: Review of up to date literature base and evidence.

Results: Osteosarcopenia, the co-existence of disease processes osteoporosis/osteopenia and sarcopenia, raises the risk of morbidity and mortality in a population disproportionately affecting women (65%). Risk of disability, loss of independence, depression and frailty are greater with concomitant osteoporosis and sarcopenia, than with either condition alone.

Developing embryologically from the same tissue, mesoderm, muscle and bone maintain intimate connections throughout life. This ‘muscle-bone unit’ communicates both mechanically and biochemically in an autocrine, paracrine and endocrine fashion; osteokines from bone, myokines from muscle, provide bidirectional feedback influencing function and metabolism.

Undoubtedly, all fractures are negative events, however, hip fracture is of particular importance given its devastating mortality rates; 10% within 1 month, 30% at 1 year. Financially, costs to NHS for inpatient care alone is £75 million/year.

Latest figures from UK National Hip Fracture database reveal increasing incidence of hip fractures, citing ‘physical deconditioning and increased risk of falling’ as direct consequence of sedentary behaviour during the COVID-19 pandemic.

95% of hip fractures result from falls, with women 2.9x more affected. Menopause accelerates the loss of lean mass and reduces bone density at a younger age than generally seen in men. Sarcopenia increases risk of falling through multiple mechanisms: diminished strength, impaired balance and stability, gait changes and inability to react to prevent falling or save oneself before impact. Clearly, the combination of osteoporosis and sarcopenia significantly worsens outcomes.

Conclusion: An ageing population accelerates the urgency to make progress here; with improved recognition of osteosarcopenia and high risk individuals, education alongside formation of guidance, implementation of holistic treatments including bone-sparing agents, supplementation, nutrition and exercise for muscle-bone unit strength. Over the past 20 years, despite many medical advances, a significant gender gap in measures of quality of life and disability-free living in older age persists. Given the huge impact on NHS and Social Care budgets, this is a developing area of medicine which demands greater attention, further female specific research and strategic planning.

¹Lead Clinical Pharmacist, North West Leicestershire GP Federation, anthony.singh1@nhs.net

Objective: To evaluate the implementation and impact of a pharmacist-led menopause clinic in primary care, improving access to specialist care for women experiencing menopausal symptoms.

Methods: A pharmacist with British Menopause Society (BMS) accreditation delivered structured menopause consultations across 12 GP practices within the North West Leicestershire GP Federation. Women were referred by GPs, nurses, or via self-referral. Each patient received a 20-minute consultation, underpinned by evidence-based guidance (NICE NG23). Educational videos and digital questionnaires were shared in advance to streamline the appointment. Outcome data, patient feedback, impact on general practice workload, and secondary care referrals were collected over 15 months.

Results: Over 12 months, 731 patients were reviewed. Monthly consultations rose from an average of 40 to 130 as awareness increased. Of those attending, 69% would have booked a GP appointment and 7% considered private consultations if the service wasn’t available. Feedback from 239 patients showed 97% found the information adequate, 86% were very satisfied with their consultation, and only one patient was very dissatisfied. Group consultations and collaborations with local councils supported holistic care. The service also helped manage complex cases, including testosterone prescribing where appropriate. Notably, gynaecology referrals across the area dropped by 24.2%, from 908 (May 2022–May 2023) to 731 (May 2023–May 2024), following the introduction of the clinic.

Conclusion: Pharmacist-led menopause clinics can deliver high-quality, evidence-based care at scale, reducing GP workload, improving patient satisfaction, and decreasing secondary care referrals. This model is scalable and reproducible across primary care networks, offering a sustainable approach to women’s health.

Funding: Organisation funded – NWL GP Federation

¹Community Gynaecologist and Menopause Specialist, Stockport, nabanita.ghosh@locala.org.uk

²Consultant, Locala Community Partnerships, Bradford

Objective: Premature ovarian insufficiency (POI) refers to amenorrhoea, hypo-estrogenic status and elevated gonadotropins due to a decline of ovarian function before the age of 40.

It is estimated that approximately 1% of women would become menopausal before the age of 40, while the prevalence in women under the age 30 is estimated to be 0.1%.

This audit was it find out whether we are informing patients in our menopause clinic at Locala Stockport about risks of POI and if we are managing these patients appropriately and safely, in line adherence to clinical guidelines from British Menopause Society UK.

• To identify if patients with POI have been counselled about long term sequalae of POI

Method: Thirty-seven case notes looked at matching the criteria of female patients under age of 40 attending the Community Menopause clinic service in the designated time period.

