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Emma N. Cleary is a PhD candidate at Indiana University Bloomington.

A study found that judicious prenatal opioid prescribing does not substantially increase the risk of autism or ADHD in children.

Emma N. Cleary explains opioid use is not linked to offspring ADHD or autism

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A study found reduced quality of life in women with premenstrual disorders, especially in anxiety, depression, and pain domains.

Premenstrual disorders linked to reduced quality of life

Helena Rutherford, PhD, is an associate professor in the Child Study Center at Yale School of Medicine.

A study using objective Doppler measures shows that more active fetuses are associated with stronger maternal-fetal bonds.

Helena Rutherford, PhD, highlights fetal movement's link to maternal attachment

A cohort study found that poverty and social disadvantage were associated with reduced fecundability and greater subfertility risk.

Poverty and social disadvantage linked to lower fecundability and greater risk of subfertility

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A recent clinical study presented by Koji Ishikawa, MD, PhD, orthopedic spine surgeon at Duke University, and Tony M. Keaveny, PhD, Founder and Chief Science Officer of O.N. Diagnostics, compared the effects of romosozumab, teriparatide, and denosumab on bone strength in patients with osteoporosis. 

The analysis focused on the hip and spine, where fracture risk is particularly great. Results showed that romosozumab provided substantially greater improvements in bone strength after 1 year of treatment compared to the other 2 drugs. At the spine, for example, romosozumab increased bone density by approximately 25% but boosted bone strength by about 40%, highlighting that strength gains are not fully reflected by bone density measurements from standard DXA scans.

The findings are significant because fracture prevention depends more on improved breaking strength than on density alone. Data from real-world clinical care also suggest even greater percentage gains than those seen in earlier phase-2 and phase-3 trials. 

Notably, romosozumab demonstrated the unique ability to transform highly osteoporotic vertebrae into bones at much lower risk of biomechanical failure, as shown through virtual stress testing models. According to the researchers, romosozumab stands out as the most effective treatment for strengthening both hip and spine bones, offering a compelling advantage over teriparatide and denosumab.

Below, Keaveny shares further details on their presentation 

”(SUN-416) Greater increase in bone strength with romosozumab vs teriparatide or denosumab in women with postmenopausal osteoporosis in real-world clinical setting

 and Ishikawa provides an overview of the presentation 

“(SUN-564) Greater increases in bone strength estimates of virtual bone-implant constructs for spinal surgery with romosozumab vs teriparatide or denosumab in women with postmenopausal osteoporosis”. 

Please provide an overview of your presentation about bone strength from romosozumab vs teriparatide or denosumab.

This study compared the breaking strength of the hip and spine bones for different osteoporosis drug treatments and showed that the strength benefits after 1 year of treatment were substantially greater for romosozumab compared to both teriparatide and denosumab.

Spinal instrumentation remains challenging in patients with bone fragility. The concept behind this project is to provide additional support for achieving favorable surgical outcomes, beyond surgical techniques. Based on simulation-based biomechanical analysis, we found that romosozumab offered multiple advantages over denosumab and teriparatide in terms of biomechanical parameters relevant to spinal surgery.

What is the significance of these findings?

Changes in bone density as measured by clinical-standard DXA testing are difficult to interpret because what matters most in terms of fracture reduction is how much the 

 changes. This study is significant because it demonstrates the substantial benefits for breaking strength – more than for bone density. For example, at the spine, romosozumab increased bone density by about 25% but bone strength by about 40%. So, the benefits of the treatment are underestimated when measured by bone density. And of course, those benefits were greater for romosozumab than either of the other 2 treatments.

Evaluating mechanical parameters such as screw fixation strength or bone-breaking force in clinical practice for assessing drugs effects is impractical and often difficult with traditional biomechanical methods. To address this, we developed a simulation approach using patient CT data. Our findings provide a new perspective on their effectiveness in the context of implant surgery.

What were the main takeaways of your presentation?

As we have seen in other clinical trials, romosozumab is the better treatment in terms of its bone-strengthening benefits, both at the hip and spine. Here we have data from actual clinical care.

