Menopause
Study links heart health to fracture risk in postmenopausal women
Postmenopausal women with high cardiovascular risk face almost double the hip fracture risk, a new study has found.
Postmenopausal women face a high risk of bone fractures.
Due to declines in oestrogen levels, which can lead to an increased risk of osteoporosis, even a low-impact fall can result in a serious hip, back or wrist injury.
An estimated one in three women over 50 will experience a fracture due to bone loss in their lifetime.
The study found that heart health may affect fracture risk after menopause, with women at a higher risk of cardiovascular disease more likely to experience hip and other major bone fractures.
The association between cardiovascular disease risk and fractures was also stronger in women under 65, compared with women aged 65 and older.
In the study, published in The Lancet Regional Health – Americas, researchers used the American Heart Association’s recently developed PREVENT score to estimate a patient’s 10-year risk of cardiovascular disease. Women in the study were grouped as low, borderline, intermediate or high risk.
The strongest link was seen with hip fractures. Women in the high cardiovascular risk group had a 93 per cent higher risk of hip fracture than women in the low-risk group.
Women in the intermediate-risk group had a 33 per cent higher risk.
Higher cardiovascular risk was also linked to a greater risk of fractures in weakened bones in major areas such as the hip, spine, forearm or shoulder.
The findings could indicate that the PREVENT score, developed by the AHA in 2024, may be a valuable tool in identifying patients who could benefit from a bone density screening or referral to a bone health specialist.
Given the prevalence of both conditions and the economic burden they impose, reducing risk for both could improve the lives of older adults.
“While previous studies have suggested a link between cardiovascular disease and fracture risk, we were surprised by the magnitude associated with hip fracture risk,” said lead author Rafeka Hossain, a researcher with the Tulane University School of Medicine. “
Both of these conditions are prevalent and costly, and reducing risk for both could improve the lives of older adults.”
The study included data from more than 21,000 women in the Women’s Health Initiative, one of the largest national women’s health studies.
The findings add to growing evidence that heart health and bone health are closely connected.
Researchers say several biological processes may help explain the link, including chronic inflammation, oxidative stress, changes in calcium regulation and reduced blood flow to bone caused by atherosclerosis.
Hormonal changes after menopause, especially declining oestrogen levels, may also raise the risk of both heart disease and bone loss at the same time.
“Many of the same factors that protect your heart, regular physical activity, a balanced diet rich in calcium and vitamin D, not smoking and managing conditions like diabetes and high blood pressure, also help protect your bones,” Hossain said.
“If you’ve been told you have intermediate or high cardiovascular risk, particularly if you are a postmenopausal woman, it may be worthwhile to talk to your doctor about bone health screening, given the many effective treatments available that reduce fracture risk.”
The study found that women in the high-risk group tended to experience fractures sooner than women in the low-risk group.
For hip fractures, the median time to fracture was 15 years in the high-risk group versus nearly 20 years in the low-risk group.
The researchers caution that more work is needed before cardiovascular risk scores are added to standard fracture screening tools.
But they say the findings suggest that women with intermediate or high cardiovascular risk may want to talk with their doctors about bone health, especially after menopause.
“Taking care of your heart and bones should go hand in hand,” Hossain said.
Article produced in association with Spital Clinic
Genitourinary syndrome of menopause (GSM) affects around one in two women after the menopause — and fewer than one in three of those affected ever bring it up with a doctor.
The condition covers a cluster of vaginal, urinary, and sexual symptoms caused by falling oestrogen levels during and after the menopause transition.
It is one of the most common and most treatable consequences of that hormonal shift, and yet it remains one of the least likely topics to come up in a clinical consultation.
What Is Genitourinary Syndrome of Menopause?
The term genitourinary syndrome of menopause replaced older descriptions like atrophic vaginitis and vulvovaginal atrophy because those names missed the point — this condition is not confined to the vagina.
It affects the entire lower genitourinary tract: the vulva, vagina, urethra, and bladder neck, all of which depend on oestrogen to maintain their structure and function.
As oestrogen levels fall during the perimenopause and drop further after the menopause, these tissues change in tangible ways.
