Category: Obstetrics & Gynaecology

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Premature Menopause Is a High Blood Pressure Risk Factor

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Large-scale study results call for earlier cardiovascular screening for women who experience menopause before age 40

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Women who reach menopause before age 40 face a meaningfully higher risk of developing high blood pressure than those who go through menopause after age 45, according to a new study of more than 107 000 women. Risk peaked among women who reached menopause prematurely between the ages of 25 and 35 years. The results of the study are published online today in Menopause, the journal of The Menopause Society.

Hormone shifts during the menopause transition are known to influence a woman’s overall disease risk, and earlier menopause has previously been linked to higher rates of coronary heart disease and stroke. However, evidence connecting the timing of menopause directly to hypertension has been inconsistent, with some prior meta-analyses finding an association and others finding none.

A key challenge has been separating the direct hormone effects of menopause from indirect effects driven by weight gain, metabolic changes, and other cardiovascular risk factors that tend to accompany the menopause transition.

To address this gap, researchers analysed data from 107 836 postmenopausal women enrolled in the UK Biobank between 2006 and 2010, following them for a median of nearly 15 years through the end of 2003. The study classified women by age at menopause – normal (after age 45), early (ages 40 to 45), and premature (before age 40) – as well as by type of menopause (natural vs surgical) and tracked new diagnoses of high blood pressure over time.

Over the follow-up period, 18 508 women (17.2%) were diagnosed with hypertension. The risk climbed steadily as age at menopause dropped: 16.6% of women with normal age at menopause developed hypertension, compared to 18.8% of women with early menopause and 22.6% of women with premature menopause. After adjusting for more than 50 variables – including weight, lifestyle habits, family history, and lab values – women with premature menopause still had a 12.3% higher risk of developing hypertension than women who reached menopause after age 45.

A further analysis modelling age at menopause on a continuous scale found that risk peaks not at the traditional premature-menopause cutoff of age 40 but between the ages 25 and 35, suggesting the cardiovascular risk associated with premature menopause may be concentrated in an even younger group of women than previously defined. Surgical menopause was associated with higher hypertension rates in initial analyses, but that association did not hold once other risk factors were considered.

Based on these findings, the study authors recommend that clinicians treat age at menopause as a distinct cardiovascular risk factor, particularly for women who reach menopause before age 40. In addition to individualised counselling on hormone therapy, they point to earlier identification and management of high blood pressure as an opportunity to help reduce long-term cardiovascular risk in this group of women.

“The results of this study highlight the potential adverse long-term health outcomes associated with premature menopause, and in particular, the need to regularly screen for cardiovascular risk factors such as hypertension. Use of hormone therapy is also routinely recommended in women with premature menopause at least until the natural age of menopause unless contraindications exist,” says Dr Stephanie Faubion, medical director for The Menopause Society.

Source: The Menopause Society

Categories : Obstetrics & Gynaecology VaccinesTags :

Wits VIDA Globally Advances Maternal Vaccine to Protect Newborns from GBS

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Wits VIDA plays central role in global effort to help protect newborns from sepsis due to Group B Streptococcus (GBS).

Photo by ManuelTheLensman on Unsplash

Researchers from the Wits Vaccines and Infectious Diseases Analytics (Wits VIDA) Research Unit at the University of the Witwatersrand (Wits) have played a leading role in a landmark international phase 1 / 2 clinical trial demonstrating the safety and immunogenicity of an investigational maternal vaccine against Group B Streptococcus (GBS) – a major cause of life-threatening infections in newborn babies worldwide. The findings have been published in Nature Medicine.

The study evaluated Pfizer’s investigational hexavalent Group B Streptococcus conjugate vaccine candidate (GBS6) in both non-pregnant women and pregnant women, together with their infants. The trial found that the vaccine was generally well tolerated, generated robust immune responses against all six clinically important GBS serotypes, and resulted in efficient transfer of GBS-specific antibodies from vaccinated mothers to their babies.

Wits VIDA was central to the implementation and successful conduct of the clinical trial. South Africa was the primary recruiting country, contributing the overwhelming majority of study participants across both the early and later stages of the trial, reflecting the country’s internationally recognised expertise in maternal and infant vaccine research.

Group B Streptococcus is one of the leading causes of neonatal sepsis, meningitis and pneumonia, accounting for approximately 300 000 serious infections, including 100 000 deaths, in young infants globally each year. The greatest burden of GBS disease in infants occurs in Africa and other low- and middle-income countries, with South Africa reporting among the highest incidence globally (approximately 2-3 cases for every 1000 births). Also, maternal GBS infection could predispose to preterm labour and stillbirths.  Current prevention strategies based on intrapartum antibiotics have important limitations, particularly in resource-constrained settings, and do not protect against late-onset disease. Consequently, the WHO has designated a vaccine against GBS, to be given to women during pregnancy aimed at protecting their young infant, as a priority vaccine for development.

