Tag: 6/11/26

Categories : Neurology Obstetrics & GynaecologyTags : Leave a comment

No Evidence that Testosterone Improves Brain Fog During Menopause

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There is not enough evidence to determine whether testosterone helps with thinking and memory in midlife women, even though it is often prescribed in the UK, according to a UCL study.

Published in Reproduction and Fertility, the review examined five existing studies of women aged 41 to 65 to understand whether testosterone treatment improves thinking and memory in women during and after menopause.  

Senior author and Director of the UCL Menopause Mind Lab Professor Aimee Spector (UCL Psychology and Language Sciences) said: “Social media is flooded with claims that testosterone improves memory and brain fog, and we hear of many women taking testosterone specifically to manage these symptoms during the menopause. While there may be some anecdotal evidence for this in perimenopausal women (who are missing from these trials), we cannot claim testosterone improves cognition during menopause without further evidence. 

“More research is needed to understand any links between testosterone and brain health.”

The menopause is when a woman’s periods stop due to lower hormone levels. This usually happens between the ages of 45 and 55. Post menopause is the stage of life that begins 12 consecutive months after a woman’s final menstrual period and lasts for the rest of her life.  

The menopause transition and post menopause have been associated with cognitive complaints, often described as ‘brain fog’. This includes difficulties recalling words and numbers, misplacing items, trouble concentrating and forgetfulness. It is thought that testosterone levels do not acutely change during menopause but instead begin to decline from a woman’s mid-20s to early 30s. 

Researchers reviewed five different studies to determine whether testosterone improved executive function, verbal learning and memory, and visuospatial learning and memory in post-menopausal women.  

Many of the study participants were given testosterone while most of the other participants were given a placebo, administered on a daily, weekly or monthly basis for periods ranging between four to 26 weeks. Researchers then compared the effects of cognition between testosterone and the placebo.  

The authors conducted a meta-analysis on the results of three of the five studies, which examined a total of 244 women in randomised controlled trials, and they did not find any statistically significant improvements for cognitive function among participants taking testosterone. 

Hormone treatments are often used to manage menopause symptoms, but it is unclear whether they help with brain fog. Current guidance from the British Menopause Society and the International Menopause Society only supports testosterone therapy for low libido, and the researchers note its effects on thinking and memory are not well understood. 

The researchers say that testosterone prescribing has anecdotally increased across NHS and private clinics in the UK, reflecting growing interest in its role during menopause.    

Corresponding author Dr Alexandra Faulkner (UCL Psychology and Language Sciences) said: “Our review found that the available evidence is limited and insufficient to determine the effect of testosterone therapy on cognition in women during the menopause transition and post menopause. This reflects a lack of sufficient evidence rather than evidence of no effect.” 

Further research is needed to guide treatment decisions and support women in making informed choices about their care, particularly in women going through the menopause. Future research should also explore how women perceive changes in their thought processes and memory. 

Data was included from Australia, Canada, the USA and Sweden to complete this review.  

The researchers note that the studies available were limited in number and sample size, with the existing evidence base too small to draw firm conclusions about whether testosterone therapy helps cognitive symptoms during menopause. The findings should not be interpreted as proof that testosterone has no effect on cognition.  

Source: University College London

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Night Shifts During Pregnancy Linked to Greater Neurodevelopmental Abnormality Risk

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But nightly prenatal sleep length may modify this association, exploratory findings suggest

Working night shifts during pregnancy is linked to a heightened risk of neurodevelopmental abnormalities detected by screening in the child by the age of 4, finds research published online in Occupational & Environmental Medicine.

But nightly prenatal sleep length during this period may modify this observed association, exploratory findings suggest.

Night shift work during pregnancy has been associated with unfavourable health outcomes for both mother and child, including neurodevelopmental issues, potentially related to body clock and sleep disturbances, note the researchers.

They therefore wanted to explore the associations between mums’ night shift work and their children’s neurodevelopment and to find out if there are potentially modifiable prenatal factors, such as changes in night shift patterns and sleep duration.

They drew on nationwide survey data for around 100 000 pregnant women from the Japan Environment and Children’s Study (JECS) who were enrolled between January 2011 and March 2014.

The women were surveyed in the first and second/third trimesters and answered questions about the number of night shifts they worked in a month.

Their responses were divided into 3 groups: no night shifts reported in either survey (27 655 women); night shifts in the first, but not second survey (‘discontinued night shifts’, 1779 women); and night shifts in both surveys (‘continued night shifts’, 2084 women).

