After updating my client to 1.4 the game no longer starts up. It will boot through to the title screen, but there are no menu options so I cannot get into the game. What are my options to get the game running again, other than a clean install and hoping the patch works the second time around?

Cheers

Using any mods? Any beta drivers? What are your system specs?

Assuming you've not used any mods, delete your ini files and verify steam cache.

Delete you ini files. I had the same problem. Your ini file might be missing some lines. I think it was the save directory in my skyrim.ini.
Also make sure you delete any ini files in the Data folder, located in the skyrim directory.

Then restart your game.

The issue should only be in your skyrim.ini and not the skyrimpreferances.ini.