Precision Menopause Hormone Therapy (MHT) — the webinar slides
The slide deck from Prof Rajesh Varma's webinar (15 September 2026), reproduced for the web with the seven live votes converted to self-test questions. Anchored to NICE NG23 (updated November 2024) and its discussion aid, the BMS-led May 2026 joint guideline on unscheduled bleeding on HRT, and NICE TA1143. Use the arrows, keyboard or swipe. Intended for UK healthcare professionals.
Precision Menopause Hormone Therapy (MHT)
Tailoring regimen, dose and route to the woman in front of you
Presenter
Professor Rajesh Varma
Professor of Primary Care · former Consultant Gynaecologist · MA (Cantab) PhD MRCGP MRCOG
NICE Guideline Committee (Osteoporosis)
This meeting was organised and fully funded by Orion Pharma (UK) Ltd. Orion Pharma has had no input into the educational content of this event. Intended for UK healthcare professionals only. Prescribing information and adverse-event reporting information were available via the hosting platform.
Declarations of interest
Financial
- Honorarium from Orion Pharma (UK) Ltd for this webinar
- Speaker / advisory honoraria: Astellas, Bayer, Besins Healthcare, Theramex and others (list on request)
- Director, MD Acumen Ltd (medical education)
Professional
- Member, NICE Guideline Committee (Osteoporosis)
- RCGP speaker
- No stock or employment interest in any pharmaceutical company
- Certificate of Advanced Studies (CAS) in Menopause & Andropause — mdacumen.com/programmes/menopause-andropause
Independence. The meeting was organised and funded by Orion Pharma (UK) Ltd. The content is the speaker's own, educational and not promotional; medicines appear by generic (INN) name only. Follow the SmPC, NICE guidance and your local formulary.
The published argument — and the RCGP update it grew into
Review article · InnovAiT (RCGP) · March 2026
Ravindran N, Varma R. Cardiometabolic changes at menopause: time for precision menopause treatment. InnovAiT 2026;19(9):504–11 · doi:10.1177/17557380261425194
- Falling oestrogen redistributes fat from a gynaecoid to an android pattern and promotes dyslipidaemia, insulin resistance, hypertension and a pro-inflammatory state.
- Vasomotor symptoms appear to signal higher cardiovascular risk even after adjustment for established risk factors.
- A practical algorithm for GPs, illustrated with a case vignette and aligned with BMS and NICE guidance.
RCGP webinar · 6 July 2026
Menopause Update: HRT Precision & Holistic Management — the RCGP evening update (19:30–21:30 BST) in which this material was first taught, refined here into a one-hour, case-based hour with live voting.
Free CPD companion: the MD Acumen Menopause & Andropause micro-course.
Case-based learning — how the hour works
Three women, one hour
- Sarah, 47 — building the prescription
- Farah, 52 — bleeding on HRT
- Maria, 53 — hormones off the table
Seven live votes → seven self-tests
In the webinar the room voted live (Mentimeter). Here each vote is a self-test: pick an option, then reveal the answer and the one-line teaching point. Self-test slides are marked with teal dots in the navigation bar.
Questions were taken in upvote order at the end of the hour; the three take-homes stayed on screen throughout the Q&A.
What is menopause — and how is it diagnosed?
The diagnosis (NG23)
- ≥ 45 y: clinical diagnosis — no blood tests (vasomotor symptoms with a change in cycle = perimenopause; 12 months' amenorrhoea off hormonal contraception = menopause).
- 40–45 y: FSH only if there is genuine diagnostic uncertainty.
- < 40 y — POI: raised FSH on 2 samples 4–6 weeks apart (NG23); ESHRE / IMS 2024: FSH > 25 IU/L (one sample; repeat only if doubt) with ≥ 4 months' menstrual disturbance · specialist-shared care.
Menopause = the final menstrual period (FMP), confirmed retrospectively after 12 months' amenorrhoea. Perimenopause = irregular cycles / symptoms up to the FMP (+ 1 year by clinical convention; STRAW+10 dates early postmenopause from the FMP itself).
Typical
Hot flushes & night sweats · fragmented sleep · low mood, anxiety, 'brain fog' · arthralgia · irregular cycles · vaginal dryness · low libido
Atypical — the ones we misattribute
Palpitations · dizziness, tinnitus · new migraine · widespread myalgia ('?inflammatory arthritis') · burning mouth · dry, itchy skin
Sources: NICE NG23 (updated Nov 2024) · STRAW+10 (Harlow 2012) · ESHRE POI guideline 2024 (with IMS, ASRM, CRE-WHiRL) · Lumsden & Hardman, BMJ 2025;389:r1077
Why say MHT rather than HRT?
