Category: Obstetrics & Gynaecology

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Study Proposes Safer Alternative to Hormone Therapy During Menopause

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Liver cells viewed under a fluorescence microscope. On the left are healthy cells, and on the right, fat droplets stand out in yellow. The research revealed that activating the ERβ receptor induces the organ to completely oxidize these lipids to generate energy. Credit: Débora Santos Rocha et al./Comprehensive Physiology

By Maria Fernanda Ziegler  |  Agência FAPESP – When it comes to balancing hormonal changes during the transition to menopause, less can be more. Researchers at the University of São Paulo (USP) in Brazil demonstrated this when testing an alternative strategy to conventional therapy. Rather than replacing oestrogen entirely, the team activated only one type of oestrogen receptor in the cells. This approach achieved a broad and beneficial metabolic effect without stimulating the growth of reproductive tissues, such as the uterus and breasts. This is important for individuals with a genetic predisposition to developing tumours.

“It’s a more targeted strategy. By acting only on that receptor, we were able to rebalance the metabolic effects of the drop in oestrogen during menopause without affecting potentially sensitive areas of the body,” explains the researcher Débora Santos Rocha, a FAPESP postdoctoral fellow at the Institute of Chemistry (IQ-USP) and first author of the article published in the journal Comprehensive Physiology.

The study was conducted on female rats that had their ovaries removed to simulate menopause. In this model, the researchers used an experimental drug to activate only oestrogen receptor beta (ERβ), which is an important regulator of metabolism and does not stimulate reproductive tissues or increase the risk of hormone-sensitive tumours.

As Rocha explains, the significant drop in oestrogen during the transition to menopause disrupts the entire metabolism, potentially promoting the accumulation of visceral fat, insulin resistance, and cardiovascular risk. “In addition to their importance in reproduction, oestrogens play a central role in energy regulation. When their levels decrease, widespread metabolic changes also occur, increasing the risk of metabolic syndrome and diseases such as diabetes and hypercholesterolaemia [high cholesterol],” she states.

Conventional hormone replacement therapy attempts to counteract this loss by providing oestrogen and progesterone through pills, patches, or creams. However, by activating all oestrogen receptors indiscriminately, it may increase the risk of tumour growth in predisposed women. “It isn’t hormone replacement therapy that causes cancer. What happens is that if there are tumour cells in oestrogen-sensitive tissues, such as the uterus, breast, or endometrium, they may respond to the hormone and multiply more quickly,” Rocha explains.

A targeted solution with broad benefits

The results of the study show that the isolated activation of ERβ promoted profound metabolic reprogramming. “With the new approach, we restored fasting blood glucose levels, normalised the lipid profile, and reduced the size of fat cells. The pancreatic islets [cells that produce insulin and other hormones] regained their normal shape, and blood levels of cholesterol, triglycerides, and free fatty acids returned to healthy levels. All of that occurred without any effect on the uterus, which indicates the safety of the approach,” comments Alicia Kowaltowski, a professor at IQ-USP and the research coordinator.

The study primarily focused on the liver. This is because the organ begins to process fats differently during the transition to menopause and in the absence of oestrogen. “Lipid metabolism changes significantly, and the liver accumulates more fat. ‘Bad’ cholesterol [LDL] in the blood increases, and various lipid profiles are altered. However, with the activation of ERβ, those parameters returned to normal,” says Rocha.

The same effect was observed in the analysis of isolated liver cells. “The drug remodels the metabolism of liver cells [hepatocytes], causing them to oxidise fatty acids more [ie, to ‘burn’ the building blocks of lipids to generate energy]. That reduces fat accumulation and improves the overall lipid profile. By activating that specific pathway, we modulate liver metabolism and make circulating lipids healthier,” the postdoctoral fellow explains.