Professor Shabir Madhi, Director of Wits VIDA and one of the study’s senior investigators, said: “This publication represents another important milestone in the decades-long effort to develop an effective maternal vaccine against Group B Streptococcus. Maternal immunisation offers the opportunity to protect newborns during the most vulnerable first months of life, when they are at greatest risk of severe infection. These encouraging findings provide further evidence supporting continued development of this vaccine.”

The trial demonstrated comparable safety outcomes between vaccine and placebo recipients. Among pregnant participants, rates of adverse events, serious adverse events and delivery outcomes were similar between the two groups. Infants born to vaccinated mothers likewise had similar safety outcomes to those born to mothers receiving placebo. Importantly, vaccinated mothers developed high concentrations of antibodies that crossed the placenta efficiently, resulting in robust antibody levels in their infants at birth.

The publication builds on Wits VIDA’s longstanding leadership in vaccine research, which has contributed to the development and evaluation of vaccines against respiratory syncytial virus (RSV), rotavirus, pneumococcal disease, influenza virus, COVID-19 and now Group B Streptococcus. The unit continues to play a pivotal role in generating evidence that informs global maternal and child health policy.

The study also highlights the importance of South Africa’s clinical research infrastructure and its contribution to advancing vaccines designed to address diseases that disproportionately affect African populations.

While additional studies are required before the vaccine can be licensed, the results provide strong support for continued clinical development of maternal GBS vaccination as a strategy to reduce newborn deaths and severe infections worldwide.

Wits is currently enrolling in a phase 3 trial for GBS6 (NCT: NCT07160244).

About Wits VIDA

The Vaccines and Infectious Diseases Analytics (VIDA) Research Unit at the University of the Witwatersrand is one of the world’s leading centres for vaccine and infectious disease research. VIDA conducts internationally recognised clinical trials, epidemiological studies and translational research focused on reducing the burden of infectious diseases, particularly among mothers, infants and children in Africa. Its research has contributed to the development and implementation of several life-saving vaccines globally.

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

Pregnancy Complications Linked to Long-term Risk of Peripheral Artery Disease

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Study of over 2 million women finds an association between adverse pregnancy outcomes and an increased risk of PAD up to 46 years after delivery

Image by Scientific Animations, CC4.0

Women who experience pregnancy complications such as gestational diabetes, preeclampsia, or preterm delivery have a significantly increased long-term risk of developing peripheral artery disease (PAD) later in life, according to a new study published July 21st in the open access journal PLOS Medicine by Casey Crump of the University of Texas, US, and colleagues.

PAD, a condition in which narrowed arteries reduce blood flow to the limbs, affects more than 230 million people worldwide and is a strong predictor of future stroke, ischaemic heart disease, and premature mortality. Adverse pregnancy outcomes have been identified as risk factors for other cardiovascular diseases, but their association with long-term PAD risk had not been well established.

In the new study, researchers analysed data from 2 201 446 women who had a singleton delivery in Sweden between 1973 and 2015, following them for PAD diagnoses from nationwide inpatient, outpatient, and primary care records through 2018. Five adverse pregnancy outcomes were examined: preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes.

In 54 million person-years of follow-up, 13 211 women (0.6%) were diagnosed with PAD, at a median age of 62. All five adverse pregnancy outcomes were independently associated with increased PAD risk. At 30–46 years after delivery, adjusted hazard ratios were highest for gestational diabetes (HR 3.83, 95% CI 3.20–4.59), followed by small for gestational age (HR 1.74, 95% CI 1.65–1.83), other hypertensive disorders (HR 1.61, 95% CI 1.21–2.15), preterm delivery (HR 1.58, 95% CI 1.48–1.70), and preeclampsia (HR 1.28, 95% CI 1.20–1.37). Women with multiple adverse pregnancy outcomes had further increases in risk. These findings were largely unexplained by shared familial factors in co-sibling analyses.

“Because this was a relatively young cohort, the risks of PAD following adverse pregnancy outcomes may be even higher as women reach older ages when PAD is more likely to manifest,” the authors write. “Women with pregnancy complications may warrant early cardiovascular risk assessment and long-term clinical follow-up given their higher subsequent risk of PAD.”

