Obstetrics and gynecology最新文献

{"title":"Hepatic Adverse Event Signals of Fezolinetant in Real-World Use Based on Postmarketing Surveillance.","authors":"Nai Lee, Yeobin Lee, Gyuyeon Kim, Yun Kim","doi":"10.1097/AOG.0000000000006331","DOIUrl":"10.1097/AOG.0000000000006331","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate hepatic adverse event reporting associated with fezolinetant after regulatory approval and the U.S. Food and Drug Administration's (FDA) boxed warning using data from the FDA Adverse Event Reporting System.</p><p><strong>Methods: </strong>We conducted a retrospective disproportionality analysis using the FDA's Adverse Event Reporting System database from the second quarter of 2023 through the second quarter of 2025. Reporting odds ratios and 95% CIs were calculated. We performed subgroup analyses, comparative hepatic adverse event assessments against reference drugs, and time-to-onset analyses using the Weibull distribution.</p><p><strong>Results: </strong>Among 1,282 fezolinetant-associated reports, a hepatic adverse event reporting signal was identified and was predominantly associated with liver enzyme elevations rather than clinically overt hepatic injury. Marked disproportionality was observed in alanine aminotransferase, aspartate aminotransferase, and liver function testing increases. Compared with reference hepatotoxic drugs and hormone therapy agents, fezolinetant was associated with higher reporting signals for laboratory-based abnormalities; however, clinically severe hepatic outcomes were less consistently observed. Median time-to-onset for hepatic events was 77 days (IQR: 30-149), with a Weibull shape parameter consistent with an early failure pattern.</p><p><strong>Conclusion: </strong>Data identify a signal of hepatic adverse event reporting for fezolinetant, primarily characterized by transaminase elevations rather than clinically overt liver injury. The early failure pattern suggests that hepatic events may tend to occur relatively early after treatment initiation, which highlights the importance of baseline assessment and early-phase monitoring, but continued clinical vigilance remains warranted.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e329-e337"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148056037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterine Leiomyomas Across the Menopausal Transition.","authors":"Diana Encalada-Soto, Lauri Silver Hochberg, Shannon Laughlin-Tommaso","doi":"10.1097/AOG.0000000000006339","DOIUrl":"10.1097/AOG.0000000000006339","url":null,"abstract":"<p><p>Leiomyomas remain highly prevalent by midlife, with persistent racial disparities in age at onset and tumor burden. Although they are traditionally expected to regress after menopause, longitudinal data demonstrate variable behavior, with many leiomyomas persisting, some regressing modestly, and a subset continuing to grow. This structured, nonsystematic review of the contemporary literature was conducted using PubMed and Embase, supplemented by guideline and reference review, with the objective of guiding the evaluation and management of uterine leiomyomas across the menopausal transition. In perimenopausal and postmenopausal patients, abnormal uterine bleeding and pelvic pain require systematic evaluation to exclude endometrial pathology and alternative causes. Transvaginal ultrasonography with structured assessment provides the foundation for evaluation, and magnetic resonance imaging serves as an adjunct when findings are indeterminate or clinical concern is elevated. No single imaging feature reliably distinguishes benign leiomyoma from leiomyosarcoma, and the prevalence of unsuspected leiomyosarcoma at surgery remains low, increasing with age. Management should be individualized and symptom driven, incorporating patient age, comorbidities, hormonal exposures, imaging findings, and preferences, with expectant management appropriate for asymptomatic patients and intervention reserved for refractory symptoms or diagnostic uncertainty.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"626-634"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Practical Management Approach to Vulvar Dermatoses and Genitourinary Syndrome of Menopause.","authors":"Olivia Negris, Afsoon Ghafari-Saravi, Melissa M Mauskar","doi":"10.1097/AOG.0000000000006422","DOIUrl":"10.1097/AOG.0000000000006422","url":null,"abstract":"<p><p>Genitourinary syndrome of menopause (GSM) is a chronic hypoestrogenic condition characterized by diffuse vulvovaginal pallor, epithelial thinning, loss of rugae, and mucosal atrophy, often accompanied by genitourinary symptoms such as dryness, dysuria, urgency, and dyspareunia. Because many vulvar dermatoses share overlapping symptoms with GSM, accurate diagnosis relies heavily on careful clinical evaluation, with particular emphasis on lesion morphology, distribution, and associated mucocutaneous findings. This review provides a practical, morphology-driven framework for distinguishing GSM from common inflammatory, infectious, and neoplastic vulvar conditions. Given the high degree of diagnostic overlap between vulvar dermatoses and GSM, a structured approach incorporating targeted history, focused physical examination, and timely biopsy when indicated is essential. Referral to dermatology or a vulvar specialist is recommended in cases of diagnostic uncertainty, refractory or multisite disease, or scarring or functional impairment or when escalation to systemic or advanced therapies is required. This approach aims to improve diagnostic accuracy, reduce misclassification as GSM, and facilitate earlier, targeted treatment of vulvar dermatoses.