Kowaltowski highlights another important finding from the study. “By activating ERβ, the drug causes liver cells to fully oxidize fatty acids, something that normally doesn’t happen since the liver typically performs only partial oxidation, generating ketone bodies [alternative energy sources that the body creates to compensate for a lack of carbohydrates]. With that ‘complete oxidation,’ fat is fully converted into CO₂, significantly improving the body’s lipid profile. It’s important to note that this pathway can be activated to provide metabolic benefits – something we hadn’t imagined,” she explains.

There is no one-size-fits-all model

Although the treatment did not prevent the weight gain characteristic of menopause, the authors note in the article that it broadly improved metabolic quality and the functioning of the liver, pancreas, and blood.

“Menopause is a phase characterised by a wide variability of symptoms among women, which makes it important to have a variety of therapeutic approaches. If we can modulate specific pathways, we pave the way for more personalized treatments. Perhaps the approach we’re presenting won’t be ideal for one person, but it could be decisive for another. The important thing is to have treatment options,” Kowaltowski emphasizes.


“Perhaps the approach we’re presenting won’t be ideal for one person, but it could be decisive for another. The important thing is to have treatment options,” emphasises Alicia Kowaltowski, a professor at IQ-USP (photo: Cecília Bastos/USP Imagens)

The research continues in a new project funded by FAPESP that is now focused on the transition to menopause (perimenopause), using an experimental model that more closely mimics human reality.

Rather than abruptly removing the ovaries from female rats, the new study will use a model of gradual ovarian reserve decline, enabling the researchers to observe hormonal change dynamics throughout the process. “We want to understand that transition and identify new therapeutic targets that could serve as alternatives to conventional hormone replacement therapy,” Rocha concludes.

The article “Estrogen receptor beta activation coordinates liver lipid remodeling and metabolic fluxes, preventing lipotoxicity” can be read at onlinelibrary.wiley.com/doi/10.1002/cph4.70228.

Source: FAPESP

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Mifepristone More Effective than Other Common Emergency Contraception Methods

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Photo by Danilo Alvesd on Unsplash

Emergency contraception containing mifepristone prevents more pregnancies with fewer side effects than some other common emergency contraceptive pills such as levonorgestrel, according to a new Cochrane review involving 87 trials. 

Emergency contraception is used to prevent pregnancy after unprotected sex. It can be used when no contraception was used or if a contraceptive method fails, as with a broken condom, or in the event of sexual assault. 

Common methods of emergency contraception include copper intrauterine devices and pills. The most widely used pill is levonorgestrel, a progestin-only medication sold in many countries as “Plan B,” “Next Choice,” or similar brand names. An alternative is the Yuzpe regimen, an older method that combines oestrogen and progestin.

More effective, fewer side effects

The review, led by researchers from Oregon Health & Science University, USA, pooled data from 87 randomised controlled trials involving approximately 36 000 women of reproductive age. The majority of studies (79 trials) were conducted in China, with additional trials from the UK, Cuba, and multi-country settings. The authors compared mifepristone against levonorgestrel, the Yuzpe regimen, and copper intrauterine devices.

Compared with levonorgestrel, both low-dose (under 25mg) and mid-dose mifepristone (25-50mg) prevented more pregnancies and were associated with fewer overall side effects. Low-dose mifepristone showed a 27% relative reduction in pregnancies compared with levonorgestrel. This was rated as high-certainty evidence, meaning that further research is very unlikely to change the result. 

When compared with the Yuzpe regimen, mifepristone showed an even larger advantage, cutting pregnancy risk substantially while also sharply reducing rates of nausea and vomiting. Evidence comparing mifepristone with copper intrauterine devices remained too limited to draw firm conclusions, based on only two included trials.

“Mifepristone in low-to-mid doses is a highly effective emergency contraceptive option that clinicians should know about,” explains Dr Shaalini Ramanadhan, lead author of the review. “As an anti-progestin, it works differently than the other steroid hormone-based methods like levonorgestrel and combined oestrogen and progestin pills to delay or block ovulation. This different mechanism is part of why it has a different side-effect profile compared to the other two methods.”

