British Menopause Society Research Articles

British Gynaecological Cancer Society and British Menopause Society guidelines: Management of menopausal symptoms following treatment of gynaecological cancer.

These guidelines have been developed jointly by the British Gynaecological Cancer Society and British Menopause Society to provide information for all healthcare professionals managing women treated for gynaecological cancer. Menopausal symptoms can have a significant impact on quality of life for women. Cancer therapies, including surgery, pelvic radiotherapy, chemotherapy and endocrine therapy, can all affect ovarian function. The benefits and risks of using hormone replacement therapy are considered by cancer type with guidance on the type of HRT and optimal time of commencement after cancer treatment. Vaginal estrogens can be very effective for improving urogenital symptoms and are safe for the majority of women, including those for whom systemic HRT is contraindicated with rare exceptions. Alternative options to HRT are reviewed including pharmacological and non-pharmacological approaches.

Management of unscheduled bleeding on HRT: A joint guideline on behalf of the British Menopause Society, Royal College Obstetricians and Gynaecologists, British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Faculty of Sexual and Reproductive Health, Royal College of General Practitioners and Getting it Right First Time.

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.

Hormone replacement therapy after myocardial infarction: British Menopause Society Tool for Clinicians.

Hormone replacement therapy after myocardial infarction: British Menopause Society Tool for Clinicians.

An evaluation of menopause service delivery during the COVID-19 pandemic.

To investigate the experience of remote outpatient menopause service delivery by clinicians and patients during the COVID-19 pandemic. Two surveys explored the experiences of patients and clinicians separately. Patients attending menopause clinics in the UK were directed to an online survey which included questions on demographics and on their experience of their most recent appointment. A clinician survey was shared to members of the British Menopause Society (BMS) via email and was made available on the BMS website. It contained questions on clinic characteristics and clinicians' experience of delivering remote menopause consultations. Surveys were available for completion between 01/12/2020 and 10/02/2021. Of 180 patients who completed the patient survey, 52% felt remote consultations were the same or better than face-to-face consultations, and 90% of patients felt a choice between remote and face-to-face consultations should be offered. Patients overall were satisfied with many aspects of care, though numerous problems were highlighted with appointment administration. Of 76 clinicians who completed the clinician survey, most found remote patient consultations either no different or a bit worse than face-to face consultations but found that they offered more flexibility. In some cases, significant rescheduling was necessary to accommodate for the clinical needs of the consultation. A 'one-size-fits-all' approach to managing the delivery of menopause care is not supported by patients or clinicians. There must be a robust process in place to avoid problems with appointment scheduling and associated communications. Lessons learned from the pandemic can help to provide holistic menopause care.

Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care “Menopausal disorders and other disorders in the perimenopausal period”

This protocol was developed on the basis of the clinical guideline “Menopausal disorders and other disorders in the perimenopausal period”, which is based on the principles of evidence-based medicine and takes into account the clinical guideline Recommendations on Women’s Midlife Health and Menopause Hormone Therapy, developed in 2016 by specialists of the International Menopause Society (IMS), and corresponds to the specifics of providing medical care in our country.Also, other international guidelines on menopause issues were used in the development of this protocol, such as: “Menopause: diagnosis and management” National Institute for Health and Care Excellence (NICE) guideline, 2019; сlinical guidance “Managing menopausal symptoms” Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), 2020; “The genitourinary syndrome of menopause” North American Menopause Society, (NAMS), 2020; British Menopause Society (BMS) & Women’s Health Concern (WHC) recommendations on hormone replacement therapy in menopausal women, 2020.The goal of the protocol: to ensure the organization of medical care, to establish uniform requirements for the diagnosis and treatment of patients with menopausal symptoms, to recommend the use of STRAW+10 (2011) criteria for menopause to all health care professionals.The protocol describes the organization of medical care for patients with menopausal disorders at all levels – from primary to tertiary care. Detailed information on diagnosis and treatment of this category of patients is presented. Special attention is paid to menopausal hormone therapy, taking into account its possible risks.The protocol is intended for general practitioners – family doctors, obstetrician-gynecologists, gynecological oncologists, oncologists, oncological surgeons, cardiologists, endocrinologists, orthopedic traumatologists and other medical professionals who provide medical assistance to women with menopausal disorders.

