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Article ; Online: Menopause transition: Physiology and symptoms.

Talaulikar, Vikram

Best practice & research. Clinical obstetrics & gynaecology

2022 Volume 81, Page(s) 3–7

Abstract: With life expectancy for women on the rise, most women will experience menopausal transition and spend a significant number of years of their life in the menopausal phase. Menopausal transition involves a myriad of physical, endocrine, and psychological ... ...

Abstract	With life expectancy for women on the rise, most women will experience menopausal transition and spend a significant number of years of their life in the menopausal phase. Menopausal transition involves a myriad of physical, endocrine, and psychological changes which are influenced by ethnic, psychological, and socio-cultural factors. Every woman's experience of the menopausal transition is unique, and a one-size-fits-all approach to the management of symptoms does not work. An understanding of the pathophysiology and severity of menopausal symptoms and the benefits and risks associated with both hormonal and non-hormonal treatments is important when individualising treatment options for menopausal symptoms.
MeSH term(s)	Female ; Humans ; Menopause/physiology ; Menopause/psychology
Language	English
Publishing date	2022-03-16
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2050090-7
ISSN	1532-1932 ; 1521-6934
ISSN (online)	1532-1932
ISSN	1521-6934
DOI	10.1016/j.bpobgyn.2022.03.003
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Article ; Online: A systematic review of randomised clinical trials - The safety of vaginal hormones and selective estrogen receptor modulators for the treatment of genitourinary menopausal symptoms in breast cancer survivors.

Hussain, Ishrat / Talaulikar, Vikram Sinai

Post reproductive health

2023 Volume 29, Issue 4, Page(s) 222–231

Abstract: Therapies utilised in breast cancer management have been found to induce or worsen the genitourinary symptoms of menopause (GSM), a group of physical symptoms associated with the systemic loss of estrogen. These symptoms are often undertreated due to ... ...

Abstract	Therapies utilised in breast cancer management have been found to induce or worsen the genitourinary symptoms of menopause (GSM), a group of physical symptoms associated with the systemic loss of estrogen. These symptoms are often undertreated due to concerns surrounding cancer recurrence, especially when considering treatments with possible pro-estrogenic effects. As breast cancer prognosis continues to improve, clinicians are increasingly focussing on managing these symptoms amongst survivors. This systematic review primarily aimed to determine the risk of breast cancer recurrence amongst survivors using vaginal hormones and selective estrogen receptor modulator therapies recommended for use in GSM in the United Kingdom amongst currently published randomised clinical trials (RCTs). The secondary aim was to determine whether these RCTs demonstrated a significant rise in serum estrogen levels following the use of these therapies. A literature search revealed three RCTs suitable for assessment, two evaluating vaginal estrogen and one evaluating vaginal DHEA treatment. Our review determined that amongst published RCTs, no studies have aimed to assess for breast cancer recurrence; however among the studies observing for serious adverse effects of vaginal estrogen preparations, none have reported an increased incidence. Furthermore, these studies did not report a persistent or significant increase in serum estrogen levels following the use of vaginal estrogen products and low concentration (3.25 mg/day) DHEA gel. Larger RCTs studying commonly used vaginal preparations and selective estrogen receptor modulator treatments for GSM over longer follow-up periods will be vital to better assess the risk of breast cancer recurrence in survivors receiving these treatments.
MeSH term(s)	Female ; Humans ; Selective Estrogen Receptor Modulators/adverse effects ; Cancer Survivors ; Neoplasm Recurrence, Local/complications ; Neoplasm Recurrence, Local/drug therapy ; Breast Neoplasms/complications ; Estrogens/adverse effects ; Menopause ; Survivors ; Dehydroepiandrosterone/therapeutic use
Chemical Substances	Selective Estrogen Receptor Modulators ; Estrogens ; Dehydroepiandrosterone (459AG36T1B)
Language	English
Publishing date	2023-10-16
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	2753537-X
ISSN	2053-3705 ; 2053-3691
ISSN (online)	2053-3705
ISSN	2053-3691
DOI	10.1177/20533691231208473
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Article ; Online: Hormone replacement therapy in women with history of thrombosis or a thrombophilia.