The main trade-off identified across nearly all comparisons was a lower risk of nausea and vomiting with mifepristone, but a higher likelihood of delayed menstruation compared with other types of emergency contraception. Given that a delay in menstruation could be interpreted as a sign of treatment failure or pregnancy, the authors explain that this side effect could be a potential source of stress and anxiety for individuals seeking emergency contraception. 

Where reported, however, treatment satisfaction was equal to or higher among those who received mifepristone versus alternative methods. 

Political and legal barriers limit access

Despite the strong evidence behind the drug’s effectiveness as emergency contraception, the authors note there are still many barriers to access. 

In some countries, drug authorities have approved mifepristone at higher doses (typically 200 mg) in combination with misoprostol specifically for medical termination of early pregnancy, not as emergency contraception. Scientific evidence is growing around the potential use of mifepristone and other anti-progestins as a routine method of contraception, for treating fibroids, for preventing and treating breast cancer, and for treating abnormal bleeding. However, because mifepristone is widely associated with abortion, it also faces intense political scrutiny, legal restrictions, and targeted bans and barriers in various countries.
 

Expanding options for emergency contraception is important. The evidence shows that mifepristone has benefits beyond abortion care, including as an effective form of emergency contraception. In some countries, recognition of this additional use may help expand access, increase familiarity with the medication, and create new opportunities for people to benefit from it.

– Dr Shaalini Ramanadhan, Oregon Health & Science University

Read the full review

Source: Cochrane

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New Method Makes IUD Insertion Less Painful for Women

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Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014“. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. – Own work

A simple method involving local anaesthesia in the uterus can reduce pain during IUD insertion, according to a new study from the Karolinska Institutet, published in the journal JAMA. The method also increased the proportion of women who found the procedure tolerable. The results may encourage more women to choose an IUD as a method for contraception.

The IUD is an effective and long-acting contraceptive, but fear of pain during insertion make many women choose not to have one inserted. Currently, IUDs are inserted without local anaesthesia or, in some cases, with local anaesthesia administered via an injection into the tissue around the cervix – an injection that could be experienced as painful.

In the new randomised study, researchers investigated whether a small amount of local anaesthetic, introduced into the uterus via a thin plastic catheter a couple of minutes before the procedure, could make the procedure less painful.

The study involved 370 women aged between 18 and 31 who had not previously given birth. The participants were randomly allocated to receive either the local anaesthetic mepivacaine or a saline solution prior to IUD insertion. Neither the participants nor the healthcare staff knew which treatment was being administered.

The results show that pain was reduced in the group receiving active treatment. On a scale from 0 to 100, the average pain score was 43.8 compared with 58.6 in the control group – a reduction of around 15 units. At the same time, the proportion of participants who found the pain tolerable rose from 91.4 to 98.3 per cent.

“We can see that the method not only reduces pain, but also means that more people find the procedure acceptable,” says Helena Kopp Kallner, professor at the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, and senior consultant at the Women’s Clinic at Danderyd Hospital, who is co-last author with Niklas Envall, a postdoctoral researcher at the same department.

The overall experience was also improved. More than half of the women in the treatment group found the procedure easier than expected, compared with around a third in the control group.

An important aspect of the study was that the administration of the anaesthetic itself should also be gentle. The results show that most participants found the administration to be only mildly painful.

“It is a simple method that does not require needles and is easy to use in everyday clinical practice,” says lead author Karin Elgemark, PhD student at the same department. 

The researchers point out that the study does not compare the method with other types of pain relief, which is a limitation. This means it is not possible to determine whether the method is more effective than alternative treatments. The results are also based on self-reported pain, which may be influenced by individual experiences.

“Our study shows that the method works when compared with no active treatment, but it also needs to be compared with other pain relief methods,” says Helena Kopp Kallner.

The study was carried out at eleven gynaecological clinics and youth health centres in Sweden. It was funded by the Swedish Research Council. Some of the researchers have reported receiving remuneration for lectures from companies that manufacture intrauterine devices (IUDs), but these organisations played no role in the conduct or analysis of the study.