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"591-606"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menopause Management in Patients With Cancer.","authors":"Kristy K Ward, Sarah Mitchem, Seema Harichand-Herdt","doi":"10.1097/AOG.0000000000006393","DOIUrl":"10.1097/AOG.0000000000006393","url":null,"abstract":"<p><p>This Narrative Review provides a practical, symptom-based framework for the management of menopause in patients with cancer, emphasizing risk stratification and collaboration with oncology. Current evidence and guideline recommendations were synthesized from randomized trials, observational studies, systematic reviews, and major society position statements, with findings organized by symptom domain and stratified by cancer type and hormone sensitivity to support clinical decision making. Menopausal symptoms are common and often severe in patients undergoing cancer treatment, particularly in those with treatment-induced menopause, and management requires balancing symptom relief with oncologic safety. Nonhormonal therapies are first-line treatment across cancer types, with strong evidence supporting selective serotonin and norepinephrine reuptake inhibitors, gabapentin, and lifestyle interventions for vasomotor symptoms. Vaginal estrogen is effective for genitourinary syndrome of menopause, is appropriate in most gynecologic cancers, and may be considered in select breast cancer survivors after shared decision making. Systemic hormone therapy remains contraindicated in hormone receptor-positive breast cancer but may be considered in carefully selected patients with non-hormone-dependent malignancies or low-risk gynecologic cancers. Nonhormonal considerations-including thrombotic risk, hepatic function, drug-drug interactions, and cardiometabolic health-are critical to safe management. A symptom-based, risk-stratified approach enables gynecologists to manage menopause in patients with cancer through collaboration with oncology, supporting individualized care and improved quality of life.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"635-645"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Menopausal Hormone Therapy After Risk-Reducing Salpingo-Oophorectomy in Women at High Risk for Breast Cancer.","authors":"Stephanie M Wong, Joanne Kotsopoulos","doi":"10.1097/AOG.0000000000006429","DOIUrl":"10.1097/AOG.0000000000006429","url":null,"abstract":"<p><p>Women who inherit a germline mutation in a hereditary breast and ovarian cancer syndrome gene are recommended to have their fallopian tubes and ovaries removed 5-15 years before the age of natural menopause to prevent the development of ovarian or fallopian tube cancer. Early surgical menopause can lead to several acute and chronic health implications, and, although menopausal hormone therapy (MHT) remains the most effective way to mitigate these issues, use remains suboptimal. This is particularly discernible in populations who face extremely high lifetime risks of developing breast cancer, likely related to the misinformation surrounding its use on subsequent breast cancer risk. Here, we provide a summary of the literature on MHT use and breast cancer as it pertains to high-risk populations, notably BRCA1 and BRCA2 mutation carriers. We also introduce our intention to evaluate how newer formulations such as conjugated estrogen combined with the selective estrogen receptor modulator bazedoxifene may treat symptoms, maintain bone health, and potentially decrease breast cancer risk. Results would be transformative for menopause management in women with hereditary breast and ovarian cancer syndrome and inform guidelines on the safety of MHT in this unique population.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"3296-e306"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Cardiometabolic Status on Cardiovascular Effects of Oral Menopausal Hormone Therapy.","authors":"Jacques E Rossouw, Aaron K Aragaki, JoAnn E Manson, Emily D Szmuilowicz, Laura B Harrington, Matthew Allison, Bernhard Haring, Matthew Nudy, John W Davis, Andrea Z LaCroix","doi":"10.1097/AOG.0000000000006381","DOIUrl":"10.1097/AOG.0000000000006381","url":null,"abstract":"<p><strong>Objective: </strong>To assess risk of adverse cardiovascular outcomes from menopausal hormone therapy (MHT) by cardiometabolic status.</p><p><strong>Methods: </strong>Secondary analysis of two double-blind placebo-controlled randomized controlled trials of conjugated equine estrogens ([CEE] 0.625 mg/d) or CEE with medroxyprogesterone acetate ([MPA] 2.5 mg/d) compared with placebo in postmenopausal women aged 50-79 years. The primary outcome was coronary heart disease ([CHD], nonfatal myocardial infarction or CHD death). Cardiometabolic status was evaluated by lipid profile, blood pressure, blood glucose, and presence of metabolic syndrome (MetS).