The authors add, “Pregnancy is a “natural stress test” that may reveal higher cardiovascular risks in early adulthood. In a population of > 2 million women, we found that all 5 major adverse pregnancy outcomes (preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes) are independently linked with higher risks of peripheral artery disease up to 46 years later. Women with pregnancy complications need early and long-term follow-up with their physician to reduce their lifetime risk of peripheral artery disease and other cardiovascular diseases.”

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Categories : Obstetrics & Gynaecology Pain ManagementTags :

Epidurals Not Linked to Increased Harm for Newborns or Children

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Study provides strong evidence that epidural analgesia in labour is safe for newborns, say researchers

Photo by Duda Oliveira

Having an epidural during labour is not associated with clinically significant increased risks of harm to newborn babies, including brain injury, severe breathing problems, sepsis and death, or cerebral palsy later in childhood.

The researchers say these findings “support widening availability and equitable access to epidural analgesia as a safe component of intrapartum care.”

Epidural analgesia in labour provides effective pain relief and may help reduce complications in mothers after giving birth, but evidence of its effect on newborn and child health is limited.

To address this, researchers analysed data for 495 695 births in Scotland over a 13 year period (2007-2019) to examine whether epidural analgesia during labour was associated with serious neurological conditions occurring within 28 days of birth.

Only women who delivered a single baby vaginally or via unplanned caesarean section between 24 and 42 weeks of pregnancy were included in the analysis.

Further measures included other severe newborn illness, sepsis, low Apgar score (a routine test of a baby’s health) five minutes after birth, death within 28 days of birth, and cerebral palsy diagnosed at any point during childhood.

Factors such as mother’s age, ethnicity, weight, existing pre-eclampsia or diabetes, smoking history, birth location and gestational age at birth, were also taken into account.

Of nearly 500 000 women included in the study, around one in four had an epidural during labour. Overall, serious neurological conditions were rare, affecting fewer than 1 in 1000 babies. These conditions occurred at the expected rate and were no more common among babies whose mothers had an epidural compared with those who did not.

No association was found between epidural analgesia in labour and serious neurological conditions, other severe newborn illness, sepsis, low Apgar score at five minutes, death at 28 days, or cerebral palsy in childhood.

This is an observational study so no firm conclusions can be drawn about cause and effect, and the authors acknowledge that the study was limited to women delivering in Scotland, a predominantly white population, so the findings may not apply to more ethnically diverse populations or other healthcare settings.

However, this was a large study with long term follow-up of newborn and childhood outcomes, and results were consistent after additional analyses across various groups including women considered to have high risk pregnancies and preterm births, supporting the reliability of the findings.

As such, the authors conclude: “These results should reassure parents and clinicians that epidural analgesia use in labour is safe for babies and support informed, evidence based decision making about analgesic options in labour.”

Source: The BMJ Group

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Early Menopause Affects 1 in 14 Women in Low and Middle Income Countries

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Prevalence higher in rural areas in all regions, pooled data analysis of 44 countries reveals. Strong protective effects of education and delayed childbearing 

Female reproductive system. Credit: Scientific Animations CC4.0 BY-SA

Early menopause affects 1 in 14 women aged 30 to 49 living in low and middle income countries, finds a pooled data analysis of its prevalence in 44 nations published in the open access journal BMJ Global Health. 

The incidence is consistently higher in rural areas than it is in urban areas across all regions and countries included in the analysis, but education and delayed childbearing strongly minimise the risk.

Women usually go through the menopause between the ages of 45 and 55, but it is considered to be early if it occurs before the age of 45, and premature if it occurs before the age of 40, note the researchers.

Early and premature menopause are major public health concerns, because they heighten the risks of cardiovascular disease, osteoporosis, metabolic disorders, cognitive decline, depression, and early death, as well as seriously affecting the quality of life, they add. 

To date, research findings on the prevalence of early and premature menopause have been fragmented, focused on individual countries, and missing a detailed look at individual-level sociodemographic and reproductive factors, explain the researchers. 

To close this important information gap, they drew on pooled data from the Demographic and Health Survey (DHS) for 716 648 women between the ages of 30 and 49 in 44 low and middle income countries, where menopause tends to occur earlier than it does in high income countries.

All regions of the world were included other than North and South America for which no data were available.

The researchers focused on the potentially explanatory variables of: health factors, such as age at first marriage and first birth; number of live births; terminations; community level factors, such as place of residence; and individual-level characteristics, such as age, education, occupation, wealth index and exposure to media.

The data revealed that most survey respondents were between 30 and 34 (29%),while both women and their husbands were most often educated up to secondary school level (34% and 17%, respectively). Most respondents lived in rural areas (62%).

