Key unanswered questions in the management of VMS in patients with breast cancer include the long-term oncologic impact of NK receptor antagonists, the broader role of patient-reported outcomes in guiding therapy selection, and the need for prospective observational studies to evaluate real-world outcomes.
Effective management of VMS in patients with breast cancer requires individualized assessment and shared decision-making, with elinzanetant (Lynkuet) emerging as the preferred pharmacologic option for patients with moderate-to-severe symptoms given its early onset of action, NCCN-preferred status, and the most robust evidence base in this population.
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.
Research presented at ACOG suggests that gaps exist in sexual medicine education across Midwestern medical schools, potentially leading to underprepared graduates.
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.
Elle Kielar Grevstad, PhD, explains how a 2-MDM panel detected endometrial cancer in self-collected vaginal fluid with 96% sensitivity and 82% specificity, according to a marker reduction study published in Gynecologic Oncology.
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.
An analysis from OASIS-4 demonstrated that elinzanetant (Lynkuet) consistently improved sleep disturbance and menopause-related quality of life across all endocrine therapy subgroups—with patients transitioning from moderate to normal sleep disturbance range by week 12—and that these benefits were sustained through 52 weeks.
In the phase 3 OASIS-4 trial (NCT05587296), elinzanetant (Lynkuet) produced clinically meaningful reductions in moderate-to-severe vasomotor symptoms frequency—beginning as early as week 1—compared with placebo, with improvements extending across all menopause-related quality-of-life domains.
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.
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
In this video, Maryam Siddiqui, MD, and Katrina Lee, MD, review updated ACOG guidance on the evaluation of postmenopausal bleeding—including a shift to dual biopsy and imaging—and discuss changes to cervical cancer screening that prioritize primary HPV testing and self-collection to improve access to care.
Maryam Siddiqui, MD, and Katrina Lee, MD, examine new CPT codes for obstetric care introduced at ACOG 2026, discussing how the revised framework more accurately captures the cognitive and clinical complexity of antepartum and postpartum care and what implementation will require from practices.
In this video, Maryam Siddiqui, MD, and Katrina Lee, MD, discuss ACOG's emphasis on physician well-being, systems-level approaches to workforce sustainability, and a featured session on artificial intelligence and its implications for obstetric and gynecologic practice.
Maryam Siddiqui, MD, and Katrina Lee, MD, reflect on record attendance at the 2026 ACOG Annual Clinical & Scientific Meeting and discussing new certificate tracks designed to deepen expertise in menopause, emergency obstetrics, and perinatal mental health.
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.
Ob-gyn clinicians should counsel patients on microplastic exposure reduction through accessible, incremental steps rather than anxiety-inducing perfection, while resisting the clinical tendency to normalize bladder symptoms in younger women—with referral to urology or urogynecology warranted when symptoms persist, cultures are repeatedly negative, or hematuria or complex pelvic floor pain is present, according to Aleece Fosnight, MSPAS, PA-C.
As GLP-1 RA prescribing in the perinatal period grows, ob-gyns must be prepared to elicit disclosure from patients who may feel ashamed, counsel on the absence of a clear teratogenicity signal while emphasizing ongoing uncertainty, and address the underrecognized fertility implications of GLP-1 RA-associated weight loss—while recognizing that most prescribing occurs outside obstetric care, according to Kevin Y. Xu, MD, MPH, and Jeannie C. Kelly, MD, MS.
Mark Simon, MD, MMM, highlights the role of the OB hospitalist as a collaborative partner who can initiate rapid treatment for hypertensive crises in the hospital setting.
Hyperactivation of hypothalamic KNDy neurons—which express kisspeptin, neurokinin B, and dynorphin—drives VMS during estrogen deprivation, providing the mechanistic basis for dual NK1/NK3 receptor antagonism as a nonhormonal strategy that may also improve sleep quality.
Vasomotor symptoms affect more than 50% of patients receiving endocrine therapy for hormone receptor–positive breast cancer and can reach 90% in younger patients on ovarian function suppression, with more than 20% of affected patients discontinuing treatment—a factor directly linked to increased recurrence risk and reduced survival.
In the final episode, "Long-Term VMS Management and Key Takeaways for Clinical Practice," the panelists explore the critical importance of viewing menopause management as a long-term, patient-centered endeavor rather than a time-limited intervention.
In "Evaluating Newer Non-Hormonal Therapies for VMS," our panel explores the similarities and distinctions between fezolinetant and elinzanetant as NK receptor antagonists, with a focus on how these differences inform clinical decision-making for a patient with inadequate response to MHT.
In "Evaluating Newer Non-Hormonal Therapies for VMS," our panel explores the similarities and distinctions between fezolinetant and elinzanetant as NK receptor antagonists, with a focus on how these differences inform clinical decision-making for a patient with inadequate response to MHT.
In this episode, "Addressing Cognitive Symptoms and Transitioning from MHT to Non-Hormonal Therapy for VMS," two menopause experts explore the clinical and societal burden of cognitive dysfunction in menopausal women, and the decision-making process around transitioning from hormonal to non-hormonal therapy.
This episode, titled "A Case of a 51-Year-Old Woman with VMS and Inadequate Response to MHT," features panelists examining the clinical approach to a patient presenting with persistent moderate to severe VMS following what appears to be an inadequate response to menopause hormone therapy.
Bladder symptoms in patients seeing ob-gyns require a multifactorial evaluation framework that builds patient timelines across medications, hormonal changes, pelvic floor function, and environmental exposures, whereas counseling on microplastic exposure during pregnancy should emphasize practical, evidence-based reduction strategies rather than fear, according to Aleece Fosnight, MSPAS, PA-C.
Practical strategies including waiting-room symptom questionnaires and a direct, symptoms-based conversational approach can help ob-gyns incorporate HSDD screening into time-limited visits, whereas the cultural visibility of "female Viagra" as a search term represents an underutilized entry point for patient education and provider-initiated conversations.
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.