After 1 year of treatment, romosozumab showed greater improvements than denosumab and teriparatide in surgical instrumentation-related biomechanical analyses.

What other research about the impact of romosozumab on bone strength would you like to highlight?

These results suggest even greater gains, percentage-wise at least, for these highly osteoporotic and treatment-naïve patients from clinical care than what we observed in a prior phase-2 BCT study in women with low bone mass (Keaveny JBMR 2017) and also in a phase-3 imaging substudy of osteoporotic women with prior bisphosphonate therapy (Langdahl Lancet 2017).

In a previous study, we were the first to demonstrate the potential benefits of short-term romosozumab treatment (3 months) in reducing postoperative complications after spinal surgery (Ishikawa K, JOR Spine 2024). Taken together with the present findings, our research further supports the role of romosozumab for surgical support.

These results are particularly compelling at the spine for romosozumab because the drug benefit is so large — it takes a highly osteoporotic bone and transforms it into one at much lower risk of biomechanical failure. This is seen visually with the virtual stress testing. Here, virtual forces are placed on the bone that would normally fracture and crush an osteoporotic bone. After treatment with romosozumab, that same level of force produces almost no damage in the bone. Romosozumab appears to be the only drug treatment that can transform the osteoporotic vertebra in this way.

Even the best surgeons face complications when patients have osteoporosis. Yet perioperative bone health care is often overlooked. Our studies underscore the importance of assessing and managing bone health in perioperative settings to improve surgical outcomes.

Recent work presented at the 2025 annual meeting of American Society of Bone & Mineral Research found that romosozumab significantly outperformed teriparatide and denosumab in improving hip and spine bone strength. 

Clinical

Romosozumab outperforms teriparatide and denosumab in bone strength

Researchers from the Medical University of South Carolina (MUSC) Hollings Cancer Center have identified cervical cancer as a potential risk factor for future anal cancer, publishing their findings in 

While anal cancer screening is recommended in organ transplant recipients, people living with HIV, and women with a history of vulvar cancer, screening guidelines have not been established for women with cervical cancer. This data highlights a nearly 2-fold increased risk of anal cancer in this population, potentially influencing future guidelines.

“We’ve known for a long time that both cervical and anal cancers are caused by HPV, the human papillomavirus,” said Haluk Damgacioglu, PhD, study lead and assistant professor at MUSC. “But what hasn’t been well-understood is how that shared risk might connect the 2 diseases over a woman’s lifetime.”

The cohort study was conducted to estimate anal cancer incidence since cervical cancer diagnosis.

 Data were obtained from the National Cancer Institute’s Surveillance, Epidemiology, and End Results registries. 

International Classification of Diseases for Oncology 

codes were referenced to identify cancer cases.

Women receiving an anal cancer diagnosis before or within 2 months of cervical cancer diagnosis were excluded from the analysis. A multiple primary standardized incidence ratios session was utilized to calculate overall, age-specific, and time since diagnosis-specific incidence rates (IRs) per 100,000 person-years.

There were 822,630 person-years of follow-up across 85,524 cervical cancer patients diagnosed from 1975 to 2021 evaluated. In the study population, 64 anal cancer diagnosis cases were identified, indicating an overall incidence of 7.8 per 100,000 person-years.

Differences in anal cancer IRs were highlighted across age groups and time since cervical cancer diagnosis. An IR of 2.4 was reported for women aged under 45 years with a history of cervical cancer but rose to 4.6 for those aged 45 to 54 years and 10.0 for those aged 54 to 64 years.

Women aged 65 to 74 years presented with the greatest IR of 17.6, while those aged at least 75 years had an IR of 10.0. When assessing the incidence based on time since cervical cancer diagnosis, an IR of 5.8 was reported in the first 5 years. Additional IRs included 5.1 for 5 to less than 10 years, 5.9 for 10 to less than 15 years, 12.7 for 15 to less than 20 years, and 16.1 for 20 or more years.