System one (electronic patient record system) search was done looking all at female patients attending Community Gynaecology Services from 1/4/23 till 31/7/24 who were aged 40 years and below.

Results:

• Thirty-seven case notes were identified matching the search criteria.

Overall clear and concise case notes with good documentation was noted in all 4 cases.

Patients were being counselled properly keeping with the standards of British Menopause Society UK.

The only exception found

1. Lack of documentation around whether there had been discussion around direct questioning about urogenital symptoms.

Areas for improvement:

1. To include direct questioning about urogenital symptoms as most patients do not volunteer this information unless asked directly as this is a very sensitive issue and document clearly in notes that this has happened.

Conclusion: It is very important that we get it right for this small yet important group of patients who have been compelled to enter menopause at a very early phase of their lives, due to whatever reason.

This is important because these patients who have not had hormone replacement therapy are at increased risk of possibly premature death due to increased risk of cardiovascular conditions, bone fragility problems as well as morbidity from early dementia.

This audit has made it obvious we would need to implement changes and re audit.

¹University of Pavia, Pavia, Italy, renappi@tin.it

²George Washington University, IntimMedicine Specialists, Washington, DC, United States

³Queen’s University, Kingston, Ontario, Canada

⁴Queen Charlotte’s & Chelsea Hospital, Imperial College London

⁵Bayer AG, Wuppertal, Germany

⁶Bayer AG, Berlin, Germany

⁷Bayer SA, Sao Paulo, Brazil

⁸Bayer CC AG, Basel, Switzerland

⁹Bayer Consumer Care, Basel, Switzerland

¹⁰Bayer AG, Wuppertal, Germany

Objective: Assess the safety and tolerability of elinzanetant, a dual neurokinin-1,3 receptor antagonist for menopausal vasomotor symptoms (VMS), using pooled data from four clinical trials.

Methods: Pooled safety data from the 120 mg elinzanetant and placebo arms of the phase 3 OASIS-1,-2,-3 trials and phase 2 SWITCH-1 trial were analysed. The 12-week analysis included 765 elinzanetant- and 754 placebo-treated women (mean (SD) age 54.7 (4.8) years for both). In OASIS-1 and -2, women switched from placebo to elinzanetant after 12 weeks, leading to a 52-week analysis with 1,113 elinzanetant-treated and 754 placebo women (mean ages 54.6 (4.8) years and 54.7 (4.8) years, respectively). Safety assessments included adverse events (AEs), liver function (regular assessment by blinded external liver safety monitoring board), endometrial safety (transvaginal ultrasound/biopsies), bone mineral density (BMD), body weight, vital signs, and biochemical markers.

Results: Over 12 weeks, treatment-emergent adverse events (TEAEs) occurred in 50.8% of elinzanetant- versus 43.2% of placebo-treated women, mostly mild-to-moderate. Headache, fatigue, and somnolence were the most common TEAEs in the elinzanetant arm, primarily occurring during early treatment weeks. Serious AEs were rare (1.2% versus 0.9%) and none were assessed as study-drug related. Over 52 weeks, study-size and exposure-adjusted incidence rates (EAIRs) per 100 patient-years for headache were 15.48 (elinzanetant) versus 11.17 (placebo), and for fatigue 9.40 versus 4.73. Discontinuations due to TEAEs were infrequent: 1.2% (EAIR 2.23) of elinzanetant-treated women reported fatigue and 1.1% (EAIR 2.01) reported headache leading to discontinuation up to week 52. No Hy’s Law cases or acute liver failure were reported. One mild liver injury case (elinzanetant group) was assessed as unlikely study-drug related and resolved post-treatment. Mean values for estradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, bone biomarkers, body weight, blood pressure, cholesterol, and triglyceride remained stable over time. Endometrial safety assessments showed no hyperplasia/malignancy; BMD aligned with age-related expectations.

Conclusion: Elinzanetant was well-tolerated over 52 weeks, with low incidence of TEAEs and discontinuations. No concerning safety signals in hepatic, endometrial, metabolic, or bone parameters emerged. The most common TEAEs, headache and fatigue, were mild-to-moderate and mostly transient, supporting elinzanetant’s potential as a long-term dual neurokinin-targeted therapy for menopausal symptoms.

Funding: Bayer. Medical writing assistance was provided by Highfield, Oxford, UK, funded by Bayer.

