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A recent mediation analysis shows 54% of elinzanetant's (Lynkuet) sleep benefit is independent of nighttime VMS reduction, suggesting NK1 blockade targets menopausal sleep disruption through a distinct pathway.

A recap of the top-performing, most-viewed Contemporary OB/GYN stories from June 2026, including new SMFM guidance on acetaminophen in pregnancy, ACOG's break from federal vaccine recommendations, and our coverage of SLEEP 2026 in Baltimore.

Because only one third of nocturnal wakefulness during the menopausal transition is directly linked to hot flashes, VMS-targeted therapies alone are insufficient for many women with sleep disruption—and cognitive behavioral therapy for insomnia, supported by sleep society guidelines and accessible through free digital platforms, should be part of every clinician's sleep management toolkit, according to Pauline M. Maki, PhD.

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.

Nishita Pondugula, MD, MS, explains her session surrounding associations of gestational weight gain and hypertensive pregnancy disorders with prepregnancy GLP-1 exposure.

The vacuum device was favored on three measures: lower ICU admission (5% vs 12%), lower blood transfusion rates (48% vs 62%), and shorter indwelling time (by 1.96 hours), all P <.001.

Experts explain the role and safety of Bayer's elinzanetant to treat vasomotor symptoms since its approval in October 2025.

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.

Eduardo Lara-Torre, MD, FACOG, emphasizes that pediatric and adolescent gynecology provides a critical bridge to ensure young patients do not lose access to care as they transition to adult providers.

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.

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

A novel methylation signature may help identify patients unlikely to respond to progestin therapy, according to Hugh Taylor, MD.

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.

Progressive menstrual pain should prompt earlier evaluation for endometriosis to prevent missed opportunities and delayed care, Hugh Taylor, MD, explained.

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

Earlier initiation of conservative therapies may improve outcomes and reduce the need for advanced treatment in stress urinary incontinence.

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

Early postpartum visits were associated with a 44% reduction in acute care use among patients with SUD, regardless of care model.

Eduardo Lara-Torre, MD, FACOG, explains that the unbundling of obstetric codes on January 1, 2027, will allow physicians to bill for each visit individually rather than receiving a single bundled payment.

Members of the BillionToOne team joined us at ACOG to discuss the launch of the new Unity Confirm fetal cell-based test for confirmation of high-risk prenatal screening results.