Prenatal sleep length was calculated from self-reported bedtime and wake-up times in the second/third trimester. Sleep length was categorised as short if less than 6 hours; moderate if 6–9 hours; and long if 10 or more hours.

Child neurodevelopmental abnormalities at the age of 4 were assessed using a developmental screening tool—the Japanese version of the Ages and Stages Questionnaire, Third Edition (J-ASQ-3).

This is made up of 5 domains: communication; gross motor skills; fine motor skills (ability to make small, precise, deliberate movements); problem solving; and personal–social functioning (interpersonal skills, emotional/behavioural development, and awareness of personal boundary/space).

In all, 31,528 mothers who worked in the first trimester and completed the child development questionnaire when their children were 4 years old were included in the analysis.

Some 4189 (just over 13%) of the 4 year olds were classified as high risk of an abnormality in at least one of the five J-ASQ-3 domains: 1210 (4%) for communication; 1599 (5%) for gross motor skills; 1906 (6%) for fine motor skills; 913 (3%) for problem solving; and 1495 (5%) for personal–social functioning.

Compared with the children of mothers who didn’t work night shifts, the children of those who discontinued night shift work were more likely to have developmental screening abnormalities, but only in the fine motor skills domain (24% higher risk).

But the children of mothers who continued night shifts during their pregnancy had higher risks of developmental abnormalities in 3 domains compared with children whose mothers didn’t work night shifts.

These were in the domains of communication skills (29% higher risk); fine motor skills (34% higher risk); and personal–social functioning (31% higher risk).

Only the fine motor skills domain showed a significant association, regardless of whether night shifts were continued or discontinued.

“One possible explanation is that maternal inflammation associated with persistent night work may preferentially affect neural pathways involved in fine motor function,” suggest the researchers.

A separate exploratory analysis showed that the observed association between night shift pattern and the child’s neurodevelopmental risk differed according to how long the mothers slept.

Prenatal sleep duration of 10 or more hours was associated with an 80% heightened risk of abnormalities in any of the 5 domains compared with prenatal sleep length of 6-9 hours.

Long prenatal sleep duration may also reflect underlying fatigue, subclinical depression, inflammation, or anaemia, rather than representing a harmful exposure in itself, suggest the researchers.

This is an observational study, and as such, can’t establish cause and effect. And the researchers acknowledge that they weren’t able to account for shift rotation systems, individual chronotype, workload, exposure to light, or the timing of night shift discontinuation, all of which might have influenced the findings.

But in light of the findings, it may be worth employers considering flexible work schedules for pregnant night shift workers, they say.

Source: The BMJ Group

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Kidney Trial Challenges Dialysis as Standard for Older Frail Adults

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Human kidney. Credit: Scientific Animations CC0

Dialysis should not necessarily be regarded as the default option for older people with kidney failure, a major study led by Bristol NHS Foundation Trust and the University of Bristol has found.

The findings are from the Prepare for Kidney Care trial, the first randomised study of its kind in the world, published in The Lancet on 5 November. The study suggests a structured, less medicalised approach without dialysis may offer an alternative without compromising a person’s overall length and quality of life.

The trial investigated whether older people living with kidney failure and multiple health conditions or frailty would benefit more from dialysis or a structured programme of care that does not include dialysis. It looked at both quality of life and survival.

The researchers aim to help patients and their families reach the best decision for them, offering by far the best evidence on this issue. They also want to influence NHS policy on care for this group of patients.

Funded by the National Institute for Health and Care Research (NIHR), the study recruited 445 participants from 31 UK kidney centres. This represents around half of all UK kidney services. 

Around 75% of participants were aged 80 or over. The remaining 25% were aged 65–79 and had additional health problems.

Participants were randomly allocated to one of two approaches: prepare for renal dialysis or prepare for responsive management (a form of conservative kidney management). The study took nine years to complete, including seven years to recruit, and participants could choose to withdraw at any time.

Over an average follow-up period of 4.5 years, the team found neither approach resulted in better outcomes when length and quality of life were considered together. 

Only one in four people (28%) who were preparing for dialysis went on to start treatment. Participants in both groups were more likely to die from other causes than to require dialysis, reflecting the vulnerability and complex health needs of this population.

The results do not apply to people already receiving dialysis, or to younger and fitter patients, for whom dialysis and transplantation remain standard care.