¹GP, Brunswick Surgery, Surbiton, yasminmaki@gmail.com

Background: Perimenopause marks the beginning of hormonal shifts and the transition from reproductive to post-reproductive stages of life. Recent attention from media and policymakers in the UK has increased public awareness and brought greater visibility of this important phase of life.

Objective: This scoping review aimed to explore existing qualitative research on perimenopause experiences in the UK, identifying which aspects of the perimenopause experience it focused on and whose voices it represented.

Methods: Following Arksey and O’Malley’s Scoping Review framework, a comprehensive search was conducted across several databases, covering studies published between May 2021 and July 2024.

Results: Twenty-one studies were identified. Studies focus was along five main themes: perimenopause at the workplace, women’s knowledge and attitudes of perimenopause, healthcare experiences, support systems, and demographic-specific experiences. Significant research gaps were found, particularly among ethnic minorities, LGBTQ+ individuals, and lower socioeconomic groups representation in the research.

Conclusion: Perimenopause is a crucial and distinct phase within the broader menopause experience. To better understand its complexities, future research should explore both its biomedical and non-biomedical dimensions. Such research should be diverse and inclusive to effectively address the varied needs of all individuals experiencing perimenopause.

¹Physician Associate, Aneurin Bevan University Health Board Menopause Specialist Service, jessica.ronan2@wales.nhs.uk

²SRH consultant, Aneurin Bevan University Health Board Menopause Specialist Service

Objective: Develop a clear clinical model for testosterone eligibility, counselling, initiation and monitoring, led by a physician associate (PA) supported by the specialist menopause team.

Methods: The exclusion criteria for the PA testosterone clinic were:

– No evidence of reduced libido on referral

Eligible patients were given a 30-minute PA telephone appointment. Assessment and counselling used a standardised proforma developed in-line with NICE and BMS guidance. Baseline testosterone levels were requested prior to dispensing a prescription. This test was required within 2 months of the initial consultation, to encourage patient engagement and avoid discharge. Prescriptions were written by an independent prescriber or doctor. After initiation, a further testosterone blood test was requested at 6–12 weeks. Results were communicated to the patient by text message or a phone call. Following 6 months of testosterone treatment, a telephone appointment, establishing the efficacy of the testosterone supplementation was conducted. Continuation of testosterone was then provided by primary care via a shared care agreement.

Results: Between June 2024 and March 2025 there were 85 patients seen in the testosterone clinic. Eighty patients attended and 5 did not attend. Fifty-one patients were eligible to start/continue testosterone supplementation from history taken via the standardised proforma.

Of the 51, four patients had existing baseline testosterone levels taken prior to their consultation and so were issued a prescription (if needed) at their first consultation. The remaining 47 patients had baseline bloods requested. At this point, 4 patients disengaged from the service. Fourty-three patients completed their baseline bloods and were issued a 6-month script for testosterone supplementation.

Conclusion: The structured, supervised practice of a PA leading this clinical model, allows consistent consultations and gathering of testosterone specific data. Should testosterone become ‘green’ and prescribed within primary care, this model could be followed by a wider group of healthcare professionals. In the future, an introduction of a standardised referral form to increase the number of eligible patients seen and an NHS baseline level to be taken before the initial contact could also improve the efficiency of the testosterone clinic.

¹Leeds Institute of Medical Education, School of Medicine, University of Leeds

²Centre for Pharmacy Postgraduate Education (CPPE), University of Manchester, um17hjb@leeds.ac.uk

Objective: Healthcare professionals lack undergraduate training linked specifically to the menopause (Macpherson and Quinton, 2022) and often feel ill-equipped to support people. The increase in the public needing support means pharmacy professionals are expected to be able to advise people within their current roles. The aim of this research was to consider how and to what extent pharmacy professionals were able to support people with menopause symptoms. A secondary aim was to understand the needs for continuing learning and development of resources to support a change in their current practice.

Methods: A qualitative study within the constructivist paradigm was designed to consider the research aims. Semi-structured interviews (n = 22) were conducted with pharmacy professionals to gather their experience to date, their perceptions of support they offer, barriers and enablers to provision of care and any learning they had undertaken linked to menopause. A broad range of perspectives was gathered by engaging pharmacy professionals from various sectors of practice across England. Interviews were conducted online and transcribed verbatim. After transcription, Reflexive Thematic Analysis (Braun and Clarke, 2022) was used to analyse and interpret the data.

Results: Initial data analysis demonstrates pharmacy professionals are keen to further their learning in menopause. Some have done this successfully which has been driven by their own interest in the topic and peer or mentor support. Confidence in their knowledge and experience of offering support appears to be a limiting factor. Different approaches to learning were identified both through using national educational resources and support from mentors.

