BackgroundThe vast majority of menopause care is delivered by primary care services; however, in recent years there has been an increase in referrals to secondary care services resulting in longer waiting times for patients.AimFacilitate the delivery of effective and timely menopause care for women without need for referral and long waits at Mid Yorkshire Hospital Teaching Trust (MYHTT). This required collaboration between primary and secondary care services.Methods(1) Development of joint Menopause Care & HRT Formulary. (2) Review of Menopause Referrals to MYHTT. (3) Developing Women's Health Leads network & Women's Health Hub via Microsoft Teams channel. (4) Streamlining management of unscheduled bleeding on HRT. (5) Developed Patient information for Menopause and HRT leaflets in the five most spoken languages in our community.ResultsOver 70% reduction in referrals to MYHTT to menopause service and over 30% reduction in referrals to post-menopausal bleeding clinics. It demonstrates that our shared learning approach has bridged the gap between primary and secondary care, creating a more supportive and inclusive healthcare environment.

IntroductionMenopause hormone therapy (MHT) is the most effective treatment for climacteric syndrome. However, its cardiovascular effects remain complex. The 'timing hypothesis' suggests these effects depend on the timing of initiation, but this has been increasingly questioned. This study evaluates evidence on cardiovascular risks associated with late MHT initiation in healthy women aged ≥60 years or ≥10 years post-menopause.MethodsA comprehensive literature search was conducted from the inception of each database until November 2023. The databases searched included PubMed, SciELO, Embase, and Cochrane. RCTs of human studies examining the cardiovascular effects of MHT in healthy women aged ≥60 years or those ≥10 years post-menopause were included. Eligibility screening, data extraction, risk of bias assessment were performed independently and in duplicate.ResultsNine RCTs comprising 36,051 participants were included. We focus on results from participants aged ≥60 years. The mean follow-up was 7.2 years. Six studies were sub-analyses of the Women's Health Initiative (WHI) trial, while three studies originated from other trials. Results from the WHI indicated no significant increase in cardiovascular risks with either CEE + MPA or Estrogen-only therapy. Non-WHI studies showed an elevated stroke risk with tibolone and higher doses of combined MHT, but no cardiovascular complications were observed with low doses.ConclusionThe increased risk of cardiovascular events in our target population is not statistically significant. There is a lack of high-quality evidence to suggest an increased risk of adverse cardiovascular outcomes in healthy women who initiate MHT at age ≥60 years or ≥10 years post-menopause.

AimMenopause, a significant life transition affecting all women, is underexplored among minoritised groups. No United Kingdom (UK) based studies have specifically investigated Muslim women’s menopause experiences. This study examines immigrant Muslim women’s experiences of and perspectives on menopause, hormone replacement therapy (HRT), and menopause-related healthcare (MRH).MethodsUsing constructivist grounded theory, we conducted online, in-depth, semi-structured interviews with participants recruited through the Brighton and Hove Muslim Women’s group. The interviews were audio-recorded, transcribed, and analysed through grounded theory coding (open, focused, selective, theoretical).ResultsTwelve interviews revealed a core theme, ‘Regaining Agency’, shaped by three interconnected categories: ‘Losing Control of My Body’, ‘Dealing with Menopause Alone’, and ‘Navigating a Web of Silence’. Women reported physical and emotional challenges, including sleep disruption, cognitive changes, and anxiety, with cultural stigma and limited knowledge compounding negative perceptions and experiences. Health-seeking behaviours varied; while some women viewed menopause as natural, others saw it as a medical issue. Misconceptions about HRT led to hesitancy; however, users reported significant symptom relief. Many encountered barriers to MRH, often facing dismissive and uninformed healthcare providers.ConclusionEnhanced education and support for menopausal women, along with mandatory training for general practitioners, are essential to improve the experience of menopausal transition for immigrant Muslim women.

ObjectiveSex cord-stromal neoplasms of the ovary are rare tumors and a very infrequent cause of androgen excess and virilization in women. We report two cases of postmenopausal women with rapidly progressive signs of virilization and negative or indeterminate imaging for pelvic masses.MethodsBoth patients underwent a complete hormone profile, inconclusive transvaginal ultrasound and contrast-enhanced abdominopelvic computed tomography.ResultsSerum hormone analysis revealed for both cases a marked increase in serum total testosterone (T). In the first woman, Δ-4 androstenedione (Δ-4 A), dehydroepiandrosterone-sulfate (DHEA-S) and cortisol levels were in a normal range for age. In the second, Δ-4 A and DHEA-S levels were below the reference range. For both women, an ovarian source of androgens was suspected and bilateral laparoscopic oophorectomy was performed. Ovarian histology demostrated bilateral Leydig cell tumor (LCT) in the first case and bilateral ovarian thecoma in the second. After surgery, total testosterone returned to normal levels and clinical symptoms subsided.ConclusionsIn cases of postmenopausal androgen excess, physicians must rule out relatively rare androgen-producing tumors originating from the adrenals or ovaries. Regardless of imaging evaluation, our report highlights the importance of prompt and careful clinical and hormonal evaluation to ensure appropriate and timely treatment for the patient.

Except for psychosis, women's mental health problems across the reproductive lifespan are common. There are periods in a woman's life, associated with significant sex hormone fluctuations, that render her particularly susceptible to mood disturbance and mental health illnesses, including eating disorders. Whilst eating disorders are usually conceptualized as diseases afflicting adolescence and young adults, there is increasing evidence to suggest the landscape for eating disorders has considerably changed and includes a peak in midlife, correlating with the perimenopause. Inpatient admissions and outpatient clinic attendances have increased amongst older women. It is likely this increasing trend is the result of numerous biopsychosocial factors. A diagnosis of an eating disorder in midlife may be more common in those women simultaneously navigating the perimenopause than in midlife women who remain pre-menopausal owing to the significant ovarian hormonal fluctuations encountered in the perimenopause. Eating disorders are serious illnesses associated with significant morbidity and mortality, which are exacerbated when present at older ages. Research is beginning to recognize the importance of including this typically under-represented cohort of middle-aged women in empirical studies, which is critical to a complete etiological understanding. Recognizing and treating these varied presentations and establishing effective treatments for chronic, recurrent and new-onset eating disorders in midlife women is crucial.

Unscheduled bleeding on hormone replacement therapy (HRT) can affect up to 40% of users. In parallel with the increase in HRT prescribing in the UK, there has been an associated increase in referrals to the urgent suspicion of cancer pathway for unscheduled bleeding. On behalf of the British Menopause Society (BMS) an expert review panel was established, including primary and secondary care clinicians with expertise in the management of menopause, with representatives from key related organisations, including the Royal College of Obstetricians & Gynaecologists, the British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Royal College of General Practitioners and Faculty of Sexual and Reproductive Health, and service development partners from NHS England and GIRFT (Getting it Right First Time). For each topic, a focused literature review was completed to develop evidence led recommendations, where available, which were ratified by consensus review within the panel and by guideline groups.