'Replacement' is a misnomer
Menopause is a physiological transition, not a deficiency disease.
'Therapy' describes what we do
Treat symptoms and indications at the lowest effective dose, titrated and reviewed.
The world has moved
The IMS and most of the current literature say MHT. (The Menopause Society, formerly NAMS, still says 'hormone therapy'.)
Sources: IMS recommendations and key messages, Climacteric 2025;28:634–56 · Davis et al., Lancet 2024 series · Lumsden & Hardman, BMJ 2025 — 'treatment requires a personalised approach'
The transition is universal. Treatment is not.
Sources: Hirst et al., BMJ Medicine 2025;4:e001349 (QResearch) · Avis et al., JAMA Intern Med 2015 (SWAN) · Bartz, Tadikonda & Manson, JAMA 2026;335:1297–9 · NHS England / Wellbeing of Women
Two questions now — both return at the end
Q1 · Confidence managing menopause & MHT today
Q2 · The benchmark. A 58-year-old on continuous combined HRT for 4 months has light unscheduled bleeding. No risk factors. Next step?
- 6 months of irregular periods, flushes, night sweats, broken sleep, 'brain fog'
- Uterus intact · no red flags · wants treatment
No test needed
Aged 45 or over with typical symptoms, the diagnosis is already made — the interesting question is her numbers.
Onset of CKM?
Her waist, blood pressure, LDL-C and QRISK3 are not incidental findings. They are the menopause presentation.
Menopause is a cardiometabolic inflection point
- Fat shifts to the viscera; LDL-C and triglycerides rise; blood pressure and insulin resistance climb.
- Metabolic-syndrome prevalence roughly doubles from pre- to post-menopause (crude figures); in SWAN the odds of new metabolic syndrome rose ~1.45-fold per year through the perimenopause, independent of ageing.
- Frequent vasomotor symptoms track higher CVD risk (SWAN: HR 1.5; persistent frequent VMS HR 1.8) — a biomarker, not a nuisance.
- Sarah's waist, BP, LDL-C and QRISK3 ARE the menopause presentation.
Should I do CKM tests?
Yes — and stage the CKM, if present.
Six extra data points in the same 10 minutes: waist · BP · HbA1c · LFTs · lipids · eGFR
Guard-rail
NG23: MHT treats symptoms — it is not CVD or dementia prevention. The benefit–risk balance is most favourable when MHT is started under 60 or within 10 years of the FMP (IMS 2025 / BMS); a nationwide Danish cohort found no excess all-cause mortality (BMJ 2026).
Sources: Ravindran & Varma, InnovAiT 2026 · Lobo & Gompel, Lancet Diabetes Endocrinol 2022 · Janssen et al., Arch Intern Med 2008 (SWAN) · Thurston et al., JAHA 2021 (SWAN) · Mikkelsen et al., BMJ 2026;392:e085998 · NICE NG23
The precision menopause review — one slide
Cardiometabolic
- BP · BMI · waist
- Lipids ± HbA1c / LFTs / eGFR → QRISK3
- Smoking, alcohol, activity
Symptoms — all domains
- Vasomotor · sleep · mood · cognition
- Urogenital and sexual — ask directly
- Impact on work and home
Housekeeping
- Contraception still needed (2 years after FMP if < 50; 1 year if ≥ 50)
- Lifestyle is the foundation
- Breast screening up to date
- Review at 3 months after initiating, then annually
Sources: NICE NG23 · BMS HRT Guide (reviewed Feb 2026) · FSRH/CoSRH contraception guidance
Three decisions build every first script
Uterus?
Present → oestrogen + progestogen
Absent → oestrogen only
Regimen for the progestogen?
Perimenopausal → sequential (sHRT)
Postmenopausal → continuous-combined (ccHRT)
Route?
Transdermal first-line.
Oral: low-risk women, by preference.
Sarah: uterus → E2 + progestogen · late perimenopause → sequential · BP + QRISK3 → transdermal. ✔
Migraine with aura is an indication FOR the transdermal route — not a contraindication to MHT. BMS 2026 nuance: oral preparations give higher amenorrhoea rates than transdermal, so in a woman at low thrombotic risk oral can be offered first-line, or when bleeding persists on transdermal despite adjustments.