More than a third (38%) of women married before the age of 18, and around 1 in 5  (21%) gave birth to their first child before this age. Over half the women (58%) had 3 or more children.  

The overall prevalence of premature or early menopause was just over 7% (51,000 out of 716,648 women), which is much higher than previous global estimates, say the researchers, with the highest prevalence among 40-44 year olds (14%).

There was a six-fold difference between those countries with the highest and lowest prevalence, the analysis showed.  

The highest prevalence was in Ethiopia, Indonesia, and Myanmar: 12%;11.5%; and just over 10%, respectively. The lowest prevalence was in Jordan, Gabon, and Armenia: just over 2%; nearly 3%; and nearly 3%, respectively.

Certain factors were associated with a high prevalence. These included giving birth before the age of 18 (11%); marriage before the age of 18 (just over 10%); no formal education (just over 9%); material disadvantage (just over 8%); no exposure to media (just over 8%); residence in rural areas (8%); and 3 or more children (7.5%).

The disparity in prevalence between rural and urban areas was consistent across all countries and regions, the analysis showed. 

This “reflects fundamental inequalities in healthcare access, nutritional status, educational opportunities and occupational exposures,” highlight the researchers, adding that women in these areas are more likely to work as manual labourers and face workplace hazards, including exposure to agricultural chemicals.

Education was protective, with progressively lower odds the higher the level of education. Compared with women with no formal education, those with a college education were 58% less likely to experience an early or premature menopause. And women who were employed were 14% less likely to do so than women who weren’t working. 

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that their study relied on self-reported data and that they weren’t able to distinguish between natural and surgically induced menopause. 

Several potentially important factors associated with menopause aren’t consistently included in the DHS survey data either, they note: smoking; alcohol intake; physical activity; diet; long term conditions; hormonal contraceptive use and breastfeeding duration; and environmental exposures.

But the health consequences of early and premature menopause will strain the health systems of low and middle income countries, particularly in South and East Asia and Pacific, and sub-Saharan Africa, point out the researchers.

“With populations in [these countries] ageing rapidly and women expected to spend an increasing proportion of their lives in the postmenopausal state, the prevalence represents a substantial and growing burden on health systems already constrained by competing priorities and limited resources,” they write.

The findings “underscore the urgent need to integrate menopause into reproductive health and non-communicable disease programmes, particularly targeting rural areas and addressing social determinants, including girls’ education and delayed marriage,” they conclude.

Source: The BMJ Group

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Study Links Oral Contraceptives to Increased Binge Eating

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Emotional eating increased when women were taking hormone-containing birth control pills compared to the hormone-free pills taken at the end of each monthly cycle

Photo by Reproductive Health Supplies Coalition on Unsplash

Birth control pills are safe and effective for millions of women, but researchers are still working to understand how the hormones they contain may influence eating behaviour.

A new study in JAMA Network Open followed 422 women who were already using combined oral contraceptives, tracking their eating patterns daily for 49 consecutive days. The goal: to examine whether binge-related eating changes depending on whether women are taking hormone-containing pills or hormone-free pills within the same cycle.

In a typical birth control pack, women take about three weeks of “active” pills that contain hormones, followed by about a week of “inactive” pills that contain no hormones.

“Because we tracked the same women day to day, we could see how eating changed with hormone exposure,” said Dr. Shaunna Clark, a co-author and associate professor of psychiatry and behavioral sciences at Texas A&M University’s Naresh K. Vashisht College of Medicine.

How birth control hormones may increase binge-eating risk

The study used a within-person design, meaning each participant served as her own comparison. Researchers measured emotional eating (overeating in response to negative emotions) while tracking whether each day corresponded to an active or inactive pill.

They found a consistent pattern:

Emotional eating was significantly higher during active pill days than during inactive pill days.

This pattern appeared:

  • across two full pill cycles
  • in the full sample of 422 women
  • and in a subset of women with diagnosed binge eating

Clark says the findings held even after accounting for negative mood, suggesting the change was not fully explained by emotional distress.

“That tells us the hormones themselves may be playing a role, rather than those changes being driven by mood or other factors,” she said.

Why birth control may increase binge-eating risk for some women, but not others

The analysis focused on average changes across the group, but the study emphasizes that not all women experience these shifts in the same way.

“Participants ranged in age from late adolescence to young adulthood and were all using the same type of pill, monophasic combined oral contraceptives, which provide a consistent dose of hormones during active pill days,” said Clark, part of the research team led by Dr Kelly Klump at Michigan State University.