Source: Karolinska Institutet

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Women Less Likely than Men to be Offered Active Medical Treatment for the Same Conditions

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Photo by Kindel Media

New research from the University of St Andrews has found that women are less like than men with the same medical condition to be offered active management such as surgery, a stent or a strong painkiller. 

The findings, published in PLOS One, come from a review that sifted 1112 published studies down to those that directly compared the care given to male and female patients. Of the 38 that analysed patient records, 33 reported a significant difference in the treatment men and women received. 

Researchers from the University of St Andrews School of Medicine found that almost none of those studies pointed to any guideline recommending different treatment by sex, leaving open whether this reflects sound clinical judgement or unequal care. 

Dr Andrew O’Malley, who co-led the study, said: “For clinicians, the findings are a prompt to check whether treatment is being offered on clinical grounds rather than assumption. For example, one study found that when the teams deciding who receives advanced heart failure therapy functioned poorly, women were less likely to be selected. Other work shows doctors more often attribute women’s symptoms to anxiety and make more diagnostic errors with female patients, even when test results are positive. 

Dr Miriam Veenhuizen, Honorary Lecturer in the School of Medicine, said: “While the direction of the findings was not a surprise the consistency was. The same pattern appeared in cardiology, surgery, transplant medicine and emergency care, and it survived statistical adjustment in most studies. It’s not entirely clear why this is happening, but it is likely because women were under-represented in clinical trials until recent decades, so many guidelines rest on data from men.” 

Dr Veenhuizen added: “What struck us most was the imbalance in attention. Over the same period, 551 studies examined sex inequality affecting doctors and other health professionals. Only 41 examined what happens to patients.” 

The researchers now intend to test whether the same patterns appear in the outputs of generative AI systems, which are trained on this literature and on clinical records, and which could entrench these differences at scale if left unchecked. 

Source: University of St Andrews

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‘Momnesia’ is Real – A Biological Explanation for Temporary Forgetfulness During Pregnancy

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Photo by SHVETS production

Many women usually say the same thing during pregnancy: they walk into a room and forget why, misplace their keys or struggle to follow a conversation. This phenomenon, often called ‘pregnancy brain’ or ‘momnesia,’ has long lacked a clear biological explanation.

Now, a new study by researchers at Baylor College of Medicine and collaborating institutions and published in Science Bulletin, identifies a specific brain circuit in an animal model that becomes disrupted under the sustained high oestrogen levels present during pregnancy. The findings offer the first biological explanation of how exposure to high-level circulating oestrogen can temporarily impair memory.

A novel brain circuit links high oestrogen levels with memory problems

“We worked with mouse models designed to mimic the sustained, high blood-oestrogen levels of pregnancy. These models showed that elevated oestrogen caused reversible memory impairment without affecting mood or motivation, suggesting a specific cognitive effect rather than a general change in well-being,” said senior author Dr Zheng Sun, associate professor of medicine – endocrinology, diabetes and metabolism and of molecular and cellular biology at Baylor.

Digging into the underlying biology, the team found that oestrogen receptor alpha, the protein that transmits oestrogen’s signals into cells, is the dominant oestrogen receptor in the brain region called the lateral hypothalamus. Furthermore, this region has abundant GABAergic neurons – brain cells that normally send calming, inhibitory signals to other parts of the brain. Using single-nucleus RNA sequencing, the researchers discovered that high oestrogen levels suppress signaling in these neurons, leading them to fire more frequently. “When we genetically removed oestrogen receptors from these hypothalamic neurons, both oestrogen-induced and pregnancy-induced memory problems in mice were reversed,” said Sun, a member of Baylor’s Dan L Duncan Comprehensive Cancer Center.

The team also found that these overactive hypothalamic neurons project directly into a region of the hippocampus that is a hub for memory formation. Using chemogenetics, a technique that allows researchers to turn specific neurons on or off, the team showed that silencing this hypothalamus-to-hippocampus pathway protected mice from estrogen-induced memory problems, whereas artificially activating the same pathway was sufficient to impair memory on its own, even without elevated estrogen.

