Vikram Sinai Talaulikar

• MD, FRCOG, PhD
• Hon. Associate Professor at University College London Hospitals NHS Foundation Trust

Objective: To identify the mental health implications among perimenopausal, menopausal, and post-menopausal women undergoing natural, surgical, or medical menopause in Sri Lanka. Design: A mixed-methods study was designed and used. Methods: The study secured ethics approval prior to commence the recruitment. This interim evaluation included 38 S...

Background: Menopause is the natural biological process marking the end of a woman's reproductive years. Common symptoms include hot flushes, night sweats, mood changes, and sleep disturbances. Menopause is diagnosed after 12 consecutive months without a period. While it’s a normal stage of life, the severity of symptoms can vary widely among women...

Objective: To assess the mental health implications among peri- menopausal, menopausal, or post-menopausal women who were undergoing natural, surgical, or medical menopause in Malaysia. Design: A mixed-methods study was designed and conducted in Malaysia following Ethics committee approval. Methods: This interim analysis involved 50 women, aged 18–...

Objective: To assess the mental health implications among per- imenopausal, menopausal, or post-menopausal women. Design: A mixed-methods study was designed and conducted in Nigeria following Ethics committee approval. Methods: This interim analysis encompasses 40 participants, including all women aged 18–90 living in Nigeria who pro- vided inform...

Objective: This study aims to determine the mental health im- pact and workforce issues of perimenopausal, menopausal, or post-menopausal women and trans men who have had natural, surgical, or medical menopause. Design: A mixed-methods study was conducted in England, Wales, Scotland and Northern Ireland following Ethics commit- tee and Health Resea...

Objective: This study aims to report the efficacy of hormone replacement therapy (HRT) in modulating lipid profile includ- ing a decrease in triglycerides (TG), subcutaneous fat thickness (SFH), and low-density lipoprotein cholesterol (LDL-C), along- side an increase in high-density lipoprotein cholesterol (HDL-C) and serum Estradiol levels. Design...

Objective: To identify the prevalence and outcomes of women undergoing pelvic organ prolapse (POP). Design: An evidence synthesis was conducted using a system- atic reivew and meta-analysis. Method: A systematic methodology was developed and pub- lished in PROSPERO (CRD42022346051). Searches were con- ducted using PubMed and Science Direct between...

Menopause marks the end of the menstruation period which can incur naturally or due to surgery where the ovaries or the uterus is removed, or the use of other treatments like chemotherapy. Menopause elicits both physiological and psychological changes such as joint or pelvic pain, headaches or migraine, cognitive function and mental health problems...

Background: Hormone Replacement Therapy (HRT) is a treatment for menopausal conditions. Studies showing benefits of HRT in preventing chronic diseases lead to development of clinical guidelines by the American College of Physicians. This study aims to assess the effectiveness of HRT treatments across cardiometabolic measures including Triglycerides...

Purpose: Hormone Replacement Therapy (HRT), an FDA-approved treatment for menopausal conditions was found to be associated with increased risk of endometrial cancer and reduced oestrogen. Studies showing benefits of HRT in preventing chronic diseases lead to development of clinical guidelines by American College of Physicians. This study aims to as...

Study question What do women know and think about the menopause? Summary answer Women reported a lack of their own and their health professional's knowledge of the menopause. Overall they had negative attitudes. What is known already Female fertility decline is strongly linked to the age a woman will go through the menopause. The menopause is def...

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...

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 dec...

Background All women experience the menopause, yet education around the topic is limited. Studies conducted in women aged over 40 show that women have limited knowledge about the menopause. Objectives This study aims to understand what women under 40 know about the menopause, how they have acquired this knowledge and where they think menopause edu...

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 grou...

Objectives NOA is often associated with hypogonadism and testicular failure. This study aims to evaluate the role of endocrine stimulation therapy prior to mTESE in men with hypogonadism and NOA. Methods This is a retrospective study on infertile men who underwent mTESE with or without prior endocrine stimulation therapy (clomiphene or hCG). Hypog...