Because the study examined within-person changes, it shows that eating behavior can shift alongside hormone exposure, even if the magnitude of that shift differs between individuals.

“These findings show a pattern at the group level,” she said, “but individual responses can vary.”

Birth control pills linked to binge eating, but not mood or body image

The study does not establish that birth control pills cause binge eating. Instead, it identifies a specific association between hormone exposure and increased emotional eating within individuals.

Importantly, researchers also tested other outcomes:

  • Weight preoccupation did not change across pill type
  • Mood changes in response to pill type were smaller and less consistent than the changes in eating

Clark says that suggests the effect is relatively specific to binge-related eating behaviour, rather than a general shift in mood or body image concerns.

How this study changes what we know about birth control and binge eating

Previous research has shown that binge‑related eating tends to increase after ovulation, when both oestrogen and progesterone are elevated.

This study extends that work by showing that synthetic hormones in birth control pills are linked to similar patterns.

By comparing hormone-containing and hormone-free days within the same individuals, the study provides some of the clearest evidence to date that binge-related eating increases during periods of hormone exposure in the birth control cycle.

“Findings like these can help us better understand how different hormone exposures affect eating behaviour,” Clark said. “Over time, that could help clinicians and patients make more informed decisions about care.”

###

By Lesley Henton, Texas A&M University Division of Marketing and Communications

Source: Texas A&M University

Categories : Obstetrics & GynaecologyTags :

Hyperemesis Gravida Linked to Pregnancy, Birth Complications

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Photo by ManuelTheLensman on Unsplash

Pregnant women with a severe form of nausea face increased risks for several pregnancy and birth complications, according to a new Stanford Medicine study of 2.5 million California births.

The research, published in the American Journal of Epidemiology, is the first large, US population-based study of the dangers of severe pregnancy nausea and vomiting, a condition formally known as hyperemesis gravidarum, or HG.

While most pregnant women – 70% to 80% – experience some nausea, it usually leaves no lasting effects. In contrast, as the new research shows, HG puts a major strain on the 1% to 3% of the pregnancies affected.

“Hyperemesis gravidarum is not just bad morning sickness; it’s severe enough to cause dehydration and significant weight loss,” said lead study author Rebecca Gardner, a Stanford Medicine graduate student in epidemiology and clinical research.

The study’s senior authors are Julia Fridman Simard, ScD, associate professor of epidemiology and population health and of immunology and rheumatology, and Gary Shaw, DrPH, the Rosemarie Hess Professor and a professor of pediatrics.

The research team looked at complications in pregnancies in which the mother was hospitalised for HG, compared with pregnancies without such hospitalisations.

“We found hyperemesis gravidarum was linked to higher risk for preterm birth, anaemia, smaller-than-expected babies, preeclampsia, gestational hypertension and placental abruption,” Gardner said. “Hospitalization for HG really does flag a pregnancy as being at higher risk for a range of serious complications.”

Struggling to get nourishment

Pregnant women with HG experience severe, sustained nausea and vomiting, often continuing throughout their pregnancies. They struggle to eat; stay hydrated; and absorb enough nutrients that play key roles in early pregnancy, such as folate. (Adequate folate intake reduces the risk of certain birth defects.) Women with HG can lose a lot of weight at a time when they should be gaining; one study found that about a quarter of HG patients lost more than 15% of their pre-pregnancy weight.

“We know from other studies that women with HG don’t get as many nutrients,” Gardner said. “This could impair placental development, which we think leads to higher risk for some of the outcomes we looked for, such as preeclampsia and babies being smaller than expected at birth.”

But previous studies examining potential links between HG and poor pregnancy outcomes had weaknesses, Gardner said: Many were small, and nearly all used data from European countries with populations that are less diverse than the U.S. population and that have medical systems structured differently from the U.S. system.

The study examined records for single-baby California births from 2007 to 2011. The researchers had access to demographic information about mothers, pre-pregnancy body mass index and census tract data that was used to calculate each patient’s level of social vulnerability. The researchers also had access to diagnostic codes from patients’ pregnancy and birth medical records.

Of the 2 476 492 births included in the final analysis, 53,681, or 2.2%, were to mothers with HG, meaning they received emergency department or hospital inpatient care for hyperemesis gravidarum.  

Compared with those who were never hospitalised for HG, women with HG had higher risk for preeclampsia, a pregnancy complication that can cause seizures if untreated; gestational hypertension, or high blood pressure in pregnancy; preterm birth, meaning delivery three or more weeks before the due date; babies that were small for their gestational age, meaning they had grown less than expected during foetal development, anaemia, and placental abruption, in which the placenta becomes partly or completely detached from the uterus before delivery.