Of anal cancer diagnoses in women aged 65 to 74 years, 59% occurred over 15 years following cervical cancer diagnosis. Overall, a standardized incidence ratio of 1.9 was reported for anal cancer, with elevated risk persisting over time following cervical cancer diagnosis. This indicated a significant increase in risk among patients with cervical cancer.

Cervical cancer has a survival rate of more than 90% when found early, thanks to routine screening and the HPV vaccine.

 However, this is one of the first studies to evaluate potential next steps in these patients who may experience elevated risks of related cancers.

“We don’t have the resources to screen everyone,” said Haluk Damgacioglu, PhD, assistant professor at MUSC. “But we can use these data to be strategic. Screening based on risk ensures we help the people who need it most.”

Medical University of South Carolina. New study reveals a hidden risk after cervical cancer. News release. EurekAlert. September 11, 2025. Accessed September 11, 2025. https://www.eurekalert.org/news-releases/1097373?

Damgacioglu H, Curtis C, Sonawane K, et al. Anal cancer incidence among women with a history of cervical cancer by age and time since diagnosis. 

2025;8(9):e2531362. doi:jamanetworkopen.2025.31362

Women with a history of cervical cancer face nearly double the risk of anal cancer, highlighting the need for tailored screening guidelines.

Cervical cancer linked to increased anal cancer risk

Fertility anxiety

, Natalia Llarena, MD, FACOG, reproductive endocrinology and Infertility specialist and ob-gyn with HRC Fertility, highlighted the growing trend of fertility anxiety among younger women, particularly Gen Z. 

Data show that approximately 72% of Gen Z women experience age-related fertility concerns, with many feeling this pressure as early as age 23. Nearly half report feeling compelled to have children before age 30. Llarena emphasized that while awareness of fertility challenges can be beneficial, panic often leads to rushed decisions about relationships or career paths.

She noted that part of the anxiety is rooted in biological realities, such as the well-documented decline in fertility with age. Still, she underscored that education is a key tool for reducing panic. Many women in their early 40s remain unaware of how age impacts fertility outcomes, highlighting the need for improved patient education. 

Llarena advised that women can take proactive steps to support their fertility, starting with a healthy lifestyle that includes avoiding smoking and vaping, eating well, and getting adequate sleep. For those not yet ready to conceive, egg or embryo freezing can serve as valuable options to preserve future fertility.

At HRC Fertility, efforts are underway to help address fertility-related anxiety through patient education and advocacy. One initiative includes moving away from outdated terminology such as geriatric pregnancy, which many women find stigmatizing and anxiety-inducing. By using more supportive language, clinicians can help patients feel more confident during pregnancy and fertility planning.

Llarena also addressed the differences between male and female fertility over time. While men do not experience the same steep age-related decline in fertility, advanced paternal age has been linked to specific genetic abnormalities, autosomal dominant conditions, and increased risks such as autism. This underscores the importance of both maternal and paternal age in reproductive planning.

Ultimately, Llarena emphasized that fertility care should be individualized. Whether a woman seeks guidance in her late 20s or early 40s, the goal is to support her in meeting her family-building goals. 

For those beginning to think about pregnancy in their late 20s or early 30s, she recommended early consultations with a reproductive endocrinology and infertility specialist, even if immediate conception is not the plan. Empowering patients with accurate information, she concluded, allows them to approach fertility decisions with clarity and confidence, rather than fear.

HRC Fertility. HRC Fertility study shows why “geriatric pregnancy” must go. News release. Business Wire. September 9, 2025. Accessed September 11, 2025. https://www.businesswire.com/news/home/20250909926256/en/HRC-Fertility-Study-Shows-Why-Geriatric-Pregnancy-Must-Go

New data reveal that more than 70% of Gen Z women report age-related fertility concerns, with experts urging education, proactive planning, and supportive language to reduce panic.

Natalia Llarena, MD, FACOG, discusses rising fertility anxiety in Gen Z

Timely cervical cancer treatment is less likely among patients with Medicaid insurance, according to a recent study published in the 

American Journal of Obstetrics & Gynecology.