HRT in Women Undergoing Pelvic Clearance for Endometriosis—A Case Report and a National Survey

The optimal hormone replacement therapy (HRT) in women who have undergone pelvic clearance for endometriosis remains uncertain with insufficient evidence. The purpose of this case report and the national survey was to highlight the potential HRT-related risks and to establish current HRT practice in this group of women. The case was a 45-year-old woman presenting with recurrence of severe chronic pelvic pain while on oestrogen-only HRT (EO-HRT) for five years after subtotal hysterectomy and bilateral oophorectomy for severe endometriosis. MRI revealed multiple peri-cervical endometriomas and severe right hydroureter/hydronephrosis with complete right renal parenchymal loss. The survey was a 21-item questionnaire administered electronically using SurveyMonkey. It was reviewed and approved by British Menopause Society and British Society of Gynaecological endoscopy and was sent to their members as well as NHS Gynaecologists. A total of 216 physicians responded including 120 (55.6%) Gynaecology Consultants and 96 (44.4%) GPs/Nurses in Menopause clinics. Overall, 68.6% of responders prescribe combined HRT (C-HRT), 11.1% tibolone, 13.0% EO-HRT and 7.8% varied HRT. Fifty-one percent prescribe the progestogen component of C-HRT indefinitely, 22% for 3-6 months and 27% for varied durations. In conclusion, this study highlights the real risk of endometriosis recurrence in EO-HRT users after pelvic clearance for endometriosis. The survey revealed that only two thirds of Gynecologists/Menopause practitioners prescribe combined HRT in this group of women.

The British menopause society consensus statement on the management of estrogen deficiency symptoms, arthralgia and menopause diagnosis in women with treated for early breast cancer.

This guidance document by the British Menopause Society provides an overview of the management of women experiencing estrogen deficiency symptoms and arthralgia following a breast cancer diagnosis. It is now recommended breast cancer patients are referred to health care professionals with an expertise in menopause for management of such symptoms, which in turn often involves liaison with patients' breast cancer teams.1 However, as many women initially present to primary health care professionals for advice, this statement is aimed to support the latter in such consultations by providing information about symptom aetiology, current management strategies and controversies and identifying useful practice points. This is an updated version of the 2018 consensus statement prepared by Miss Jo Marsden Consultant Breast Surgeon, King's College Hospital, London, (retired), Mr Mike Marsh, Consultant Gynae-endocrinologist, King's College Hospital, London, Dr Anne Rigg, Consultant Medical Oncologist, Guy's and St Thomas' Hospital, London.

British Menopause Society Tool for clinicians: Testosterone replacement in menopause.

British Menopause Society Tool for clinicians: Testosterone replacement in menopause.

Joint position statement by the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on best practice recommendations for the care of women experiencing the menopause.

This article is temporarily under embargo.

Optimizing the menopause transition: Joint position statement by the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on best practice recommendations for the care of women experiencing the menopause.

The British Menopause Society (BMS), Royal College of Obstetricians and Gynaecologists (RCOG) and the Society for Endocrinology (SfE) have produced a joint position statement providing best practice recommendations on menopause care This article is protected by copyright. All rights reserved.

Developing the Women's health strategy: The British Menopause Society's recommendations to the department of health and social care's call for evidence.

In the early part of 2021, the government launched a call for evidence to inform the development of the Women's Health Strategy with the objective of better understanding women's experiences of the health and care system and to help improve the health and wellbeing of women. The British Menopause Society Medical Advisory Council and the BMS Board of Trustees recommendations specific to the menopause and post reproductive health in relation to all six core themes included in the call for evidence assessing the different areas of women's health are discussed in this document.

British Menopause Society tools for clinicians: Progestogens and endometrial protection.

Progestogen administration is required to oppose naturally produced or administered estrogens to provide endometrial protection. Within HRT regimens, this should be delivered for at least the same duration as that produced during the luteal phase of the monthly cycle and in the recommended doses to protect against the risk of endometrial hyperplasia and endometrial cancer. This includes progestogens administered for 12-14days a month in sequential regimens and continuous daily intake in continuous combined HRT regimens. Shorter durations and lower doses of progestogen intake are likely to be associated with an increased risk of breakthrough bleeding, endometrial hyperplasia, and endometrial cancer.

Response to changes in menopausal symptoms after use of testosterone: a retrospective analysis

Background: Androgen therapy in the form of testosterone has been used for many years for the management of low sexual desire in women and this often becomes a problem for women during the menopause transition. Testosterone is currently recommended by the International Menopause Society, the British Menopause Society and the National Institute for Health and Care Excellence (NICE) for the treatment of diminished sexual desire that causes the affected woman to experience significant distress.

A cross-sectional national questionnaire survey assessing the views of members of the British Menopause Society on the management of patients with unscheduled bleeding on hormone replacement therapy.