The increase in relative risk for each complication varied. For instance, after adjusting for possible confounding factors, women with HG were about 18% more likely to have preeclampsia, about 25% more likely to deliver early, about 37% more likely to be anaemic and about 14% more likely to experience a placental abruption than women without HG.

Women who were first hospitalised for HG during the second trimester of pregnancy were more likely to experience complications than those hospitalised during the first trimester, the study found.

A flag for closer monitoring

Guidelines from the American College of Obstetricians and Gynecologists for treating HG changed in 2018, after the data used for this study was collected, Gardner noted. The guidelines now encourage treating pregnancy nausea faster and more aggressively, and two medications are now approved by the US Food and Drug Administration for nausea and vomiting in pregnancy. More research could help clarify the effects of these newer guidelines, Gardner said.

More research could also show whether HG should prompt physicians to offer additional preventive care, such as low-dose aspirin, which is already used to prevent preeclampsia in patients who are at risk for other reasons.

The research team hopes that its findings will motivate physicians and pregnant women to pay closer attention to HG.

“For physicians, I think this data means that pregnancies with HG hospitalisation may warrant closer monitoring for certain complications,” Gardner said.

“Pregnant women need to know that most HG pregnancies still result in healthy outcomes for the mom and baby, but HG does need to be taken seriously,” she said. It’s important to advocate for yourself by asking your doctor if you need more monitoring or anti-nausea medication, Gardner said, adding, “This is not just something to push through.”

Source: Stanford Medicine

Categories : Obstetrics & Gynaecology Pain ManagementTags :

Supermarket Receipts Show Trends in Menstrual Pain Relief

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An analysis of 211 million supermarket transactions found that more than a quarter of customers buying menstrual products bought pain relief at the same time.

Photo by Sora Shimazaki on Pexels

More than a quarter of women buying menstrual products also purchase pain relief at the same time – and those in lower-income areas are significantly less likely to do so – according to a new study published this week in the open-access journal PLOS Digital Health by Dr. Victoria Sivill of the University of Bristol, UK, and colleagues, which used supermarket loyalty card data to map menstrual pain disparities across England.

Menstrual pain is a common concern affecting many individuals globally. Existing research highlights its negative impact on daily activities, including school and work attendance.

In the new study, researchers analysed anonymised loyalty card data from a major UK health and beauty retailer, encompassing 211 million transactions by 3.4 million individuals between 2006 and 2015. They analysed how often shoppers purchased menstrual products at the same time as pain relief, and how that compared to a customer’s baseline rate of buying pain relief.

The analysis found that 26.7% of customers who purchased menstrual products also bought pain relief in the same transaction. These customers were nearly four times more likely to buy pain relief while buying menstrual products compared to other shopping trips. As a validation of the approach, the most common interval between consecutive menstrual purchases across the dataset was exactly 28 days – consistent with the average menstrual cycle.

Regional income emerged as the strongest predictor of menstrual pain purchases: customers in the lowest-income areas were 32% less likely to purchase pain relief at the same time as menstrual products compared to those in the highest-income areas. The authors note that lower rates of pain relief purchases in deprived areas likely reflect an inability to afford over-the-counter medication rather than lower rates of menstrual pain itself

“The study highlights the need for greater awareness and policy interventions to address the high prevalence of menstrual pain as well as socioeconomic dimensions of menstrual pain,” the authors say. “Public health initiatives should incorporate menstrual pain relief as part of broader efforts to improve health equity.”

 Co-author Dr James Goulding notes: “It is wonderful that smart data research in the UK is able to bring issues which may have once been overlooked in scientific settings – such as the sheer scale and impact of menstrual pain – to light. This is well overdue.”

Co-author Dr Anya Skatova adds: “Like many women, I was aware of how common menstrual pain is, but the scale of painkiller purchases alongside menstrual products was still striking. Using shopping data, we can see just how widespread the need for pain relief really is. This kind of evidence helps make menstrual pain visible at a population level and provides a strong foundation for systemic change in how it is recognised, treated, and prioritised in public health.” 

Provided by PLOS

Press Preview: https://plos.io/42wSl1W

In your coverage please use this URL to provide access to the freely available article in PLOS Digital Health: https://plos.io/4wzrwbh

Contact: Anya Skatova, anya.skatova@bristol.ac.uk; James Goulding, james.goulding@nottingham.ac.uk 

Image Caption: Fig 1. Average (mean) individual summary statistics for Menstrual, Pain and Menstrual Pain customer sets via analysis of transactional logs between 30th April 2006 to 16th April 2015. 

