Menopause

A recap of the top FDA news stories covered by Contemporary OB/GYN in Q2 2026, spanning cervical cancer screening, menopause therapeutics, and antibiotic treatment for urinary tract infections.

A look ahead to the second half of 2026 for ob-gyns, including Viatris's pending FDA decision on a low-dose estrogen contraceptive patch and previews of the IDSOG, AUGS PFD Week, and The Menopause Society annual meetings.

Stephanie Faubion, MD, and Fiona Baker, PhD, discuss how elinzanetant can play a role in sleep disturbances because of VMS, emerging data on the subject, and how to determine the right candidate for the NK1-3 dual-receptor antagonist.

SWAN data from 2066 women demonstrate that sleep disturbance has a greater independent effect on health-related quality of life than VMS alone, with the combination of both symptoms producing the most pronounced impact on physical functioning and energy—findings that support prioritizing sleep as a treatment target alongside vasomotor symptoms in menopausal care, according to Pauline M. Maki, PhD.

Shared decision-making around nonhormonal VMS and sleep management requires moving through contraindications, patient preferences, and monitoring burdens together, with elinzanetant's (Lynkuet) dual receptor profile making it a particularly relevant option for women with both VMS and sleep disruption—and with follow-up at 2 to 3 months essential to evaluating response, according to Stephanie S. Faubion, MD, MBA, FACP, MSCP, IF.

Fiona C. Baker, PhD, explains how menopausal sleep disturbance differs from other forms of sleep disruption, citing the role of vasomotor symptoms, hormone changes, and an increased postmenopausal risk of sleep apnea in driving nighttime awakenings.

Among SWAN participants, sleep disturbance was independently associated with lower HRQoL relating to role-physical, role-emotional, and energy/fatigue, with no change in these associations over time.

Jessia Gaulton, MD, MPH, speaks to knowledge and gaps surrounding the menopause transition and mental health associations, while highlighting new Menopause Hub resources from FamilyWell Health.

In part 2 of our discussion with Fiona Baker, PhD, she details how to interpret data from the NIRVANA study, which revealed reductions in wakefulness after sleep onset in the elinzanetant group vs placebo.

Elinzanetant produced a numerically greater reduction in PSG-measured WASO vs placebo across the 12-week NIRVANA trial, with the effect more pronounced at week 4 than week 12.

A post hoc analysis of the phase 2 NIRVANA trial presented at SLEEP 2026 found that elinzanetant reduced WASO versus placebo across in-lab PSG, home-based Sleepiz One+ monitoring, and patient-reported Sleep Diary.

Presented at SLEEP 2026, NIRVANA data show a consistent elinzanetant treatment signal across three sleep measurement modalities, extending earlier OASIS trial findings on patient-reported sleep outcomes in menopausal women.

The total treatment effect of elinzanetant on sleep disturbance relative to placebo was -4.92 (95% CI, -5.73 to -4.12), indicating a clinically meaningful reduction.

Two neurokinin receptor antagonists are now available for vasomotor symptom (VMS)-related sleep disruption, with elinzanetant's (Lynkuet) NK1 and NK3 dual-receptor profile potentially offering more targeted sleep benefit than fezolinetant's (Veozah) NK3-selective mechanism—but effective management requires systematic screening for obstructive sleep apnea, restless leg syndrome, and primary insomnia before attributing sleep disruption to VMS alone

The HRT uptake meta-analysis is largely drawn from high-income country data and cannot be generalized globally, whereas the ongoing influence of WHI-era risk framing on prescribing underscores the need for individualized absolute risk assessment—supported by decision aids that do not yet adequately exist for many clinical scenarios.

A meta-analysis of 53 studies found that Black women had 53% lower odds of HRT use than White women, and that diabetes, obesity, stroke, and VTE history were each associated with lower uptake—findings that point to both racial inequities and potentially overcautious prescribing in women with cardiovascular risk factors who may benefit from individualized assessment.

Genevieve Neal-Perry, MD, PhD, highlights that phase 4 real-world data confirm that fezolinetant significantly reduces VMS bother, particularly in high-burden groups such as Black women and patients with obesity.

David Shalowitz explains why experts now recommend a dual approach for most patients with postmenopausal bleeding due to limitations in ultrasound accuracy.

At ACOG, David Shalowitz, MD, highlighted the biggest takeaways from April's updated guidance on postmenopausal bleeding.

Meaningful improvements in gynecologic care for LGBTQ patients require both environmental changes—inclusive waiting rooms, trained front desk staff, flexible scheduling—and clinical recalibration, including routine screening for contraceptive needs and menopausal symptoms regardless of gender identity or presentation.

Pelin Batur, MD, emphasizes that half of patients are unsatisfied with their sexual health and clinicians should normalize these concerns through simple, open-ended questions.

Jill Liss, MD, MSCP, FACOG, outlines aspects of hormonal and non-hormonal treatments for vasomotor symptoms.

In this discussion from ACOG's 75th Annual Meeting, Genevieve Neal-Perry, MD, PhD, explains how elinzanetant has impacted patients since it's approval in October 2025.

A study of 1206 women found that while many remain sexually active as they age, a higher number of menopausal symptoms was linked to decreased sexual satisfaction.

Contemporary OB/GYN will be on site in Washington, D.C. to cover the latest data out of the 75th Annual ACOG Clinical & Scientific Meeting.