Approximately 14,050 new US cervical cancer cases and 4290 cervical cancer deaths were reported in 2024.

 While screening and human papillomavirus vaccination have been linked to significantly reduced risks, disproportionate morbidity and mortality rates have been identified in marginalized populations, requiring complex care.

“Thus, identifying risk factors for delayed time to treatment may help determine those in need of further assistance in this transitional period and identify mechanisms to improve quality of life and clinical outcomes in this high-risk population,” wrote investigators.

The cohort study was conducted to identify risk factors of delayed cervical cancer treatment. Participants included patients aged at least 18 years and with a locally advanced cervical cancer diagnosis visiting the University of California, San Francisco for care between January 1, 2003, and September 30, 2023.

Exclusion criteria included insufficient follow-up records, initial cervical cancer not managed at UCSF, active treatment during data abstraction, rare histology, and not receiving cancer-directed therapy. Timely initiation to treatment, defined as 60 days or less between diagnosis and treatment initiation, was reported as the primary outcome.

The first day of curative or palliative cancer-directed treatment indicated treatment initiation. Time from biopsy to staging and time from staging to treatment were reported as secondary outcomes. Age, race, insurance status, travel distance, Charlson Comorbidity Index (CCI), and social vulnerability index (SVI) were included as demographic risk factors.

Insurance, social factors, and delayed treatment

There were 280 participants included in the final analysis, 37.1% of whom received timely initiation to treatment. Overall, a median duration of 68.5 days was reported between biopsy and treatment initiation. Of participants, 49.6% were White, while 30.4% did not self-report race, and an age of 40 to 49 years was reported in 31.4%.

Medicaid insurance was found in 75.4% of patients, private insurance in 17.1%, Medicare in 6.4%, and uninsured status in 1.1%. Additionally, 65.4% had stage 3 disease and 78.2% squamous cell carcinoma histology.

In those with timely treatment, 81.8% had Medicaid insurance vs 64.4% with delayed treatment. Rates of having no self-reported race were 36.9% and 19.2%, respectively, while rates of being in the third highest SVI quartile were 14.4% and 24.4%, respectively.

A significant increase in delayed treatment risk was identified in patients with Medicaid insurance, with an OR of 2.76 vs private insurance. For being in the third highest quartile of SVI vs the first SVI quartile, the OR was 2.68, indicating a significant rise in risk.

Delayed treatment was less likely in patients with stage 3 A-C vs IB3-2B cancer, with an OR of 0.56. However, an increased risk with an OR of 2.62 was reported in patients with no self-reported race vs White patients, alongside an OR of 0.53 indicating decreased odds in non-Hispanic vs Hispanic patients.

Decreased odds of delayed treatment based on an OR of 0.19 were also found in patients aged at least 70 years vs those aged under 30 years. No significant associations were reported for CCI, travel time, or histology.

In a multivariate analysis, the odds of delayed treatment were increased 2.42-fold among patients with Medicaid vs private insurance, while significant associations were not observed for SVI and stage of disease. Overall, the data highlighted significant treatment delay for cervical cancer in patients with Medicaid insurance.

“Our findings emphasize the need for future studies to examine associations with clinical outcomes and identify meaningful interventions that target the referral and navigation process…to address social needs to reduce this inequity in delivery of care,” wrote investigators.

Liang J, Mvemba A, Swanson M, et al. Delay to timely treatment in locally advanced cervical cancer: insurance inequities in access to gynecologic oncology. 

2025;233(3):186.e1-186.e9. doi:10.1016/j.ajog.2025.02.032

Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. 

. 2024;74(1):12-49. doi:10.3322/caac.21820

A study found women with Medicaid insurance are more than twice as likely to experience delays in starting cervical cancer treatment.

Cervical cancer treatment delayed in Medicaid patients

A cross-sectional analysis published in the 

American Journal of Obstetrics & Gynecology

 found that menstrual product use in the United States varies significantly by sociodemographic, gynecological, and menstrual cycle characteristics.