Image Credit: Sivill et al, PLOS Digital Health, 2026

High-Resolution Image Link: https://plos.io/4ujYPxl

Citation: Sivill V, Ljevar V, Goulding J, Skatova A (2026) What can shopping transactional data reveal about relative prevalence of menstrual pain and period poverty in England? PLOS Digit Health 5(5): e0001308. https://doi.org/10.1371/journal.pdig.0001308 

Categories : Obstetrics & GynaecologyTags :

Why PCOS Is Now Called PMOS and What It Means for Women’s Health

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Polycystic ovaries. Credit: Scientific Animations Wiki CC4.0

For decades, women diagnosed with Polycystic Ovary Syndrome (PCOS) have often been told that the condition centres on cysts forming on the ovaries. In reality, many women who meet the diagnostic criteria never develop ovarian cysts at all, which means that the name has long created confusion for both patients and clinicians alike.

In May 2026, global health experts formally introduced Polyendocrine Metabolic Ovarian Syndrome (PMOS) as the updated terminology for this condition, which reflects the growing scientific consensus that it involves multiple hormonal and metabolic systems, not only the ovaries.

The change follows more than a decade of international consultation among endocrinologists, researchers and patient groups. The goal is to align the name of the condition with what research has increasingly shown about how it works in the body.

“Up to 70% of PCOS cases remain undiagnosed due to gaps in awareness, recognition and care, leaving many women navigating years of unexplained symptoms,” says Dr Themba Hadebe, Clinical Executive at Bonitas Medical Fund. “The new terminology recognises that this is a complex endocrine and metabolic disorder that affects several systems in the body.”

A name change to pay attention to

For years, the label Polycystic Ovary Syndrome suggested that ovarian cysts were the defining feature of the condition. Yet the small follicles seen on ultrasound scans are not true cysts, and they are not present in every patient.

Doctors diagnose the condition using a combination of symptom monitoring that may include irregular ovulation, elevated androgen levels and characteristic ovarian changes on ultrasound. This broader clinical picture often sits uneasily with the name itself.

“The terminology shaped how people understood the condition,” says Hadebe. “When patients heard ‘polycystic ovaries’, many assumed the problem was limited to reproductive health. In practice, the condition affects hormones, metabolism and long-term health risk.”

Women living with the syndrome frequently experience a wider set of health concerns. Hormonal imbalances can lead to acne, excess facial or body hair and irregular ovulation. The condition can also influence mood and mental wellbeing.

“Patients often arrive in consulting rooms with a range of symptoms that appear unrelated,” says Hadebe. “When you step back and view the condition as a broader endocrine disorder, those symptoms begin to make sense.”

One of the strongest drivers of the renaming is the role of metabolism in the condition. Research shows that many women living with the syndrome experience insulin resistance, where the body’s cells respond poorly to insulin and struggle to regulate blood sugar effectively. This metabolic disruption can contribute to weight gain and increase the risk of developing Type 2 Diabetes and cardiovascular disease later in life.

The importance of early diagnosis

Despite how common the condition is, many women spend years searching for answers before receiving a diagnosis, with updated NICE guidelines for PMOS aimed at standardising diagnostic pathways expected to be released towards the end of 2026. Symptoms such as irregular periods, persistent acne, excess hair growth or unexplained weight gain are often dismissed as routine hormonal fluctuations.

Delayed diagnosis can carry long-term consequences. Without proper management, metabolic complications may develop gradually over time. “Early detection allows clinicians to manage the condition more effectively and reduce future health risks,” says Hadebe. “Women who notice persistent hormonal or menstrual changes should seek medical advice so that underlying causes can be assessed.”

Addressing stigma and misunderstanding

The name change also addresses the emotional impact many women describe when navigating the condition. Patients frequently report that their symptoms were minimised or attributed to stress, weight or lifestyle factors before they received an explanation.

Language plays a powerful role in shaping how conditions are understood. A name that reflects the complexity of the syndrome helps validate the experiences of those living with it.

“Renaming the condition does not change the biology,” says Hadebe. “However, updating the name to better reflect current scientific understanding will improve awareness, support earlier diagnosis, enhance quality of care, drive greater consistency in research, and ultimately improve the overall patient experience.”

As awareness grows, experts hope the shift to Polyendocrine Metabolic Ovarian Syndrome, or PMOS, will encourage earlier recognition of symptoms and more holistic care for women affected by the condition.