Morris, Guy / Talaulikar, Vikram

Post reproductive health

2022 Volume 29, Issue 1, Page(s) 33–41

Abstract: Findings from the Women's Health Initiative (WHI) randomised placebo-controlled trial (RCT) were published at the beginning of this century. They suggested that hormone replacement therapy (HRT) use increased the risk of cardiovascular disease and venous ...

Abstract	Findings from the Women's Health Initiative (WHI) randomised placebo-controlled trial (RCT) were published at the beginning of this century. They suggested that hormone replacement therapy (HRT) use increased the risk of cardiovascular disease and venous thromboembolism including pulmonary embolism and deep vein thrombosis The findings led to a decline in HRT prescriptions and negative publicity about the use of HRT for women with significant menopausal symptoms. Subsequent studies have shown that the risk of thrombosis with HRT relates to whether estrogen is combined with a progestogen and the route of administration of estrogen. In healthy women with no background medical problems, transdermal hormone replacement is not associated with an increased risk of thrombosis. However, much less is known about the safety of various HRT preparations in women with a high background risk of thrombosis. These cases can often be challenging for clinicians with uncertainties around testing for thrombophilia, use of anticoagulation and striking a balance between the risks and benefits of prescribing HRT. This article will review the mechanism of thrombosis with differing types of HRT and present the evidence from the relevant trials. The article will also present the evidence that specifically relates to women with a personal history of thrombosis or thrombophilia (heritable and acquired) to enable clinicians to better individualise the risk assessment for each woman requesting HRT and understand the role of thrombophilia screening or concomitant anticoagulation in such situations.
MeSH term(s)	Female ; Humans ; Estrogen Replacement Therapy/adverse effects ; Hormone Replacement Therapy/adverse effects ; Thrombosis/prevention & control ; Thrombosis/chemically induced ; Estrogens/adverse effects ; Thrombophilia/drug therapy ; Thrombophilia/chemically induced ; Thrombophilia/complications ; Anticoagulants ; Risk Factors ; Randomized Controlled Trials as Topic
Chemical Substances	Estrogens ; Anticoagulants
Language	English
Publishing date	2022-12-27
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2753537-X
ISSN	2053-3705 ; 2053-3691
ISSN (online)	2053-3705
ISSN	2053-3691
DOI	10.1177/20533691221148036
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Article ; Online: Preface.

Talaulikar, Vikram / Davies, Melanie C

Best practice & research. Clinical obstetrics & gynaecology

2022 Volume 81, Page(s) 1–2

Language	English
Publishing date	2022-03-17
Publishing country	Netherlands
Document type	Editorial
ZDB-ID	2050090-7
ISSN	1532-1932 ; 1521-6934
ISSN (online)	1532-1932
ISSN	1521-6934
DOI	10.1016/j.bpobgyn.2022.03.004
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Article ; Online: Non-oestrogen-based and complementary therapies for menopause.

Al Wattar, Bassel H / Talaulikar, Vikram

Best practice & research. Clinical endocrinology & metabolism

2023 Volume 38, Issue 1, Page(s) 101819

Abstract: Women are living a significant portion of their adult lives in the post-reproductive phase, and many seek help for debilitating menopausal symptoms. Every individual's experience of menopausal transition is unique. Adopting a holistic approach to ... ...