Reconciling mixed evidence

Oestrogen’s relationship with memory has puzzled researchers for decades. For instance, hormone replacement therapy after menopause has been linked to cognitive benefits in some studies, while high oestrogen during pregnancy or with oral contraceptive use has been linked to memory complaints in others. The new findings suggest a possible explanation – it may not simply be a matter of ‘more oestrogen is better’ or ‘worse,’ but rather where in the brain that oestrogen acts, and at what levels.

“Low-level, cyclical oestrogen exposure appears to support cognitive function, which is part of why hormone therapy can help postmenopausal women,” said senior author Dr Yanlin He, associate professor at Pennington Biomedical Research Center. “But sustained, high-level oestrogen exposure seems to engage a different pathway altogether, one centred in the hypothalamus rather than the hippocampus itself. That distinction may help reconcile a lot of conflicting data in the field.”

Confirming the link in pregnant women

To determine whether these findings translate to humans, the researchers assessed memory performance in women across different stages of pregnancy. They found task-specific memory impairments that emerged during late pregnancy, and that correlated with circulating oestrogen levels, even after accounting for other factors that might influence cognition. This human data supports the idea that the hormone-driven circuit identified in mice may underlie the memory changes many pregnant women experience.

“Momnesia is real, it has a defined biological basis and is temporary,” said senior author Dr Xianghua Zhuang, professor at the Second Qilu Hospital of Shandong University. “We hope this work helps validate what many women have described anecdotally for years, and gives researchers a concrete target for future study.”

“The memory changes observed in both mice and women were temporary and task-specific, not a sign of broader cognitive decline,” said senior author Dr Xinguo Hou, professor at the Qilu Hospital of Shandong University. “Nonetheless, understanding the underlying circuit could eventually inform how clinicians counsel patients about the cognitive side effects of pregnancy or hormonal contraceptives, and could open avenues for therapies targeting this specific pathway without disrupting oestrogen’s broader, beneficial roles in the body.”

Source: Baylor College of Medicine, EurekAlert!

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Women’s Health Matters Conference 2026 Puts Women’s Health at the Centre Of South Africa’s Healthcare And Workplace Agenda

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The inaugural Women’s Health Matters Conference 2026, sponsored by Discovery Health, will take place on Thursday, 3 September 2026, at GIBS Business School in Johannesburg. Supported by Spar Group, the event will bring together leaders from healthcare, business, academia and civil society to tackle some of the most pressing health issues facing women in South Africa today.

Across a full-day programme, delegates will explore women’s health at every stage of life, from reproductive health, pregnancy and childbirth to menopause, cancer prevention and mental wellbeing. Discussions will also shine a spotlight on critically important issues that continue to receive insufficient attention, including period poverty, endometriosis and the health impact of gender-based violence.

Dr Noluthando Nematswerani, Chief Clinical Officer at Discovery Health and headline sponsor of the conference, will open the programme with an address on Women’s Health Through the Life Course. Her presentation will highlight the importance of data-driven insights, prevention, early intervention and equitable access to care in improving health outcomes for women across their lifespan.

“Supporting women’s health requires a life-course approach. Improved outcomes are achieved through a strong focus on health promotion, disease prevention, early intervention, and timely access to appropriate care. It also demands a coordinated response from healthcare systems, employers, and communities that reflects the changing needs and challenges women experience throughout their lives. Discovery is proud to support a platform that unites these stakeholders around meaningful, action-oriented solutions,” says Dr Nematswerani.

The conference programme will move beyond awareness and explore the practical actions required to transform healthcare systems, workplaces, communities, and public policy in support of women’s health.

Key conference discussions will include:

Women’s Health Across the Life Course Exploring prevention, early intervention and access to care across reproductive health, maternity care, cancer, mental health and midlife health.

Pregnancy and Birth in South Africa Addressing high-risk pregnancies, preventable complications, informed decision-making and respectful maternity care.