Categories : Mental Health Obstetrics & GynaecologyTags :

Postpartum Psychosis Found to Have a Substantial Genetic Component

On By ModernMedia

Study finds postpartum psychosis is strongly influenced by genetics and reveals links to cholesterol metabolism, immune biology, and psychiatric disorders

Photo by Alina Matveycheva

Researchers at the Icahn School of Medicine at Mount Sinai have uncovered a substantial genetic component to postpartum psychosis, a rare but severe psychiatric illness that occurs in the days to weeks after childbirth. The findings, published May 14 in Molecular Psychiatry, provide new evidence that the condition has a substantial biological and genetic basis and may help guide future research into prediction, prevention, and treatment. 

The study, which combined whole genome sequencing with population-level family data, identified rare damaging mutations in the gene HMGCR as associated with increased risk for postpartum psychosis. The researchers also found significant genetic overlap between postpartum psychosis and bipolar disorder, schizophrenia, and several autoimmune diseases, including rheumatoid arthritis, Sjögren’s syndrome, myasthenia gravis, and Crohn’s disease. 

Postpartum psychosis affects approximately 1 in 1000 mothers and is considered a psychiatric emergency because of the elevated risk of suicide and infanticide. Symptoms can include delusions, hallucinations, severe mood changes, confusion, and disorganised behaviour. 

“Our findings show that postpartum psychosis is a biological illness with a substantial genetic basis,” said Behrang Mahjani, PhD, Assistant Professor in the Departments of Psychiatry, Genetics and Genomic Sciences and Artificial Intelligence and Human Health at the Icahn School of Medicine and senior author of the paper. “It is not a parenting failure or a personal weakness, and women affected by it deserve the same medical seriousness afforded to other severe illnesses.”  

This condition has historically been understudied, particularly at the genetic level, and we hope these results help move the field toward a more mechanistic understanding of why some women become vulnerable during the postpartum period.” 

The study estimated that approximately 55 percent of risk for postpartum psychosis is attributable to inherited genetic factors based on family data, while whole genome sequencing analyses estimated heritability from common genetic variants at approximately 46 percent. 

Researchers were particularly surprised by the identification of HMGCR, which encodes the rate-limiting enzyme in cholesterol biosynthesis. The study also revealed broader-than-expected overlap between postpartum psychosis and immune-related conditions. Researchers say the findings are consistent with longstanding clinical observations that autoimmune disease activity often changes during the postpartum period and suggest that immune biology may play a role in the illness. 

“Cholesterol biosynthesis was not a pathway we had anticipated, but once HMGCR emerged, the biology became highly coherent in light of the changing dynamics of cholesterol during and after pregnancy, because cholesterol serves as the precursor for steroid hormone synthesis and prior reports linking low serum cholesterol to first episode psychosis and suicidal behaviour,” said Dr Mahjani. “The postpartum period is marked by dramatic hormonal and metabolic shifts, and this gene sits directly within pathways affected during that transition.” 

The research, with analyses performed by Seulgi Jung, PhD, a postdoctoral fellow in the Mahjani Lab at Mount Sinai, is the first study to apply whole genome sequencing to postpartum psychosis, allowing investigators to examine rare damaging mutations across the genome rather than focusing solely on common genetic risk variants. The team combined data from Swedish national health registers with genomic information from the National Institutes of Health’s All of Us Research Program, enabling researchers to study one of psychiatry’s rarest and least understood conditions at an unprecedented scale. 

“It is important to understand that multiple genes are involved in postpartum psychosis and that HMGCR can be used as a research tool for further scientific discovery,” said Veerle Bergink, MD, PhD, Director of the Women’s Mental Health Research Center at Mount Sinai and an author of the paper.  

Future work will focus on expanding sample sizes and improving ancestral diversity. The team is now pursuing functional studies of HMGCR and other candidate genes in neuronal and immune cell models relevant to pregnancy and the postpartum period. Researchers also plan to integrate genetic findings with hormonal and immunological changes associated with childbirth to better understand why the illness emerges during such a tightly defined window. 

“In the long term, our goal is to understand postpartum psychosis well enough to predict it, prevent it where possible, and develop treatments that target the underlying biology rather than symptoms alone,” said Dr Bergink. 

The investigators also emphasized the importance of large-scale collaborative research infrastructure in enabling discoveries for rare conditions. 

“This work would not have been possible without the NIH’s All of Us Research Program and the participants who contributed their data,” said Dr. Mahjani.  “For rare and historically neglected illnesses such as postpartum psychosis, equitable access to large genomic datasets is essential for scientific progress.” 

Source: Mount Sinai