Sources: BMS HRT Guide, Feb 2026 · BMS-led joint guideline, unscheduled bleeding on HRT, May 2026 · NICE NG23 · Mukherjee & Davis, Clin Endocrinol 2025
Route decides clot risk; progestogen decides the rest
Route — VTE & stroke
- Transdermal 17β-estradiol: VTE risk not increased (NG23); stroke unlikely to increase with transdermal oestrogen at standard doses.
- Excess thrombotic risk belongs to the oral route.
- Titrate transdermal to control symptoms, then reassess.
Progestogen — breast & endometrium
- Micronised progesterone / dydrogesterone: the most favourable breast and VTE profile in observational data (NG23: evidence still insufficient to be certain).
- 52 mg LNG-IUS: endometrial protection PLUS contraception.
- Under-dosed progestogen is itself an endometrial-cancer risk factor.
Sources: NICE NG23 (2024) · BMS 2026 · Gompel & Simcock, Lancet Diabetes Endocrinol 2026;14:259–74 · Mukherjee & Davis 2025
Match the progestogen to the oestrogen — every time
| Oestradiol dose band | Gel (pump) | Gel (sachet) | Spray | Patch | Oral estradiol | Micronised progesterone cont / seq | Synthetic progestogens cont / seq (mg) | 52 mg LNG-IUS |
|---|---|---|---|---|---|---|---|---|
| Low | 1 pump | 0.5 mg | 1–2 sprays | 25 / 30 / 37.5 µg | 0.5 mg | 100 / 200 mg | NET 5 / 5 · MPA 2.5–5 / 10 · dydrogesterone 10 / 10 | Any band — up to 5 years' use |
| Medium | 2–3 pumps | 1 mg | 3 sprays | 40 / 50 / 75 µg | 1–2 mg | 100 / 200 mg | NET 5 / 5 · MPA 5 / 10 · dydrogesterone 10 / 10 | |
| High† | 4 pumps | 2–3 mg* | 4–6 sprays* | 100 µg | 3 mg* | 200 / 300 mg | NET 5 / 5 · MPA 10 / 20‡ · dydrogesterone 10 / 20 |
* Outside SmPC licence. † High and off-licence doses only in exceptional, individualised cases after full discussion — change preparation before exceeding licence. ‡ Limited evidence for MPA with high-dose oestrogen. NET 1 mg and dydrogesterone 2.5–5 mg protect at low–medium dose, but the lowest UK stand-alone tablets are 5 mg and 10 mg. BMS May 2026, Tables 2–3.
Sequential minimums
Micronised progesterone 12(–14) days / cycle · NET or MPA 10(–12) days / cycle
Raise the oestrogen →
re-check the progestogen the same day. Bleeding on low–medium dose? Micronised progesterone 200 mg continuous / 300 mg sequential.
Why it matters
Matching E2 and progestogen prevents unscheduled bleeding and prevents endometrial cancer.
Source: BMS joint guideline (BMS · BSGE · BGCS · CoSRH · GIRFT · RCGP · RCOG), Management of unscheduled bleeding on HRT, May 2026 — Tables 2–3
Sarah, 47 — perimenopausal, uterus intact, BMI 29, BP 142/88, QRISK3 12%. Most appropriate first-line MHT?
"Will it give me breast cancer?"
1,000 women take combined HRT for 5 years from age 50. Measured to age 69, how many more develop breast cancer than never-users?
Breast cancer — the numbers NICE asks us to use
Mortality — NICE 2024 wording
"A very small increase in risk of death from breast cancer with combined HRT"; "little or no increase" with oestrogen-only; either is "unlikely to affect life expectancy". WHI 20-year follow-up (Chlebowski 2020): 71 vs 53 breast-cancer deaths — 0.045% vs 0.035% per year, HR 1.35 (95% CI 0.94–1.95) for CEE + MPA; HR 0.60 for CEE alone.
Use it live
Open the NICE discussion aid with the patient and point at the dots, not at percentages. "Fifty-nine in a thousand get breast cancer with no HRT; with five years of combined HRT it is seventy-nine — twenty more, counted over twenty years. Now let's weigh that against your symptoms, together."