Period Poverty and Access to Dignity Examining the affordability of menstrual products, menstrual health education, stigma, and the role of schools, workplaces, government and public-private partnerships in improving access.

The Endometriosis Diagnosis Gap Exploring the impact of delayed diagnosis on chronic pain, fertility, treatment outcomes and women’s participation in the workplace.

The Menopause-Ready Workplace Focusing on manager education, employee support, healthcare benefits and practical workplace interventions to better support women during menopause.

Closing the Women’s Cancer Care Gap Covering screening, early diagnosis, treatment access, survivorship and the role of employers and healthcare funders in improving outcomes.

GBV Is a Women’s Health Crisis Examining the physical and mental health consequences of gender-based violence, and the importance of survivor-centred healthcare, support services and prevention strategies.

SPAR will place a special focus on period poverty through a session led by Mpudi Maubane, National PR, Communications and Sponsorship Manager at SPAR, titled “Period Poverty: Dignity Should Not Depend on Income.”

“Period poverty extends far beyond access to menstrual products. When girls and women are unable to manage menstruation safely and with dignity, it affects school attendance, workplace participation, confidence and future opportunities. Addressing this challenge requires solutions that combine access, education and sustained partnerships to ensure that menstruation never becomes a barrier to full participation in society,” says Maubane.

The discussion will continue in a panel session titled “From Products to Policy: What It Will Take to End Period Poverty,” which will explore how business, government, educational institutions and community organisations can collaborate to develop sustainable, long-term solutions.

The programme features contributions from leading experts and advocates in women’s health, including clinical psychologist and founder the CBT group Dr Colinda Linde, obstetrician and gynaecologist Dr Sumayya Ebrahim, menstrual health activist Candice Chirwa, reproductive medicine specialist Prof Zozo Nene, menopause researcher and practitioner Dr Nicole Jaff, Co-CEO Tiko Benoit Renard, and  head of oncology risk management and care coordination, discovery health Dr Kagiso Seripe.

The Women’s Health Matters Conference is expected to bring together between 200 and 250 stakeholders, including healthcare professionals, medical schemes and insurers, corporate and HR leaders, government representatives, NGOs, academics, researchers, workplace wellbeing practitioners and women leaders.

The conference will conclude with a forward-looking session, “From Awareness to Action,” focused on identifying practical commitments and collaborative actions that healthcare providers, employers, policymakers and communities can take forward beyond the event to create meaningful and lasting change in women’s health.

Event Details

Event: Women’s Health Matters Conference 2026 Date: Thursday, 3 September 2026 Registration: 08:30 Conference: 09:00 – 17:00 Venue: GIBS Business School, Johannesburg Headline Sponsor: Discovery Health

Discovery Health’s registered wellness providers will be on-site from 08:00 to 19:00, offering a complimentary Wellness Health Screening Experience for all attending delegates and guests. This includes glucose, cholesterol, blood pressure and BMI checks. Conference delegates will have the opportunity to gain valuable insights into their health and wellness throughout the day.

To buy tickets please email James@creativespacemedia.co.za

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The Silent Epidemic in Maternal Health: Why More Pregnant Women Need Hepatitis B Screening

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  • Hepatitis B remains one of the world’s most underdiagnosed infections.[1]
  • Untreated hepatitis B can remain silent for years while increasing the risk of severe liver disease and preventable infant infection.[1,2]
  • Integrated point-of-care testing during antenatal care visits presents an important opportunity to identify undiagnosed infections and support measures aimed at reducing transmission to newborns.[2,3] 

A pregnant woman attending her first antenatal care (ANC) appointment will often be screened for conditions that could affect her health and the health of her unborn child, including HIV and syphilis, but not always for hepatitis B virus (HBV) infection. This is not because hepatitis B is rare; in fact, quite the opposite. Millions of people worldwide are living with chronic hepatitis B infection, yet many remain unaware of their infection because the disease can progress silently for years without symptoms.[1] As a result, infection is often diagnosed only after serious liver complications develop.[1]

Late diagnosis increases healthcare costs, may limit treatment options and contributes to preventable illness and death.[1] For pregnant women, delayed diagnosis creates an additional risk of vertically transmitting the virus to their babies during childbirth.[2] That missed opportunity is why hepatitis B needs to be seen not only as a liver disease, but as a maternal and child health priority. For healthcare companies such as Abbott, there is an opportunity to help health systems make every ANC touchpoint work harder by bringing reliable, rapid and integrated testing closer to the point of care.