Abstract	Women are living a significant portion of their adult lives in the post-reproductive phase, and many seek help for debilitating menopausal symptoms. Every individual's experience of menopausal transition is unique. Adopting a holistic approach to managing the menopause using a combination of lifestyle, hormonal, and non-hormonal interventions is key to maximise the quality of life of affected women. However, many opt to use non hormonal options or have contraindications to using hormonal therapy. Studies have shown that several pharmacological non-hormonal medications such as SSRIs, SSRI/SNRIs, Gabapentin, and Pregabalin are effective for managing vasomotor symptoms as well as other menopausal symptoms. Their main side effects are dry mouth, nausea, constipation, reduced libido, and loss of appetite. Clonidine is the only non-hormonal drug which is licenced for control of vasomotor symptoms in the UK, but has several side effects including dizziness and sleep disturbance. Cognitive Behavioural Therapy is recommended as a treatment for anxiety, sleep problems and vasomotor symptoms related to menopausal transition. Evidence for clinical efficacy and safety of herbal remedies and alternative therapies remains weak. Studies with neurokinin receptor 3 antagonists on women with hot flushes have shown improvement in vasomotor symptoms and results of large-scale studies are awaited.
MeSH term(s)	Adult ; Female ; Humans ; Quality of Life ; Menopause ; Gabapentin/therapeutic use ; Gabapentin/pharmacology ; Hot Flashes/drug therapy ; Complementary Therapies
Chemical Substances	Gabapentin (6CW7F3G59X)
Language	English
Publishing date	2023-08-25
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2052339-7
ISSN	1878-1594 ; 1532-1908 ; 1521-690X
ISSN (online)	1878-1594 ; 1532-1908
ISSN	1521-690X
DOI	10.1016/j.beem.2023.101819
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Article ; Online: In praise of ovulation induction for the management of anovulatory subfertility.

Al Wattar, Bassel H / Talaulikar, Vikram

Reproductive biomedicine online

2023 Volume 47, Issue 2, Page(s) 103219

Abstract: Rapid advances in assisted reproductive technology have revolutionized fertility treatments for couples worldwide seeking a pregnancy. Although this is promising, concerns are emerging over the overuse of unnecessary assisted conception treatments, ... ...

Abstract	Rapid advances in assisted reproductive technology have revolutionized fertility treatments for couples worldwide seeking a pregnancy. Although this is promising, concerns are emerging over the overuse of unnecessary assisted conception treatments, particularly among couples with anovulatory subfertility. Some experts are calling for the cessation of ovulation induction as the primary treatment of anovulatory subfertility in favour of more sophisticated assisted conception treatments. In the absence of other causes of subfertility, ovulation induction in patients with type 1 and type 2 anovulation disorders can achieve an up to 80% ovulation rate with a 40% cumulative pregnancy rate and few adverse effects. Considering the various risks and high costs associated with assisted reproductive technology treatments, it is hard to argue for their cost-effectiveness when simpler, safer and cheaper pharmacological ovulation induction could achieve comparable pregnancy rates. We argue here for the safe, effective and ethical use of ovulation induction in this population, supplemented by a judicious use of assisted conception treatments. We emphasize the essential role of ovulation induction as a first-line intervention for couples with anovulatory subfertility delivered within a patient-centred multidisciplinary care model and with a clear escalation pathway to use assisted reproductive technology treatments based on the person's response, characteristics and treatment preference.
MeSH term(s)	Pregnancy ; Female ; Humans ; Anovulation/drug therapy ; Infertility/complications ; Fertilization ; Ovulation ; Ovulation Induction/adverse effects
Language	English
Publishing date	2023-04-19
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2113823-0
ISSN	1472-6491 ; 1472-6483
ISSN (online)	1472-6491
ISSN	1472-6483
DOI	10.1016/j.rbmo.2023.04.010
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Article ; Online: An online survey and interview of GPs in the UK for assessing their satisfaction regarding the medical training curriculum and NICE guidelines for the management of menopause.