The vaginal lining thins; mucus production decreases; vaginal pH rises, making bacterial imbalance more likely; and the cushioning fat tissue around the vulva diminishes.
Crucially, these changes are progressive — without treatment, they continue to worsen rather than settling on their own.
NICE guideline NICE guideline NG23: Menopause — identification and management, updated in November 2024, defines genitourinary symptoms as a core part of the menopause syndrome. The guidelines support active treatment across all severity levels — not just when symptoms are severe.
The Full Symptom Picture: Genital, Urinary and Sexual
Genital symptoms are the most widely recognised.
Vaginal dryness is the most common, affecting up to 93 per cent of women with GSM — and described as moderate to severe in 68 per cent of those affected.
Other symptoms include burning, itching, soreness, and unusual or offensive discharge caused by changes in the vaginal environment.
The tissue can become fragile enough to bleed from minor friction, including during a gynaecological examination.
Urinary symptoms arise because the urethra and bladder neck are equally dependent on oestrogen.
These include needing to urinate more often or urgently, waking in the night to urinate, pain or burning when urinating, recurrent urinary tract infections, and stress incontinence — leakage triggered by coughing, sneezing, or exercise.
Many women with recurrent UTIs are treated again and again with antibiotics without the underlying GSM ever being identified or addressed.
Sexual symptoms complete the picture: painful intercourse from reduced lubrication and tissue fragility, spotting or bleeding after sex, and reduced arousal, lubrication, and ability to orgasm.
These changes are physical in origin, not psychological — though if symptoms go unmanaged for long enough, the two often start to reinforce each other.
Prevalence data from North Tees and Hartlepool NHS Foundation Trust shows that vaginal dryness affects around one in four women in the lead-up to the menopause, rising to one in two after it, and approximately seven in ten women in their seventies.
Symptoms can begin during the perimenopause — well before periods have stopped.
Anyone noticing these changes can seek assessment through a GP or NHS sexual health service — or through a private gynaecology specialist.
Why GSM Does Not Improve Without Treatment
Unlike hot flushes and night sweats — which typically ease over two to five years — genitourinary symptoms do not improve over time and return once treatment stops.
They are chronic and progressive: the longer they go untreated, the more entrenched the underlying tissue changes become.
This makes the gap between prevalence and treatment especially significant.
Around 70 per cent of women with GSM symptoms never raise them with a healthcare professional, and only 4 per cent to 35 per cent use any form of treatment — partly from embarrassment, partly because many assume nothing can be done.
A condition with safe, effective, NICE-recommended treatments goes largely unmanaged.
First-Line Self-Care: Moisturisers, Lubricants and OTC Options
Vaginal moisturisers — such as Replens, Regelle, and Sylk gel — differ from vaginal lubricants: they are for regular, ongoing use (typically two to three times per week) to maintain tissue hydration.
They do not treat the underlying hormonal cause, but are effective at reducing dryness and discomfort and are NICE NG23-supported as first-line non-hormonal management.
Vaginal lubricants are for use during sexual activity. Water-based lubricants are compatible with latex condoms and diaphragms; oil-based products are not. Both are available over the counter and are a reasonable first step for mild or early symptoms.
NICE NG23 supports their use alongside vaginal oestrogen, and recommends them as the primary option when hormonal treatment is not suitable.
Vaginal Oestrogen and Prescription Treatments
For symptoms that persist beyond a few weeks of self-care, or that are moderate to severe from the outset, NICE NG23 sets out the evidence-based first-line treatment: offer vaginal oestrogen to anyone with genitourinary symptoms associated with the menopause — including those already using systemic HRT — and review regularly.
Vaginal oestrogen restores oestrogen levels in local tissue without significant absorption into the wider body.
NHS information on vaginal oestrogen confirms it does not carry the same risks as systemic HRT — the dose is low and very little reaches the general circulation, which matters for women who have been advised against systemic treatment. It comes as a tablet, pessary, cream, gel, or ring.
NICE NG23 specifically recommends vaginal oestrogen for women already using systemic HRT as well as those who are not — recognising that between 10 per cent and 25 per cent of women on systemic HRT still experience genitourinary symptoms that systemic treatment alone does not fully address.