By domain, age and route
| Domain | Direction | The nuance that changes the consultation |
|---|---|---|
| Bone / fracture | ▲ benefit | Real and sustained while treated — the forgotten benefit |
| VTE / stroke | ▲ oral only | Transdermal: VTE risk not increased (NG23); stroke unlikely to increase with transdermal oestrogen |
| Breast cancer | △ small | NICE aid: 20 more per 1,000 (combined, 5 years' use, ages 50–69); NG23 2024: a very small increase in breast-cancer death with combined HRT |
| Endometrium | protected | IF the progestogen is proportionate — unopposed oestrogen is the risk |
| CVD / cognition | neutral | Not prevention indications (NG23); dementia risk might increase with combined HRT if started at 65 or over |
| All-cause mortality | neutral / ↓? | No increase (adjusted HR 0.96); lower with 1–9.9 years of use, null at ≥ 10 years (Danish cohort, BMJ 2026); NG23: unlikely to affect life expectancy |
Sources: NICE NG23 + discussion aid · BMS 2026 · Mikkelsen et al., BMJ 2026 · Crandall, Mehta & Manson, JAMA 2023
- Recurrent unscheduled bleeding on two sequential regimens — month 4
- Progestogen intolerance: low mood, bloating in the progestogen phase
- BMI 27 · no risk factors for endometrial cancer
- TVS: endometrium 6 mm, uniform, fully visualised — on sequential HRT
How often is USB?
Unscheduled bleeding in the early months affects up to 38% on sequential and 41% on continuous combined HRT (BMS 2026).
Farah — recurrent bleeding on sequential HRT, month 4, no risk factors for endometrial cancer, TVS 6 mm, uniform, fully visualised. Next step?
USB on HRT → assess risk factors for endometrial cancer → act
Why the reflex retired: USCP referrals rose 43% over three years while cancers diagnosed rose 2% (BMS 2026). The delegate quick reference reproduces this pathway.
Source: BMS-led joint guideline (BMS · BSGE · BGCS · CoSRH · GIRFT · RCGP · RCOG), Management of unscheduled bleeding on HRT, May 2026 — flowchart p. 6
Endometrial-cancer risk factors — major vs minor
Any one MAJOR → USCP
- BMI ≥ 40 kg/m²
- Lynch / Cowden syndrome
- Unopposed oestrogen > 6 months (uterus present)
- Tricycling (quarterly progestogen) > 12 months
- Sequential HRT > 5 years, started age ≥ 45
- ≥ 12 months' under-dosed sequential progestogen*
Three or more MINOR → USCP · two MINOR → urgent TVS
- BMI 30–39 kg/m²
- Unopposed oestrogen 3–6 months
- Tricycling 6–12 months
- 6–12 months' under-dosed sequential progestogen*
- Progestogen not proportionate to oestrogen > 12 months (incl. expired IUS)
- Anovulation / PCOS · Diabetes
* Under-dosed sequential progestogen = norethisterone or MPA for < 10 days, or micronised progesterone for < 12 days, per month (BMS Table 1). Minor factors count in twos (urgent TVS) and threes (USCP). Note how many are iatrogenic: expired IUS, under-dosed progestogen, forgotten tricycling.
Source: BMS-led joint guideline, unscheduled bleeding on HRT, May 2026 — Table 1
Endometrial thickness — the 4 mm / 7 mm rule
| On TVS (double layer, maximal width) | Reassuring — low risk | Act |
|---|---|---|
| Continuous-combined HRT | ≤ 4 mm, uniform, fully visualised | > 4 mm → endometrial assessment on the USCP |
| Sequential HRT | ≤ 7 mm, uniform, fully visualised (NPV ≈ 99%) | > 7 mm → endometrial assessment on the USCP |
| Endometrium incompletely visualised | — | Endometrial assessment regardless: urgent (within 6 weeks) if the visualised portion is within limits; USCP if above threshold |
No bleeding (incidental finding): ET > 4 mm (cc) / > 7 mm (seq) with ≥ 1 major or ≥ 2 minor risk factors → USCP. ET ≥ 10 mm → endometrial assessment — USCP if major risk factors, otherwise urgent (within 6 weeks). ET < 10 mm without major risk factors → adjust the progestogen; sample only if bleeding occurs.
Equity caveat
A 4 mm TVS threshold is markedly less sensitive in Black women (47.5% vs 87.9%; more fibroids, more non-endometrioid disease — Doll et al., JAMA Oncol 2021) — keep a lower threshold for direct endometrial assessment. 'Uniform + fully visualised' is part of the rule, not decoration.