Objectives NOA is often associated with hypogonadism and testicular failure. This study aims to evaluate the role of endocrine stimulation therapy prior to mTESE in men with hypogonadism and NOA. Methods This is a retrospective study on infertile men who underwent mTESE with or without prior endocrine stimulation therapy (clomiphene or hCG). Hypog...

Study question Does iron overload affect ovarian reserve markers in women with transfusion-dependent beta thalassaemia major? Summary answer Ovarian reserve markers were lower in women with transfusion dependent beta thalassaemia major as compared to controls suggesting an impact of iron overload on ovary What is known already Although spontaneou...

Introduction Women are not usually taught about the menopause formally, and many general practitioners have relatively little training. The aim of this study was to explore perimenopausal women’s attitudes and knowledge of the menopause. Method An online survey was designed to evaluate attitudes and knowledge of the menopause in women older than 4...

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 Ja...

Objective: Induction of puberty with exogenous oestrogen results in considerable variability in final uterine and breast volumes. We set out to quantify the variability of these two outcome measures with a view to establishing monitoring methods that could be used to individualise treatment protocols. Design: A prospective observational study....

With life expectancy for women on the rise, most women will experience menopausal transition and will 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 wo...

Breast cancer is the commonest cancer among women in the western world, accounting for up to 30% of all cancers in women. There is a long-standing controversy about the potential link to hormone replacement therapy (HRT), with large observational studies suggesting that HRT increases the risk, while the Women's Health Initiative (WHI), a prospectiv...

Plain language summary This paper deals with the use of hormone replacement therapy (HRT) after the removal of fallopian tubes and ovaries to prevent ovarian cancer in premenopausal high risk women. Some women have an alteration in their genetic code, which makes them more likely to develop ovarian cancer. Two well‐known genes which can carry an al...

Study question What is the role of endocrine stimulation therapy prior to mTESE in men with hypogonadism and non obstructive azoospermia (NOA)? Summary answer In hypogonadal men there is a positive correlation between change of serum Testosterone (ΔT) before and after stimulation, and a successful mTESE. What is known already NOA is the most comm...

Study question Is there a difference in treatment outcome between gonadotrophin releasing hormone (GnRH) pump or hMG for women with Type 1 anovulation undergoing ovulation induction? Summary answer Treatment with GnRH was more efficient compared to hMG, with fewer number of cycles to pregnancy, fewer days of stimulation and fewer cycle cancellatio...

Caesarean section rates are on the rise and this may be partly due to lack of appropriate training and experience in instrumental deliveries as well as medico-legal issues. Since caesarean section performed in the second stage of labour is associated with increased maternal morbidity, an appropriately performed instrumental vaginal delivery may hel...

Context Clinical practice guidelines (CPGs) are key instruments to implement the practice of evidence-based medicine. We aimed to evaluate the methodological quality and variations in CPGs recommendations on the diagnosis and management of polycystic ovary syndrome (PCOS). Evidence Acquisition We searched MEDLINE, EMBASE, and CENTRAL until Decembe...

Background: Although induced abortion is one of the most commonly performed gynecological procedures in Great Britain and medical termination of pregnancy is being used more frequently, very little is known about the role of ambulation during the procedure. We sought to compare ambulatory and non-ambulatory groups of patients undergoing medical ter...

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. Rec...

The apparent gender differences in favor of women in the risk of contracting and dying from coronavirus disease 2019 (COVID-19), and the fact that such trends have also been observed in recent epidemics including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), have prompted the obvious question: Are the reasons...

Objective Age at first date and sexual intercourse have been observed to be delayed in women with Turner syndrome (TS), with delayed puberty being the main factor. We sought to assess relationship and sexual experiences comparing women with TS and premature ovarian insufficiency (POI). Design Cross‐sectional observational study. Patients 302 wome...

The global increase in life expectancy to 74 years for women, while the median age of the menopause remains at 51 years, means that an increasing number of women will live a significant portion of their adult lives in the menopause. The WHI publications in 2003/4 reported on the dangers of hormone replacement therapy, in particular with respect to...

Isaac Manyonda and Vikram Sinai Talaulikar. MRCOG Part 3: 50 Clinical Tasks. Publisher: Jaypee UK; 1st edition

Vikram Talaulikar, Sabaratnam Arulkumaran. Folic Acid and Reproductive Health. J Jaffna Sci.Association,2019, 1(1),1-11.

