What are the common symptoms that your patients tend to present with?

The common types of patient I see are either young women who don't have periods or women who have menopausal symptoms. Every week, I see a number of young women with a lack of periods as a result of either being underweight or over-exercising. Rarer cause of a lack of periods is a presence of a small pituitary tumour, so called prolactinoma.

Young women with polycystic ovary syndrome often present with irregular periods and/or unwanted hair growth, problems with controlling weight or infertility.

I also see a significant proportion of women who have hot flashes, sweats, palpitations, disturbed sleep, who are either menopausal or perimenopausal.

In terms of osteoporosis, there are no symptoms. Sometimes the first sign is a fracture which prompted testing for bone density and diagnosis of osteoporosis. Patients then come to my clinic for a proper investigation and treatment.

These are the commonest scenarios for patients presenting in my clinic.

What are the treatments that you're able to offer your patients?

For young women who have amenorrhea as a result of over-exercising or not eating properly, there is no treatment. They actually have to eat properly and stop running. The best results are sometimes achieved with a psychologist and cognitive behavioral therapy. Stopping running, which is a form of addiction with young generation now, is quite tough. I monitor them and encourage them. Those who accept and change their life style, could see changes in their hormones and eventually return of their periods but it takes time. The most motivated women are those who want to get pregnant and they readily accept my advice about the necessary changes in lifestyle.

As for menopausal women, I try to provide them with the safest possible HRT option. HRT has been, for the past 10 to 15 years, vilified in the press, but no devil is as bad as described. I offer treatment with transdermal oestrogen and micronized progesterone which are bio-identical hormones. It usually works very well.

In terms of osteoporosis, there are various treatments available. I increasingly use bone-forming agent parathyroid hormone to start with. Then, after two years, I change to antiresorptive treatment, which is the current recommendation of The Endocrine Society.

What are your areas of sub-specialist interest?

There are two major areas of my subspecialist interest. One is reproductive endocrinology, which covers menstrual cycle irregularities like polycystic ovarian syndrome (PCOS), chronic hypothalamic amenorrhea as a result of being underweight and over-exercising, premature menopause. This covers mostly younger population of my patients, those between the age of 16 and 45. This group together with women with natural menopause and significant menopausal symptoms would constitute over 50% of my clinical work.

The second area of my subspecialist interest is osteoporosis and metabolic bone diseases. I see women and men with osteoporosis and calcium metabolism disorders like hyperparathyroidism.

I also see patients with hyperthyroidism, hypothyroidism and Hashimoto's thyroiditis. Within thyroid disorders, I have special interest in autoimmune thyroid disease in young women who are trying to conceive or who have had miscarriages and who have positive thyroid antibodies.