</p><p><strong>Results: </strong>The CEE-alone trial enrolled 10,739 participants who had undergone hysterectomy, and the CEE+MPA trial enrolled 16,608 participants with an intact uterus. Randomization to oral MHT did not increase CHD risk in participants with a history of treated hyperlipidemia or in untreated participants with favorable lipid profiles, but risk increased in those with unfavorable lipid profiles. In the CEE+MPA trial, the CHD risk in untreated participants with normal low-density lipoprotein (LDL) cholesterol levels (less than 130 mg/dL) was similar to that of placebo-treated participants (hazard ratio [HR] 0.59; 95% CI, 0.31-1.10); however, for elevated LDL 190 mg/dL or higher, the risks were more than doubled (HR 2.77; 95% CI, 1.42-5.40; P -trend=.002). Risk of CHD increased with higher LDL/high-density lipoprotein (HDL) ratios (ratio less than 2.5: HR 0.73; 95% CI, 0.39-1.37 vs ratio 4 or higher: HR 1.76; 95% CI, 1.08-2.88 ( P -trend=.008). Similar but nonsignificant risk patterns risk by increasing level of LDL/HDL ratio were seen for CEE-alone compared with placebo. Participants with HDL cholesterol levels 60 mg/dL or greater (vs less than 50 mg/dL) appeared to be at somewhat lower risk (HRs 0.68 and 1.24, P -trend=.02). The patterns for effect modification on CHD risk by untreated LDL cholesterol levels within 10-year age groups (50-59, 60-69, and 70-79 years) were consistent with the overall results in both trials. Blood pressure, blood glucose, triglycerides, or MetS did not modify CHD risk due to CEE or CEE+MPA.</p><p><strong>Conclusion: </strong>Higher baseline levels of LDL cholesterol when using CEE+MPA or lower levels of HDL cholesterol when using CEE resulted in an increased risk for CHD across all age groups. Prior treatment of hyperlipidemia demonstrated no increased risk of CHD in patients treated with CEE+MPA or CEE compared with those receiving placebo. Assessment of blood lipids could assist with selection of patients for treatment with CEE of CEE+MPA.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, https://clinicaltrials.gov , NCT0000611.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e307-e317"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative Medicine Approaches for Menopause.","authors":"Jyoti Patel, Rajita G Patil, Denise M Millstine","doi":"10.1097/AOG.0000000000006388","DOIUrl":"10.1097/AOG.0000000000006388","url":null,"abstract":"<p><p>Women transitioning through menopause are often affected by vasomotor symptoms (VMS), bone loss, metabolic dysfunction, and increased cardiovascular risk. Although menopausal hormone therapy remains the most effective treatment for menopause, nonhormonal strategies are essential for women with contraindications, personal preference, or a history of hormone-sensitive cancers. This narrative review evaluates evidence-based integrative approaches to menopause care, including lifestyle interventions, mind-body therapies, nutritional strategies, botanicals, and complementary modalities. Cognitive behavioral therapy and clinical hypnosis have been shown to significantly reduce vasomotor symptom distress and are recommended as nonhormonal options. Although mindfulness-based interventions may improve sleep and quality of life (QOL), they are not recommended for the relief of VMS. Regular physical activity and dietary optimization are foundational for bone health and improving metabolic risk factors. Acupuncture may provide subjective improvements in overall symptom burden and QOL for some individuals. Despite the common use of phytoestrogens and various botanical therapies, high-quality evidence supporting their efficacy for VMS remains inconsistent. Consequently, these modalities are not advised for routine symptom management, particularly given their lack of standardization and potential safety concerns. Integrative approaches should be incorporated as part of an individualized, patient-centered care plan. Further research is needed to clarify effectiveness, safety, and optimal integration of these treatment approaches into clinical practice.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"646-661"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gonadotropin-Releasing Hormone Antagonist Combination Therapies for Perimenopausal Uterine Leiomyoma Care.","authors":"Jane Q Yap, Shannon K Laughlin-Tommaso","doi":"10.1097/AOG.0000000000006399","DOIUrl":"10.1097/AOG.0000000000006399","url":null,"abstract":"<p><p>In this clinical perspective, we examine the role of gonadotropin-releasing hormone (GnRH) antagonist combination therapies in the management of uterine leiomyomas during perimenopause, a period marked by hormonal variability and heightened symptom burden. Drawing on mechanistic comparisons, randomized trial data, and long-term safety findings, we review evidence demonstrating that GnRH antagonist combination therapies provide rapid, reversible suppression of gonadotropin secretion without an estrogen flare. This, in turn, results in consistent reductions in heavy menstrual bleeding associated with leiomyomas, management of bulk-related symptoms, and improvement with anemia. We further highlight limitations of conventional hormonal and expectant management strategies during perimenopause and discuss practical considerations for patient selection and monitoring. Collectively, these findings support GnRH antagonist combination therapy as a targeted, time-limited, and well-tolerated treatment option that addresses a critical therapeutic gap for perimenopausal patients with symptomatic uterine leiomyomas.