Vikram Sinai Talaulikar, Sabaratnam Arulkumaran. Chapter 21 Birth Asphyxia in Arias' Practical Guide to High-Risk Pregnancy and Delivery. A South Asian Perspective. Editors: Fernando Arias, Amarnath Bhide, Arulkumaran S, Kaizad Damania, Shirish Daftary. 4th Edition. Pages 359-72. Elsevier India, 2020.

Key content The World Health Organization (WHO) type 1 anovulatory disorders include hypogonadotrophic hypogonadism, hypothalamic amenorrhoea and hypopituitarism. These conditions are encountered primarily in endocrine, gynaecology and reproductive medicine clinics, and can result in amenorrhoea/oligomenorrhoea, subfertility or pregnancy loss. Thes...

The process of labour and delivery can be a hazardous journey for the fetus. The principal aim of monitoring a fetus during labour is to detect changes in the fetal heart rate that suggest a possibility of fetal hypoxia and metabolic acidosis so that timely action can be taken to prevent adverse outcomes. For the last four decades, intrapartum moni...

Complications of early pregnancy, including pregnancy loss and threatened miscarriage, are common. Miscarriage affects almost one in five pregnancies and accounts for utilization of a significant proportion of healthcare resources. Women presenting with miscarriage should ideally be assessed, diagnosed, and managed in early pregnancy assessment uni...

As the epidemic of obesity spreads, increasing numbers of overweight or obese women are seeking fertility treatments as high body mass index (BMI) appears to be associated with delayed conception. Weight loss is recommended for women with high BMI before attempting natural conception or starting infertility treatment to improve fertility outcomes....

Combined (estrogen and a progestogen) hormone replacement therapy (cHRT) is associated with an increased risk of breast cancer, while estrogen replacement therapy is not. Whatever the underlying mechanism, it is the progestogen in cHRT that seems to increase the risk. Fear of breast cancer is a major limiting factor in the use of hormone replacemen...

Vikram Talaulikar. See your GP about the menopause. The Menopause Exchange, Issue 82, Page 4, Autumn 2019.

Objective: Women with early-onset oestrogen deficiency are at risk of reduced bone mineral density (BMD). We sought to assess fracture history and BMD in women with Turner syndrome (TS) and premature ovarian insufficiency (POI). Design: A cross-sectional observational study. Patients: 267 women with TS (median age 34.3 years) and 67 women with...

Objective: Adequate uterine growth is an essential component of pubertal induction with exogenous oestradiol in those with hypogonadism. Poor uterine development will render the individual vulnerable in the context of fertility. We assessed uterine size using ultrasound in those who had undergone pubertal induction treatment compared to a referenc...

Objective: Although spontaneous fertility and successful pregnancies have been reported in well-chelated and transfused women with beta thalassaemia major (BTM), majority of women are subfertile due to hypogonadotropic hypogonadism (HH). Little is known about the effect of iron overload on ovarian follicles and whether ovarian reserve is affected...

Context Turner Syndrome (TS) is often associated with delayed puberty. To induce puberty, estrogen is administered in incremental doses at an age determined by age of presentation. After puberty, various types of maintenance Estrogen Replacement Therapy (ERT) are used. Objective We sought associations between age of induction of puberty and type o...

Objective: To study the safety and efficacy of ovarian stimulation and oocyte cryopreservation as a method of fertility preservation in women with Turner syndrome (TS). Design: Retrospective cohort study. Setting: Reproductive medicine clinic. Patient(s): Seven women with TS who attended the clinic between 2011 and 2017. Intervention(s): Ovarian st...

HRT Myths in Menopause Exchange autumn issue

Professional Development Skills for Obstetricians and Gynaecologists - edited by Tahir Mahmood September 2018

Cambridge Core - Obstetrics and Gynecology, Reproductive Medicine - Professional Development Skills for Obstetricians and Gynaecologists - edited by Tahir Mahmood

Objective: There is uncertainty whether treatment with dehydroepiandrosterone (DHEA) decreases menopausal symptoms for women in the peri- or postmenopausal phase. A previous systematic review considering this subject suggested that DHEA may slightly improve sexual function compared with placebo (CS. Scheffers, S. Armstrong, AEP. Cantineau, C. Farq...