Sources: BMS-led joint guideline, May 2026 — Section 4 & Appendix 2 · Doll KM et al., JAMA Oncol 2021;7:1158–65
Your benchmark woman: 58, continuous-combined HRT, 4 months, light bleeding — but her BMI is 41. Next step?
- ER-positive breast cancer — treatment completed
- 15–20 flushes a day · drenching night sweats · sleep destroyed
- Systemic MHT contraindicated · CBT helped mood; flushes persist · SSRI declined
What should you offer?
Until recently
"An SSRI and hope."
The non-hormonal landscape — ranked by evidence
Elinzanetant (dual NK-1 / NK-3)
MHRA-licensed July 2025; indication extended in 2026 to VMS caused by adjuvant endocrine therapy for breast cancer (OASIS 4); improves sleep. NICE appraisals pending — check your formulary.
Sources: NICE NG23 (2024) · Hickey et al., Lancet 2024 · OASIS 1–2, JAMA 2024 · OASIS 3, JAMA Intern Med 2025 · OASIS 4, NEJM 2025 · elinzanetant SmPC (rev. Aug 2026)
Fezolinetant 45 mg — what it does, and the liver rule
What it does
- Blocks NK3 on hypothalamic KNDy neurons → restores the thermoneutral zone. Non-hormonal.
- Benefit from week 1, sustained to 52 weeks (SKYLIGHT 1/2); works in women unsuitable for HRT (DAYLIGHT, 24 weeks).
- Network meta-analysis: VMS frequency reduction comparable to MHT regimens and better than SSRI / SNRI / gabapentin (Morga 2024) — NICE's own indirect comparison with desvenlafaxine was uncertain.
- NICE TA1143 (31 Mar 2026): an NHS option when HRT is unsuitable — HRT-contraindicated, HRT-caution, HRT-stopper or HRT-averse. Not licensed during breast-cancer endocrine therapy; after completed treatment → individual risk assessment.
The liver rule (MHRA / SmPC) — examinable
- Baseline LFTs — do not start if ALT/AST ≥ 2× ULN or bilirubin elevated (≥ 2× ULN).
- LFTs monthly for the first 3 months, then periodically at clinical discretion (the US label adds months 6 and 9).
- Stop if ALT/AST ≥ 3× ULN with bilirubin > 2× ULN or symptoms, or > 5× ULN — warn about fatigue, pruritus, jaundice, dark urine, pale stools, nausea, abdominal pain.
- Moderate / strong CYP1A2 inhibitors contraindicated · not recommended alongside ongoing oncological endocrine therapy.
Sources: SKYLIGHT 1 (Lancet 2023) · SKYLIGHT 2 (JCEM 2023) · DAYLIGHT, BMJ 2024;387:e079525 · Morga et al., Menopause 2024 · NICE TA1143 · MHRA Drug Safety Update 10 Apr 2025 / EMA DHPC Dec 2024–Jan 2025 · Veoza SmPC
Who can you offer fezolinetant?
The benchmark, re-asked — watch your own learning gain
58-year-old, continuous combined HRT, 4 months, light unscheduled bleeding, no risk factors. Next step?
Confidence, re-polled — same 1–5 scale
In the webinar, the 13:10 and 13:46 charts were put side by side: "At ten past, X% fast-tracked her. Now it is Y%. That is the pathway, learned — measured on you, live." One word for how the hour felt was the feedback form.
The three take-homes
- 1 · Menopause medicine IS cardiometabolic medicine. Waist · BP · lipids in the same 10 minutes. Treat symptoms; screen risk; never sell prevention.
- 2 · The modern default, dosed in proportion. Transdermal estradiol + micronised progesterone / 52 mg LNG-IUS · titrate to the woman · re-match at every change.
- 3 · Assess the bleed — and know the exits. Major / minor · 4 mm / 7 mm · optimise the low-risk. Hormones off the table? Fezolinetant and CBT are real answers.
Precision menopause care is not more work — it is the same ten minutes, aimed better. Thank you · enquiry@mdacumen.com · mdacumen.com
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Key references
- NICE. Menopause: identification and management. NG23 (updated 7 Nov 2024) — incl. Incidence of medical conditions with and without HRT: a discussion aid.