Dintakurti, Nitya / Kalyanasundaram, Shreya / Jha, Prashant / Talaulikar, Vikram

Post reproductive health

2022 Volume 28, Issue 3, Page(s) 137–141

Abstract: Background: The UK is home to 13 million menopausal women. The aim of this study was to determine the views of GPs on their levels of confidence and comfort when advising or treating menopausal women and assess the need for further training.: Method: ...

Abstract	Background: The UK is home to 13 million menopausal women. The aim of this study was to determine the views of GPs on their levels of confidence and comfort when advising or treating menopausal women and assess the need for further training. Method: An anonymous online questionnaire was sent out to GPs working within the NHS across the UK between January 2021 and March 2021. The questionnaire was circulated via GP e-mail lists, Facebook, and LinkedIn, and included an option for respondents to volunteer for a semi-structured interview. Results: The questionnaire had 173 responses. 52% of GPs indicated that they were not offered enough support to be able to advise and treat women with menopausal symptoms appropriately. 77.5% of GPs expressed that there is a need to improve training provided on menopause in medical school and GP training. 60.7% of GPs felt comfortable managing menopausal women and offering them management options. 22.5% of the respondents felt that the NICE guidelines are easy and clear guidance for clinical practice. Five GPs were further interviewed, and the analysis of the responses showed the perceived need by the GPs for improvements in medical training regarding menopause. Conclusion: There is a need for better support and medical training for GPs to help them advice and treat women with menopausal symptoms. This is key for ensuring that every woman in the UK feels supported in their journey during the menopausal transition and is offered evidence-based advice to help them make informed decisions.
MeSH term(s)	Curriculum ; Female ; Humans ; Menopause ; Personal Satisfaction ; Surveys and Questionnaires ; United Kingdom
Language	English
Publishing date	2022-05-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2753537-X
ISSN	2053-3705 ; 2053-3691
ISSN (online)	2053-3705
ISSN	2053-3691
DOI	10.1177/20533691221106011
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Article ; Online: Medical Therapy for Fibroids: What Next for Ulipristal Acetate?

Ekanem, Emmanuel / Talaulikar, Vikram

Advances in therapy

2020 Volume 38, Issue 1, Page(s) 137–148

Abstract: Ulipristal acetate (UPA) was introduced as a novel progesterone receptor modulator as effective therapy for symptomatic fibroids. Randomised clinical trials established its effectiveness in the management of heavy menstrual bleeding due to uterine ... ...

Abstract	Ulipristal acetate (UPA) was introduced as a novel progesterone receptor modulator as effective therapy for symptomatic fibroids. Randomised clinical trials established its effectiveness in the management of heavy menstrual bleeding due to uterine leiomyomas. The trials did not find any significant evidence of clinical harm to the participants. Recently, however, there have been reports of liver injury necessitating liver transplant in women who have had UPA treatment. This has led to the suspension of UPA as one of the medical therapies in the treatment for uterine fibroids while the European Medicines Agency (EMA) conducts a review of liver injury risk with its use. The European Medicine Agency safety committee has advised that women should stop taking 5 mg UPA and that no new patients should commence treatment with the medicine until the ongoing review is completed. In this article, we review the rise of UPA as one of the emerging medical therapies for symptomatic uterine fibroids and the subsequent reports of adverse events leading to the suspension of its use.
MeSH term(s)	Female ; Humans ; Leiomyoma/drug therapy ; Menorrhagia ; Norpregnadienes/therapeutic use ; Uterine Neoplasms/drug therapy
Chemical Substances	Norpregnadienes ; ulipristal acetate (YF7V70N02B)
Language	English
Publishing date	2020-11-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632651-1
ISSN	1865-8652 ; 0741-238X
ISSN (online)	1865-8652
ISSN	0741-238X
DOI	10.1007/s12325-020-01555-z
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Article ; Online: Medical therapy for fibroids: An overview.

Sinai Talaulikar, Vikram

Best practice & research. Clinical obstetrics & gynaecology

2018 Volume 46, Page(s) 48–56

Abstract: Uterine fibroids are the most common benign tumours in women of reproductive age group and are a cause of significant healthcare burden. Although surgical treatments have been the traditional gold standard for symptomatic uterine fibroids, several ... ...