Two further prescription options are available for women who cannot use vaginal oestrogen or have not responded to it.
Prasterone — a DHEA vaginal pessary — is recommended by NICE NG23 when vaginal oestrogen or non-hormonal treatments have not worked or are not tolerated.
Ospemifene, an oral tablet, is recommended where locally applied treatments are not practical — for example, due to physical disability.
Choosing between these options involves a clinical review of individual history, any contraindications, and personal preference.
A BMS-accredited private menopause assessment can provide that review alongside a full discussion of treatment options.
On laser therapy: the RCOG Scientific Impact Paper No. 72 concluded that vaginal laser treatment for GSM should not be offered outside of randomised controlled trials, and NICE NG23 takes the same position.
For women with a history of breast cancer, non-hormonal moisturisers and lubricants come first; vaginal oestrogen may be considered if those are ineffective, but only with the involvement of the treating oncologist.
When to See a Doctor
The NHS recommends seeking assessment when genital menopause symptoms have persisted for more than a few weeks despite self-care, when they are affecting daily life or sexual function, or when they involve post-menopausal bleeding, unusual discharge, or recurrent urinary tract infections.
Post-menopausal bleeding always warrants prompt GP review. It should not be assumed to be friction-related or attributable to GSM without a clinical examination — it is a red flag symptom that requires investigation to rule out other causes.
Recurrent UTIs in a postmenopausal woman — particularly without an obvious cause — are worth assessing for an underlying GSM component, rather than treating with repeated antibiotic courses alone.
A GP can initiate first-line treatment; for more complex presentations or where initial management has not helped, a menopause specialist can offer a more thorough evaluation.
The shift from terms like atrophic vaginitis to genitourinary syndrome of menopause reflects something important: these are medical symptoms, not a normal inconvenience to be quietly endured.
Effective treatment exists at every level of severity — from OTC moisturisers through to NICE NG23-recommended prescription options.
Anyone whose symptoms are affecting quality of life can see an NHS GP, or book a private menopause assessment with a BMS-accredited specialist.
The gap is not in what medicine can offer — it is in how reliably those options reach the women who need them.
This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment. Clinical guidance referenced reflects published NHS and NICE standards as at March 2026. Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article. This piece was produced in association with Spital Clinic, which provided background clinical information for editorial purposes. Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
More than three million cells have been mapped, showing how breast tissue changes with age, with the biggest shifts seen during menopause.
The research, described as the most detailed map of its kind so far, shows that as women age, all types of cells in breast tissue become fewer, those cells divide less often, and the tissue itself changes.
Together, these shifts create what the researchers call a “micro-environment”, meaning a local tissue setting in which cancer cells may find it easier to take hold.
Breast cancer is the most common cancer in women, accounting for 15 per cent of all new cases.
Four out of five cases occur in women over 50, and as many as one in seven women will develop breast cancer in their lifetime.
The study was led by scientists at the Universities of Cambridge and British Columbia.
The team used advanced imaging techniques to analyse breast tissue from more than 500 women aged 15 to 86, including biopsies taken for non-cancer-related reasons.
Pulkit Gupta from the Cancer Research UK Cambridge Institute at the University of Cambridge, joint first author, said: “Even though breast cancer affects well over 2 million women worldwide, we understand very little about why and when it occurs. As cells divide and replicate, they accumulate mutations that can drive cancer, but why is it that the body can get rid of these mutated cells when we’re younger, but struggles later in life?”
By combining the images with data on hormone receptors, immune cells and tissue architecture, the team mapped how breast tissue changes over time in unprecedented detail.
The findings point to reasons why breast cancer risk rises with age and why tumours in younger women differ biologically.
Gupta added: “Our map revealed that as women age, their breast tissue goes through major changes, with the most dramatic changes occurring at menopause.
“There are changes, too, during their twenties, possibly linked to pregnancy and childbirth, but these are far less pronounced.”
The map showed that milk-producing structures known as lobules shrink or disappear, while ducts, the channels that carry milk, become relatively more common.
The supporting layer around the ducts becomes thicker, fat cells increase and blood vessels decrease.
Changes were also seen in the immune environment. Younger breast tissue contains more B cells and active T cells, immune cells that help identify and kill cancer cells.