Conclusion: Preliminary findings show great variability in confidence to support those with menopause. Some have confidence and knowledge to support people effectively, for others experience of conducting menopause consultations, available time, demand and access to training can be barriers. Further exploration of themes will be conducted to consider learning needs to further enhance patient care and make recommendations about educational support needed moving forwards.

References

1. Macpherson, B.E. and Quinton, N.D. 2022. Menopause and healthcare professional education: A scoping review. Maturitas. 166, pp.89–95.

2. Braun, V. and Clarke, V. 2022. Thematic analysis a practical guide. London: SAGE Publications Limited.

¹Consultant in Obstetrics Gynaecology, New Cairo Hospital, Egypt, hala.md123@gmail.com

Objective: To validate the psychometric properties of the Arabic version of the Day-to-Day Impact of Vaginal Aging (DIVA) Questionnaire for use in an Arabic context, specifically in Egypt.

Source: ashasexualhealth.org/pdfs/DIVA.pdf

The DIVA questionnaire is intended for use in studies of postmenopausal female sexual health, which remains a largely unexplored and culturally sensitive area in Arab communities, where silent endurance is often normalized and sexuality is considered taboo. Utilizing a validated, culturally adapted, and sensitive tool is therefore crucial.

Methods: The questionnaire was translated into Arabic by two independent translators, followed by back-translation and retranslation. Ten experts analysed each item for clarity, semantic equivalence, appropriateness, and cultural relevance. The final version was presented to 30 postmenopausal women for face validation to ensure its suitability for the target population.

A random sample of 150 postmenopausal women from various clinics in Cairo was included, after excluding those with allergic vaginitis, desquamative inflammatory vaginitis, lichen simplex, lichen sclerosus, lichen planus, a history of vulvar, vaginal, or cervical cancer, active major medical illness, undiagnosed vaginal bleeding, prior or current use of hormonal replacement therapy, or local treatments for GSM symptoms.

Psychometric measures used for validation:

• Confirmatory Factor Analysis (CFA): Used to assess the model constructs.

Results: The Arabic version of the DIVA questionnaire was confirmed to be a valid tool. CFI value was 0.96, indicating a good model fit. Cronbach’s alpha was 0.89 for the entire scale, showing internal consistency. A correlation coefficient of 0.70 indicated acceptable test–retest reliability.

Conclusion: The final Arabic version of the DIVA questionnaire demonstrated confirmed face and content validity.

¹GP, Warlingham Green Medical Practice, Surrey, UK and Riga Stradins University, Latvia, cindy.heaster@nhs.net

²GP, Dorking Healthcare and Clinic 51

³GP, Warlingham Green Medical Practice, Dorking Healthcare and Menopause Care

⁴The Wall House Surgery, Reigate and Dorking Healthcare

Objective: To identify gaps in the literature about ADHD and the menopause in order to guide further research.

Methods: A systematic search was conducted using the Primo search engine using the search words ‘ADHD’ and ‘menopause’. Thirty-four studies were identified as being published up to February 2025. The resulting list of papers was screened, and the reference lists in relevant papers were further screened to find other papers of relevance.

Papers were included if they identified existing knowledge, or presented new information regarding ADHD, the (peri)menopause, or could be used to identify knowledge gaps in the existing literature regarding ADHD and the (peri)menopause. Two authors independently reviewed all screened articles in order to build the final selection.

Results: Women with ADHD continue to face barriers to care such as gender biased diagnostic criteria and long waiting lists. A delay in diagnosis has been reported to inhibit women from seeking timely help when needed. The mechanisms of hormonal shifts on cognitive changes in women with ADHD are largely under-studied, and the cause of improvement in symptoms for those over the age of 60 poorly understood. Many studies on ADHD do not include women over the age of 50, and others exclude those already taking psychostimulant medication. Psychostimulants have been shown in small studies to improve the cognitive symptoms of menopause in some women without ADHD.

Conclusion: Studies on ADHD and the menopause are limited. Gaps in the literature relating to ADHD and the menopause, including the perimenopausal period include: Hormonal shifts and cognitive changes, exploring barriers to ADHD diagnosis and care in the perimenopausal period, how menopausal symptoms are experienced differently in women with ADHD, the role of psychostimulants and non-stimulants for menopausal women with ADHD, the role of HRT in improving cognitive symptoms, and combination treatments for ADHD in the perimenopause. Further research is needed to understand how women with ADHD are affected by menopause and how to optimise treatment.