Fergus Caskey, Professor of Renal Medicine in Bristol Medical School, Consultant Nephrologist at Bristol NHS Foundation Trust and project lead, said:

“Our findings could have global implications for how kidney failure is discussed and managed in older patients living with multiple health conditions or frailty. Conservative kidney management is an active treatment that does not include dialysis. It is increasingly recognised around the world, but until now there has been limited evidence to compare both approaches.

“This trial establishes that if you are an older person with failing kidneys and other health problems, both preparing for dialysis and conservative kidney management are worth considering. Both have pros and cons. They result in similar overall length and quality of life. Neither should be the default.

“Carrying out a trial like this presented significant ethical challenges, but we worked hard to develop a trial where all participants retained their choice about taking part and could change their treatment pathway at any point.”

Dialysis can place a considerable burden on patients and families, often requiring frequent travel, regular treatments and medical procedures. It also carries the risk of complications. With costs estimated at around £35 000 per patient each year, dialysis also represents a significant commitment of NHS resources.

The trial was co-designed with patients and kidney specialists and included interviews with participants and their families to better understand their experience of the treatments.

The research team recommend that dialysis preparation should no longer be the default pathway for older people living with kidney failure and multiple other health problems or frailty. Instead, both treatment approaches should be presented as equally valid options, with decisions made jointly by patients and their healthcare teams.

Watch the video

Source: Bristol NHS Foundation Trust

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Lung Antibodies Can be Measured in Exhaled Breath

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Illustration: Lovisa Thålin

For the first time, researchers have successfully measured antibodies against specific respiratory viruses in exhaled air. This is shown in a new study involving, amongst others, the Karolinska Institutet, published in eBioMedicine. The method may make it easier to study the immune system in the small airways of the lungs.

Antibodies in the mucosal lining of the respiratory tract play an important role in protecting against respiratory viruses such as influenza virus, SARS-CoV-2 and respiratory syncytial virus (RSV). While antibodies in the upper airways are relatively easy to measure, sampling from the lower airways has previously required invasive procedures such as bronchoscopy.

In the new study, researchers used a non-invasive method called PExA (Particles in Exhaled Air). By breathing into a specially designed instrument, participants generated tiny exhaled particles originating from the respiratory tract lining fluid of the small airways. These particles were collected and analysed for virus-specific antibodies.

“Antibodies in the nasal mucosa are important for protection against respiratory infections, but immune responses further down the lungs are also crucial, particularly for preventing severe disease such as pneumonia. This method opens up new possibilities for understanding how immunity differs between the upper and lower airways,” says Charlotte Thålin, adjunct professor at the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, and co-last author of the study.

The study included 28 participants in the COMMUNITY cohort at Danderyd Hospital, 18 of whom had recently experienced a respiratory tract infection. The researchers analysed paired samples from blood, nasal secretions and exhaled breath.

In the exhaled breath samples, the researchers successfully detected IgA and IgG antibodies directed against SARS-CoV-2, influenza virus and RSV. Virus-specific IgG levels in the lower airway samples largely mirrored those observed in blood, whereas IgA showed a different pattern, consistent with a greater contribution from local mucosal antibody responses.

“Sampling is relatively simple, as participants simply need to breathe into a device. This enables us to collect samples from the small airways without invasive procedures, which is particularly valuable if we wish to take repeated samples and monitor the immune system over time,” says Katherina Aguilera, a PhD student at the same department, and the study’s first author.

In the future, the method could help researchers investigate how immune responses in the lower airways change following respiratory infections or vaccinations, and and support the evaluation of preventive treatments. The researchers emphasise that this was an initial methodological study involving a limited number of participants and that further validation in larger studies is needed.

The study was conducted in collaboration between Karolinska Institutet, Danderyd Hospital, Uppsala University, and SciLifeLab. Funding was provided by the European Research Council (ERC), the Knut and Alice Wallenberg Foundation and the Swedish Society for Medical Research (SSMF). 

Source: Karolinska Institutet

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Shockwave Therapy and Manipulation may Bring Temporary Relief for Frozen Shoulder

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Findings may be useful for informing early treatment decisions, but evidence on longer term effectiveness and safety lacking 

Photo by Kampus Production

Extracorporeal shockwave therapy probably reduces short term pain linked to frozen shoulder, while manipulation under anaesthesia – with or without steroid injections – probably improves short term flexion (raising the arm forward and overhead) compared with usual care, finds a review of the latest trial evidence published by The BMJ.