Abstract	Uterine fibroids are the most common benign tumours in women of reproductive age group and are a cause of significant healthcare burden. Although surgical treatments have been the traditional gold standard for symptomatic uterine fibroids, several medical therapeutic approaches have been used to achieve symptom suppression in women who wish to preserve their uterus or are at elevated risk of complications during surgery. Medical therapies used for uterine fibroids include tranexamic acid, NSAIDs, contraceptive steroids, progesterone coil, GnRH analogues, aromatase inhibitors, SERMs and progesterone receptor modulators. The levonorgestrel containing intrauterine system reduces menstrual blood loss associated with fibroids, but drawbacks include the possibility of device expulsion and fitting difficulties. The use of GnRH agonists for 3-4 months prior to fibroid surgery can achieve reduction in uterine volume and fibroid size. They are beneficial in the correction of preoperative iron deficiency anaemia, if present, and reduce intra-operative blood loss. Although medical treatments provide effective symptom relief, women resorting to these therapies should be made aware of the high rates of future re-intervention. It is important for clinicians to recognise limitations of these therapies and that appropriate patient selection is of utmost importance.
MeSH term(s)	Female ; Humans ; Leiomyoma/drug therapy ; Observational Studies as Topic ; Prospective Studies ; Randomized Controlled Trials as Topic ; Uterine Neoplasms/drug therapy
Language	English
Publishing date	2018-01
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2050090-7
ISSN	1532-1932 ; 1521-6934
ISSN (online)	1532-1932
ISSN	1521-6934
DOI	10.1016/j.bpobgyn.2017.09.007
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Article ; Online: Women's knowledge and attitudes to the menopause: a comparison of women over 40 who were in the perimenopause, post menopause and those not in the peri or post menopause.

Tariq, Bisma / Phillips, Samantha / Biswakarma, Rina / Talaulikar, Vikram / Harper, Joyce C

BMC women's health

2023 Volume 23, Issue 1, Page(s) 460

Abstract: Objectives: To evaluate women's knowledge and attitudes towards the menopause by comparing three groups of women: perimenopause, post menopause and those women not in either the peri or post menopause (other).: Methods: A 35 question online survey ... ...

Abstract	Objectives: To evaluate women's knowledge and attitudes towards the menopause by comparing three groups of women: perimenopause, post menopause and those women not in either the peri or post menopause (other). Methods: A 35 question online survey was advertised on social media to evaluate women's attitudes and knowledge of the menopause. Three groups of women were compared: perimenopause, post menopause and those women not in either the peri or post menopause (other). Results: Most women were completely uninformed or only had some knowledge of the menopause before the age of 40. Most women thought that the menopause should be taught at school, but over 80% had received no menopause education at school themselves. The most popular sources of menopause information were independent websites and friends. Perimenopausal women were significantly more likely than postmenopausal women to use online resources for menopause information. The perimenopausal and postmenopausal groups had more positive attitudes towards the menopause than the other group. 57.5% of postmenopausal women found the menopause difficult or very difficult. Most women were happy about no longer menstruating, although some expressed sadness regarding fertility loss. Conclusions: Most women had limited knowledge and negative attitudes towards the menopause, leaving them unprepared to cope with the physical and psychological changes associated with this stage of life. Improved menopause education is required to improve quality of life during the menopausal transition and a most positive narrative of life postmenopause.
MeSH term(s)	Female ; Humans ; Postmenopause ; Perimenopause ; Quality of Life ; Menopause ; Attitude
Language	English
Publishing date	2023-08-30
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2050444-5
ISSN	1472-6874 ; 1472-6874
ISSN (online)	1472-6874
ISSN	1472-6874
DOI	10.1186/s12905-023-02424-x
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