- BMS (with BSGE, BGCS, CoSRH, GIRFT, RCGP, RCOG). Management of unscheduled bleeding on HRT. Joint guideline, May 2026 (Tables 1–3, Appendices 1–2).
- BMS. Tool for Clinicians: HRT Guide. Reviewed Feb 2026.
- Ravindran N, Varma R. Cardiometabolic changes at menopause: time for precision menopause treatment. InnovAiT 2026;19(9):504–11. doi:10.1177/17557380261425194
- Lumsden MA, Hardman S. NICE guidelines on menopause are missing nuance. BMJ 2025;389:r1077.
- Mikkelsen AP, Bergholt T, Lidegaard Ø, Scheller NM. Menopausal hormone therapy and long term mortality: nationwide, register based cohort study. BMJ 2026;392:e085998.
- Gompel A, Simcock R. Menopausal hormone treatment and breast cancer. Lancet Diabetes Endocrinol 2026;14:259–74.
- Mukherjee A, Davis SR. Update on menopause hormone therapy; current indications and unanswered questions. Clin Endocrinol (Oxf) 2025. doi:10.1111/cen.15211
- Crandall CJ, Mehta JM, Manson JE. Management of menopausal symptoms: a review. JAMA 2023;329:405–20.
- Hickey M, et al. An empowerment model for managing menopause. Lancet 2024;403:947–57.
- Panay N, et al. International Menopause Society (IMS) recommendations and key messages on women's midlife health and menopause. Climacteric 2025;28:634–56.
- Lederman S, et al. Fezolinetant (SKYLIGHT 1). Lancet 2023;401:1091–102 · Johnson KA, et al. (SKYLIGHT 2). J Clin Endocrinol Metab 2023;108:1981–97.
- Schaudig K, et al. Fezolinetant in individuals unsuitable for hormone therapy (DAYLIGHT). BMJ 2024;387:e079525.
- NICE. Fezolinetant for treating moderate to severe vasomotor symptoms associated with menopause. TA1143, 31 Mar 2026 · MHRA Drug Safety Update, 10 Apr 2025 (EMA DHPC Dec 2024–Jan 2025).
- OASIS programme (elinzanetant): Pinkerton JV, et al. JAMA 2024;332:1343–54 · Panay N, et al. JAMA Intern Med 2025;185:1319–27 · Cardoso F, et al. N Engl J Med 2025;393:753–63 · MHRA licence Jul 2025, extended 2026 to endocrine-therapy VMS.
- Hirst JA, Mtika WM, Coupland C, Dixon S, Hippisley-Cox J, Hillman S. Inequalities in HRT prescribing in UK primary care: population based cohort study. BMJ Medicine 2025;4:e001349.
- ESHRE Guideline Group on POI. Evidence-based guideline: premature ovarian insufficiency. Hum Reprod Open 2024;2024(4):hoae065.
- Doll KM, Romano SS, Marsh EE, Robinson WR. Estimated performance of TVUS for postmenopausal bleeding in Black and White women. JAMA Oncol 2021;7:1158–65.
- Chlebowski RT, et al. Association of menopausal hormone therapy with breast cancer incidence and mortality (WHI). JAMA 2020;324:369–80 · Manson JE, et al. JAMA 2017;318:927–38.
- Thurston RC, et al. Menopausal vasomotor symptoms and risk of incident CVD events in SWAN. J Am Heart Assoc 2021;10:e017416 · Avis NE, et al. JAMA Intern Med 2015;175:531–9.
Provenance & governance: web adaptation of the slide deck for the webinar "Precision Menopause Hormone Therapy", Prof Rajesh Varma, 15 September 2026 — an event organised and funded by Orion Pharma (UK) Ltd; Orion Pharma had no input into the educational content. Cases are fictional teaching vignettes. Sources: NICE NG23 (updated Nov 2024) and discussion aid · BMS-led joint guideline, Management of unscheduled bleeding on HRT, May 2026 · NICE TA1143 (31 Mar 2026) · MHRA Drug Safety Update 10 Apr 2025 · ESHRE 2024 / IMS 2025. Generic (INN) names throughout. Educational material for UK healthcare professionals — not a substitute for the full guidelines, SmPC or local pathways, and not patient-facing advice. Slides fact-checked against primary sources and quick reference v5 · page last reviewed 15 September 2026 · continue with the free Menopause & Andropause micro-course · enquiry@mdacumen.com.