The central question is no longer whether hepatitis B can be detected, prevented or managed. It can. The question is whether health systems are using routine moments of care, especially pregnancy, to find the infection early enough to enable interventions that can improve outcomes for mothers, infants and families.

  • Hepatitis B is often silent, but its consequences are not.[1]
  • ANC offers a critical window to prevent mother-to-child transmission through timely immunoprophylaxis.[2,3]
  • Integrated testing can help expand access while reducing practical barriers for patients and frontline healthcare workers.[3]
  • Africa has the tools to change the trajectory; now systems must scale them.[1,3]

The cost of not knowing

Hepatitis B remains one of the world’s most significant infectious diseases despite being preventable and treatable. According to the World Health Organization’s (WHO) Global Hepatitis Report 2026, an estimated 240 million people were living with chronic hepatitis B in 2024, and the WHO African Region accounted for 68% of new hepatitis B virus infections globally.[1]

Behind these numbers are people who may be asymptomatic for years while the virus quietly damages the liver. When hepatitis B is not detected, the first sign of illness may be cirrhosis, liver cancer or liver failure.[1] For families, delayed diagnosis may contribute to repeated clinic visits, rising treatment costs, lost income and the emotional burden of managing a condition that could have been identified much earlier.

“Hepatitis B challenges health systems because it is often invisible until the consequences are severe,” says Dr Evans Mathebula, Senior Medical Affairs Manager at Abbott’s rapid diagnostics business in Africa. “If we wait for symptoms, we have waited too long. The priority should be to make hepatitis B screening routine, accessible and connected to care, particularly at moments when people are already engaging with the health system.”

This is especially important in maternal care. Pregnancy represents one of the most important opportunities to identify previously undiagnosed hepatitis B infection. For many women, ANC is among the few periods of regular engagement with the healthcare system.[2] This visit already serves as an important screening and health education opportunity and can facilitate preventive interventions. Many African countries have made important progress in preventing mother-to-child transmission of HIV. That progress shows what is possible when testing, treatment, policy and community trust are aligned. Hepatitis B now needs the same systems discipline, because the antenatal care clinic may be one of the few reliable points of contact between a pregnant woman and the health system.

This approach aligns with the WHO’s triple elimination initiative, which encourages countries to eliminate mother-to-child transmission of HIV, syphilis and hepatitis B together, rather than through fragmented disease-specific programmes.[3] It recognises a simple reality: healthcare systems across Africa continue to face constraints, workforce pressures and laboratory challenges. In this context, adding new screening priorities must be practical and sustainable. Additionally, pregnant women should not have to navigate three separate pathways when one integrated screening moment can support identification of multiple risks and enable timely care during a single encounter.[3]

An integrated antenatal panel that screens for HIV, syphilis and hepatitis B from a single finger-prick is one example of how health systems can simplify access while maintaining a comprehensive standard of care.[3] For mothers, it can help reduce the risk of missed results and clarify next steps. For healthcare workers, it can support faster decision-making at the point of care when linked to appropriate follow-up pathways. For newborns, timely identification of maternal hepatitis B can support measures that reduce the risk of exposure and enable timely preventive action.

“The most powerful public health interventions are those that fit naturally into the realities of existing care,” adds Mathebula. “The easier it is for healthcare workers to identify hepatitis B during a single antenatal visit, through the use of an integrated panel, the sooner patients can be considered for appropriate follow-up care. We are not only improving diagnosis; we are giving clinicians the information they need to support mothers, help reduce the risk of infant infection and strengthen confidence in the health system.”