Most other treatment effects remain uncertain due to low certainty evidence and inconsistent data, and comparative safety and longer term effects are not well established.

Frozen shoulder (adhesive capsulitis) occurs when the strong connective tissue surrounding the shoulder joint becomes thick, stiff and inflamed, causing pain and restricted movement. It’s more common in people aged 40-60 years, and among women than men.

Many treatments are available, including drugs, steroid injections, and surgery, but their comparative benefits and harms remain uncertain.

To address this, researchers analysed the results of 189 randomised controlled trials involving 12 988 adults (average age 54 years) with adhesive capsulitis comparing active treatments with another intervention, placebo, or usual care on pain, function, range of motion, and adverse events.

Moderate certainty evidence showed that extracorporeal shockwave therapy (low energy sound waves delivered to damaged tissue to stimulate blood flow and healing) probably reduced short term pain compared with usual care (mean difference -1.97 on a 0-10 scale).

There was some indication that extracorporeal shockwave therapy may also improve short term function, flexion, and abduction, but the researchers say these apparent benefits are less certain because they are based on low certainty evidence and inconsistencies in the data.

Moderate certainty evidence also suggested that manipulation by a clinician under anaesthesia combined with a steroid injection probably improved short term flexion (mean difference 33.29 degrees), as did manipulation under anaesthesia alone (26.16 degrees), compared with usual care.

Evidence for most other treatments, outcomes beyond three months, and comparative safety is substantially less certain because adverse events were incompletely and inconsistently reported.

While this was a comprehensive synthesis of randomised evidence, the researchers acknowledge that most trials were at high risk of bias, factors such as disease duration, clinical stage, and previous treatment, were incompletely or inconsistently reported, and the findings may be limited to patients with primary adhesive capsulitis.

As such, they say these findings might be useful for informing specific treatment decisions within the first six months and do not establish longer term comparative effectiveness or overall benefit-harm profiles.

Treatment decisions should also consider invasiveness, costs, patient preferences, clinical expertise, and uncertainty about longer term benefits and harms, they conclude.

Source: The BMJ Group

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Fireworks are an Underestimated Danger to Public Health, Warn Experts

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Stronger regulations and education campaigns could help avoid life changing injuries

Photo by Gabriel Mihalcea on Unsplash

Fireworks pose an underestimated danger to public health and require stronger regulations and sustained public education campaigns to help prevent devastating, yet entirely avoidable injuries, warn US experts in The BMJ.

Fireworks related injuries are a major cause of vision and limb loss globally, largely affecting already marginalised communities, explain Indu Subramanian and colleagues.

In the UK, for example, almost 4500 people in England attended emergency departments with firework injuries in 2017, double the number in 2009-10, while a Los Angeles trauma centre study found that firework injuries rose 142% from 0.19 per 100,000 in 2015 to 0.66 in 2021, mostly in young men aged 15-34. Typical injuries included burns, eye trauma, and finger amputations, with 79% requiring surgery.

And according to research published in the Indian Journal of Ophthalmology, during Diwali in India, fireworks account for nearly 20% of eye trauma, and firework related eye injuries result in complete blindness in 15% of patients, mainly affecting young boys in rural communities.

Other negative effects of fireworks include fires, substantial air and noise pollution, and risk of heavy metal poisoning, skin burns, inhalation injuries, and death among workers producing fireworks, mostly in low and middle-income countries, they add.

They note that some countries, such as the Netherlands, Ireland, Chile, and Australia have banned consumer use of fireworks, but in many countries, where consumer bans are not in place, including India, UK, and US, there remains a critical need for education and regulation.

In the US, sales of consumer fireworks more than doubled from $1 billion in 2019 to $2.3 billion in 2025. Firework regulations also vary between states and countries, and policies have become less restrictive over time in some places, despite research showing that firework injuries are more common in states with fewer restrictions.

The authors call for stronger regulations and sustained public education campaigns in the US and internationally.

Global action is needed to increase data collection, regulation, and public safety of fireworks usage and injuries, while medical organisations and public health bodies should encourage people to attend public displays rather than using fireworks at home, they write. Warning labels with graphic images of injuries on firework packaging similar to those on cigarettes may also be impactful.

Harm reduction campaigns for children in primary and secondary schools, using the stories and images of people whose lives have been affected, is also critical to warn of the real-life consequences of mishandling fireworks, they add.

Source: The BMJ Group