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"Given the high morbidity associated with CSEP and the increasing incidence of CSEP and PAS, patients with prior cesarean delivery should have imaging (either by a specialist familiar with the diagnosis of CSEP or a formal radiology ultrasound) as early as possible in pregnancy, when treatment is safest with the lowest risk of complications," write the authors.

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.

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