To explore the views of members of the British Menopause Society on the management of women with unscheduled bleeding on hormone replacement therapy. An electronic cross-sectional questionnaire survey. Investigations, treatment options and preferences for the management of women with unscheduled bleeding on hormone replacement therapy. A total of 91/178 (51%) clinicians investigate patients with unscheduled bleeding within three to six months of starting sequential hormone replacement therapy (seq-HRT) versus 83/178 (47%) for continuous combined hormone replacement therapy (con-HRT). A total of 52/178 (29%) versus 54/178 (30%) would investigate unscheduled bleeding continuing beyond six months while 18/178 (10%) versus 26/178 (15%) would investigate within three months. Assessment is requested as urgent by 88/176 (50%) clinicians, routine by 47/176 (27%) and a two-week-wait-suspected cancer referral by 41/176 (23%). A total of 97/178 (55%) clinicians would continue seq-HRT and refer versus 117/178 (66%) for con-HRT. A total of 46/178 (26%) clinicians would change the progestogen preparation in women with unscheduled bleeding on seq-HRT. For women on con-HRT, 12/178 (7%) clinicians would change to seq-HRT and 8/178 (5%) to the Mirena IUS. The Mirena IUS is the preferred progestogen for 81/178 (45%) of clinicians when prescribing hormone replacement therapy. There is a varied approach in the practise amongst British Menopause Society members to managing women with unscheduled bleeding on hormone replacement therapy. Further research is needed to determine the optimal assessment pathways for women with unscheduled bleeding on hormone replacement therapy.

The testosterone prescribing practice of BMS menopause specialists

The NICE Guidelines published in 2015 state that testosterone supplementation can be considered for menopausal women with low sexual desire if hormone replacement therapy alone is not effective. There is however, no detail on what to prescribe, how much to prescribe or whether monitoring is required. At the time of conception of this project, there was no national guideline or official advice from the British Menopause Society. We decided to ask menopause experts from around the UK to see if a consensus could be reached about good prescribing practice. The method and results as discussed below may be helpful in future recommendations and guidance.

Vision for menopause care in the UK.

Menopause is a major life event affecting all women in a variety of ways, both short and long term. All women should have access to accurate information, available in all forms and through all recognised sources. All healthcare professionals should have a basic understanding of the menopause and know where to signpost women for advice, support and treatment whenever appropriate. Every primary care team should have at least one nominated healthcare professional with a special interest and knowledge in menopause. All healthcare professionals with a special interest in menopause should have access to British Menopause Society Menopause Specialists for advice, support, onward referral and leadership of multidisciplinary education. With the introduction of the comprehensive British Menopause Society Principles and Practice of Menopause Care programme, the society is recognised throughout the UK as the leading provider of certificated menopause and post reproductive health education and training for healthcare professionals. Restrictions imposed by the coronavirus pandemic have been a springboard for the British Menopause Society to bring innovations to the services provided for our membership and for healthcare professionals throughout the UK.

The British Menopause Society & Women's Health Concern 2020 recommendations on hormone replacement therapy in menopausal women.

The British Menopause Society & Women's Health Concern 2020 recommendations on hormone replacement therapy in menopausal women.

Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care.

Testosterone is one of the sex hormones that women produce, yet it is often overlooked. Women actually produce three times as much testosterone as oestrogen before the menopause. Levels of testosterone gradually decline because of increasing age or they reduce abruptly following oophorectomy. The most commonly described symptoms of androgen insufficiency include dysphoric mood, unexplained fatigue, change in sexual function including reduced libido, changes in cognition, vasomotor symptoms, bone loss, and decreased muscle strength.1 Reduced or lack of libido is very common in menopausal women. The National Institute for Health and Care Excellence (NICE) guidelines state that testosterone supplementation can be considered for menopausal women with low sexual desire if hormone replacement therapy (HRT) alone is not effective.2 The British Menopause Society (BMS) 2016 recommendations advise that this indication could be extended to include menopausal women with low sexual desire and tiredness.3 Testosterone can be important in women for bone density and muscle mass, cognitive function, mood, sexual function, and energy.1 Adequate levels of testosterone are important for the maintenance of musculoskeletal health and possibly vascular and brain function. Numerous studies have shown that adding testosterone to hormonal therapy can improve sexual function and general wellbeing among women during their menopause. A recent systematic review and meta-analysis of testosterone treatment in women has provided robust support for a trial of testosterone in women when clinically indicated. In postmenopausal women, testosterone supplementation improved several domains of …

British Menopause Society 29th Annual Scientific Conference, Chesford Grange, Kenilworth

British Menopause Society 29th Annual Scientific Conference, Chesford Grange, Kenilworth

British Menopause Society Tools for Clinicians: HIV and the menopause

British Menopause Society Tools for Clinicians: HIV and the menopause