Obstetric malpractice claims and their escalating costs, together with the increase of medical malpractice insurance premiums, have become a major concern for maternity service providers across most of the developed world. Electronic fetal monitoring is the recommended method of intrapartum fetal surveillance in high-risk pregnancies and cardiotoco...

Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase. The national caesarean section (CS) rate in the UK is almost 25%, having increased by 5.7% in the last 10 years. A rising primary CS rate is a significant contributor to this trend. The latest available data show that almost 1 in 5 women in the world...

Chapter 23 - Medicolegal Considerations of CTG in Handbook of cardiotocography edited by Roza Olyai, pages165-76. CBS Publishers & Distributors, India 2018.

Nearly 95% of fetuses at term present with the vertex and with such a presentation, the vast majority of women progress well in labour and have a spontaneous vaginal delivery. Any presentations other than vertex can lead to difficulties in labour and hence are called as malpresentations. Malpresentations of fetal head occur due to extension of the...

The mucopolysaccharide diseases are a group of heterogeneous, inherited conditions that are characterized by the deficiency of specific lysosomal enzymes. These lysosomal enzymes are responsible for the breakdown of glycosaminoglycans (GAGs), which are a key component of connective tissue. When lysosomal enzymes are deficient, the resultant build-u...

Talaulikar V. Continuous combined HRT in Menopause Exchange, Issue 74, Autumn, November 2017.

Electronic fetal monitoring (EFM) is the recommended method of intrapartum fetal surveillance for high-risk pregnancies. The cardiotocogram (CTG) trace forms a central piece of documentary evidence in medico-legal cases related to intrapartum hypoxia and birth asphyxia. Cardiotocography was introduced in 1960s as a screening tool with the view to r...

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 pres...

http://www.hospitalpharmacyeurope.com/featured-articles/medical-treatment-uterine-fibroids

Going on HRT in Menopause Exchange by Dr. Vikram Talaulikar, UCLH, Issue 70, Page 3, autumn 2016

Poster presented on Outcome of ovarian stimulation for oocyte cryopreservation in women with Turner syndrome at the SfE BES 2016 7th November at Brighton Centre, Brighton, UK

http://www.glowm.com/Critical_current_issue/page/38

Luteal phase support during IVF

Importance: Metformin, an oral antihyperglycemic drug, acts as an insulin sensitizer in the treatment of type 2 diabetes mellitus. It has also been widely used in the treatment of polycystic ovary syndrome (PCOS) and gestational diabetes mellitus. Although randomized clinical trials have failed to establish its superiority over other forms of trea...

Antral follicle count (AFC) variation was examined across the menstural cycle and its effect on clinical management assessed. In 79 women, AFC was documented in early (iAFC) and late follicular phase (sAFC). Absolute agreement between iAFC and sAFC and agreement for classification into categories of risk of extremes of ovarian response were examine...

In light of new recommendations for intrapartum care, this fully updated second edition offers a review of best practice in all aspects of labour and delivery. This authoritative guide incorporates revised recommendations from the latest MBRRACE-UK Report, NICE guidelines, Cochrane Reviews and RCOG Green-top Guidelines to provide advice that is in...

Postpartum hemorrhage (PPH) continues to be one of the leading causes of maternal deathsworldwide [1]. Several treatment procedures used in the management of severe PPH are based on the principle of uterine or pelvic vessel compression [2]. PPH compression belts are a novel uterine compression device aimed at reducing uterine blood flow to prevent...

Caesarean section (CS) has evolved from a procedure with considerable morbidity and mortality risks into one that is safe enough to be considered as a matter of maternal choice in high resource countries. Improvements in operative techniques, anaesthesia, intensive care, blood transfusion services and availability of antibiotics have all contribute...

Nearly 95% of fetuses at term present with the vertex (an area subtended by the two parietal eminences and the anterior and posterior fontanelles). With vertex presentation, the vast majority of women progress well in labour and have spontaneous vaginal delivery. Any presentations other than vertex can lead to difficulties in labour and hence are c...