A hopeful path to elimination

For too long, hepatitis B has remained overshadowed by other infectious diseases despite its scale and impact. The tools needed to prevent transmission, diagnose infection and support long-term management already exist.[1] What remains is the challenge of finding the millions of people who are living with this virus without knowing it, starting with those accessing maternal and primary healthcare.

To move from awareness to action, policymakers and healthcare leaders should prioritise routine hepatitis B screening in antenatal care, support point-of-care testing in decentralised settings, strengthen linkage to treatment and ensure newborns receive timely protection.[1,3] These are practical steps that can turn a silent infection into a manageable health issue and help prevent transmission to the next generation.

Eliminating hepatitis B as a public health threat will require more than technology alone. It will require political will, domestic investment, continued education to increase awareness, trusted community engagement and health systems designed around people’s real lives. But the path is clear: if one antenatal care visit can identify risk, enable timely care and support measures that help reduce a child’s risk of infection, then it is one of the most powerful opportunities public health has to change two lives at once.

References: 

[1] World Health Organization. (2026). Global hepatitis report 2026. Geneva: World Health Organization.

[2] Afolabi, I. B., Phillips, J. C., El-Chaar, D., Bainbridge, S. A., & Phillips, K. P. (2026). Preventing vertical transmission of hepatitis B in sub-Saharan Africa: protocol for a systematic review and meta-analysis on vaccination uptake and determinants among pregnant women. BMJ Open, 16(1), e113229. https://doi.org/10.1136/bmjopen-2025-113229

[3] World Health Organization & United Nations Children’s Fund. (2025). Country guidance for planning triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus programmes. Geneva: World Health Organization.

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How Can We Cut Gynaecologic Cancer–related Deaths in Low- and Middle-income Countries?

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

Review offers insights on evidence-based strategies.

Low- and middle-income countries (LMICs) bear a disproportionate burden of gynaecologic malignancies – cancers of the cervix, endometrium, ovary, vagina, and vulva. A review published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, reveals that survival disparities for these cancers are driven by late-stage diagnosis, limited screening coverage, inadequate radiotherapy infrastructure, workforce shortages, and restricted access to essential and novel therapies.

By analysing studies published between 2015 and 2024, investigators observed that LMICs account for approximately 94% of global cervical cancer deaths, with the highest mortality observed in East Africa. Despite persistent survival disparities in LMICs, research has generated evidence that cost-effective and scalable interventions – including single-dose HPV vaccination, screen-and-treat strategies, HPV self-sampling, radiotherapy expansion, and workforce development with international training partnerships – can substantially improve outcomes when embedded within national cancer control policies and supported by sustainable financing mechanisms.

The authors stressed that policy-driven, system-level reforms should prioritise prevention, strengthen service delivery, and expand equitable access to care.

“The survival gap in gynaecologic cancers between low- and middle-income countries and wealthier nations is not inevitable – it is largely the result of delayed diagnosis and under-resourced health systems,” said corresponding author Dr Alfi Sophian, SSi, MSi, of the Indonesian Food and Drug Authority. “Our review shows that proven, cost-effective interventions already exist. What is needed now is stronger political commitment and sustainable financing to embed them into national cancer control policies.”

CANCER’s Editor-in-Chief, Suresh S. Ramalingam, MD, FASCO, who is the Executive Director of the Winship Cancer Institute of Emory University and the Roberto C. Goizueta Chair in Cancer Research at the Emory University School of Medicine, agreed that the review highlights key opportunities to reduce the burden of gynaecological malignancies in low- and middle-income countries. “Gynaecological malignancies claim the lives of far too many women globally; implementation of evidence-based tools consistently and uniformly across the world will save numerous lives,” he said.

Source: Wiley

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

Premature Menopause Is a High Blood Pressure Risk Factor

On By ModernMedia

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

Photo by Hush Naidoo on Unsplash

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

On By ModernMedia

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.