The prospective digital cohort recruited participants through the Apple Research application beginning November 14, 2019. Eligible participants were aged 18 years or older, had menstruated at least once, and provided written informed consent.

 Data for this analysis included 11,455 participants who completed surveys between November 2019 and January 2024.

 Median age at enrollment was 33 years, with an interquartile range of 26 to 40 years. Ninety-seven percent of participants self-identified as women, and 81% reported at least a college-level education.

"Examining variations in menstrual product use across sociodemographic groups could deepen the understanding of usage differences, especially among historically marginalized groups," wrote investigators.

Across the cohort, the most frequently reported products were regular tampons in 48% of patients, sanitary pads in 47%, panty liners in 43%, super-absorbent tampons in 36%, period underwear in 20%, and menstrual cups in 18%. In addition, 18% of participants reported using a combination of tampons and pads nonsimultaneously, 2% used other products, and 4% reported using no product. Among tampon users, 61% reported sleeping overnight with a tampon in place.

Product use differed across age groups. Compared with participants aged 30 to 39 years, younger participants aged 18 to 19 years reported more pad use and less cup use, at 57% and 12%, respectively, vs 35% and 21%, respectively, in the older group. Participants aged 50 years or older reported lower use of regular tampons and cups, at 32% and 7%, respectively. In comparison, tampon use was reported in 50% of those aged 30 to 39 years.

Patterns also varied by race and ethnicity. Compared with non-Hispanic White participants who had regular tampon use of 50% and cup use of 19%, those who self-identified as non-Hispanic Asian, Hispanic, or non-Hispanic Black reported lower use of tampons, at 37%, 39%, and 31%, respectively. Cup use was lower among Asian and Hispanic participants at 15% each.

Socioeconomic status (SES) also influenced use. Compared with participants in the low SES group, those reporting high SES were less likely to use pads at 50% vs 42%, respectively, and more likely to use cups at 17% vs 21%, respectively, or period underwear at 19% vs 22%, respectively.

Gynecological and menstrual cycle differences

Participants with gynecological conditions demonstrated distinct usage patterns. Those with endometriosis reported higher use of super-absorbent tampons at 38% vs 33% without endometriosis. Participants with fibroids more frequently reported sleeping overnight with tampons at 69% vs 60% without fibroids. Those with infertility reported higher use of pads, super-absorbent tampons, and period underwear compared with participants without infertility.

Menstrual cycle length and bleeding days were also associated with product choice. In participants reporting a cycle length of 26 to 31 days, cup use was 23%, but those with cycles less than 21 days, at least 40 days, or that were irregular were less likely to use cups, with rates of 10%, 18%, and 15%, respectively. Use of pads, super-absorbent tampons, cups, and period underwear increased incrementally with longer bleeding durations.

“Our findings contextualize menstrual product use in the United States, which could be useful for discussions among clinicians, policymakers, and patients regarding menstrual management," wrote investigators.

The study authors noted that differences in product use may reflect cultural norms, socioeconomic barriers, and health conditions influencing menstrual management. They also highlighted that these findings provide reference data for clinicians counseling patients on menstrual health, particularly among historically underrepresented groups.

In this large US cohort, tampons and pads remained the most commonly used products, while menstrual cups and period underwear were less frequently used. Usage varied significantly by age, race and ethnicity, SES, gynecological diagnoses, and menstrual cycle characteristics. The authors concluded that further research is needed on affordability, accessibility, and potential health implications of different menstrual products.

Wang Z, Peebles E, Baird DD, et al. Menstrual product use patterns in a large digital cohort in the United States: variations by sociodemographic, health, and menstrual characteristics. 

2025;233(3):184.e1-184.e15. doi:10.1016/j.ajog.2025.03.002

Mahalingaiah S, Fruh V, Rodriguez E, et al. Design and methods of the Apple Women's Health Study: a digital longitudinal cohort study. 

2022;226(4):545.e1-545.e29. doi:10.1016/j.ajog.2021.09.041

A recent study found variations in menstrual product use by race, age, socioeconomic status, and menstrual factors.

Helena Rutherford, PhD

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