As tissue ages, these decline and are replaced by other immune cells linked to a more inflammatory and potentially less protective environment.
Co-senior author Dr Raza Ali from the Cancer Research UK Cambridge Institute at the University of Cambridge said: “We don’t know for certain why the types of immune cell change.
We can speculate that one reason may be because breast milk contains a high concentration of immunoglobulins, probably to help build the infant’s immunity, and these are produced by B cells.
At the same time, cells begin to interact with each other less. Immune cells and stromal cells, which form a supportive scaffold within tissue, become physically more distant from epithelial cells, the specialised cells lining the mammary ducts and lobules that produce and transport milk.
This may make it easier for pre-cancerous cells to escape control.
Co-senior author professor Samuel Aparicio from BC Cancer, University of British Columbia, Canada, said: “We’ve previously seen that age-dependent changes in oestrogen activity occur strongly in milk secreting cells of the breast and now we can see the surprising extent of changes in all cell types, including the immune system, with age.
“We are now seeking to understand the relationship between changes in immune cells and surveillance of early mutations that can arise in milk secreting cells over time.”
Dr Ali added: “It isn’t surprising that we should see fewer epithelial cells, as these play a role in producing breast milk, something that becomes less important with age, but the sheer scale of changes across the breast surprised us.
“What is clear from our map is that all of these changes create an environment where cancer cells that emerge naturally find it easier with age take hold and spread.”
HRT patches used for menopause may be as effective as injections at preventing prostate cancer spread, a study suggests.
Patches that lower testosterone by delivering oestradiol, a form of oestrogen, through the skin were found to be as effective as injections at stopping the cancer from spreading.
Researchers at University College London investigated whether the patches could match the effectiveness of current injection-based hormone therapies.
These injections are routinely given to men with locally advanced prostate cancer, where the disease has spread just beyond the gland.
The main aim of this hormone therapy is to suppress testosterone levels, a hormone that is crucial for the cancer’s growth.
The study, published in the New England Journal of Medicine, involved 1,360 men with an average age of 72, recruited from cancer centres across the UK.
Participants were either given patches to wear or received injections designed to block testosterone production, allowing researchers to compare the effectiveness of the two methods.
The patches used in the trial are the same as those used in hormone replacement therapy, or HRT, to treat menopause symptoms in women.
Researchers found the patches were just as effective as injections at preventing the cancer from spreading.
The patches also led to fewer side effects than injections, which can include hot flushes, bone density problems and risk factors for heart disease such as higher cholesterol, higher blood sugar and higher blood pressure.
However, the patches were linked to more breast tissue swelling.
Experts said patients who are given injections of LHRH agonists, a type of hormone therapy, need multiple hospital or GP visits, while oestradiol patches can be applied by patients at home.
Ruth Langley, from the MRC Clinical Trials Unit at UCL and lead author of the study, said: “We believe our findings should lead to men with locally advanced prostate cancer being able to choose which hormone therapy suits them best.
“For some men, for instance, hot flushes can be very debilitating, and so the patches could greatly increase their quality of life.”
Commenting on the study, Caroline Geraghty, senior specialist nurse manager at Cancer Research UK, said: “Thanks to research, over eight in 10 men diagnosed with prostate cancer will now survive for 10 years or more, as well as finding more effective treatments, we need to find ways to make them kinder too.
“This trial has done exactly that, it shows that hormone patches are just as effective as traditional injections at controlling locally advanced prostate cancer, while being much easier and gentler to administer.
“This should give men greater choice over their treatment in the future, allowing them to live not just longer lives, but better lives.”
The results were published as the UK national screening committee, which advises the Government, prepared to meet to decide the future of screening men for prostate cancer.
In a draft recommendation last year, it rejected population-wide screening using the prostate specific antigen, or PSA, test, saying it ‘is likely to cause more harm than good’.
The committee recommended only screening men with BRCA1 and BRCA2 genetic mutations, who are at much higher risk of prostate cancer, every two years between the ages of 45 and 61.
Health secretary Wes Streeting said he was surprised by the move but that any final decision needs to be ‘based on science and evidence, not on politics’.
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