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e289-e295"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness Analysis of Menopausal Hormone Therapy.","authors":"Elizabeth Gill, Wu Zeng, Katerina Shvartsman, Jill Brown","doi":"10.1097/AOG.0000000000006404","DOIUrl":"10.1097/AOG.0000000000006404","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the cost effectiveness of menopausal hormone therapy (MHT) based on the risk-benefit profiles of current MHT formulations.</p><p><strong>Methods: </strong>We used a Markov model to examine the cost effectiveness of MHT for hypothetical 50-year-old women with vasomotor symptoms compared with transdermal estradiol (E2) alone for patients without a uterus and transdermal E2 in combination with micronized progesterone for patients with a uterus, assuming 5 years of use. Using a health system perspective, we expressed the effectiveness in quality-adjusted life years (QALYs), and the willingness-to-pay threshold was set to $100,000 per QALY gained. We derived probabilities, cost data, and utilities from the literature and estimated the incremental cost-effectiveness ratios between the MHT and no MHT strategies as our primary outcome. Secondary outcomes included the number of cases of cardiovascular disease, breast cancer, colon cancer, and hip fracture and the number of deaths.</p><p><strong>Results: </strong>Use of MHT demonstrated absolute dominance over not using MHT for both the E2 and E2+micronized progesterone arms. Per 10,000 patients over a lifetime, E2 compared with no MHT was $135,396,560 less expensive, resulted in a gain of 33,196 QALYs, and was associated with 259 fewer cases of atherosclerotic cardiovascular disease (ASCVD), 105 fewer colon cancer cases, 87 more breast cancer cases, 181 fewer hip fractures, and 647 fewer deaths. Micronized progesterone compared with no MHT was $127,738,990 less expensive, resulted in a gain of 33,083 QALYs, and was associated with 285 fewer cases of ASCVD, 18 more colon cancer cases, 46 more breast cancer cases, 183 fewer hip fractures, and 615 fewer deaths. Sensitivity analysis showed that variables related to ASCVD had the most effect on the model. Probabilistic sensitivity analysis revealed absolute dominance for both MHT strategies at all willingness-to-pay thresholds up to $200,000.</p><p><strong>Conclusion: </strong>Our model suggests that MHT is cost effective for typical patients experiencing menopausal symptoms with initiation of MHT at age 50 years and use for 5 years. The reduction in ASCVD risk by MHT is the largest driver of cost effectiveness in the model.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"693-702"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative Analysis of Menopause Experiences and Care Gaps for Servicewomen and Veterans.","authors":"Stephanie Micucci, Catherine Witkop, Allison Eubanks, Margaret Wood, Katerina Shvartsman, Lindsey Borgia, Carolyn Gibson, Jill Brown","doi":"10.1097/AOG.0000000000006402","DOIUrl":"10.1097/AOG.0000000000006402","url":null,"abstract":"<p><strong>Objective: </strong>To assess the midlife and menopause experiences and unmet health needs of servicewomen and veterans.</p><p><strong>Methods: </strong>For this qualitative study, we conducted virtual focus groups with servicewomen and veterans aged 45-60 years using a semi-structured, open-ended interview guide focused on midlife and menopause experiences and related health care access. Focus groups were held from June to August 2025 until thematic saturation was met. Transcripts were coded and thematic analysis performed using Atlas.ti software.</p><p><strong>Results: </strong>We conducted five focus groups with 30 participants (mean age 51.5 years; 53.3% active duty). Participants received health care across the Military Health System, Veterans Health Administration (VHA), and private sector. Four categories emerged: effects on personal life, menopause-related care delivery, effects on military and professional career, and recommendations for improvements. Within these categories, seven themes were identified: feeling unprepared and navigating menopause independently, effects on relationships, frustration with care delivery, positive care delivery experiences, effects on military performance and readiness, unique military settings complicating symptoms and treatment, and recommendations to improve menopause experiences and care delivery in the military. Frustration with care delivery included feeling dismissed, symptom misattribution or treatment of individual symptoms, lack of menopause knowledge among clinicians, inconsistent access to knowledgeable clinicians, and seeking care outside the Military Health System or VHA. Positive care experiences included symptom validation, provision of treatment, and continuity of care.</p><p><strong>Conclusion: </strong>Menopause symptoms substantially affect quality of life and occupational functioning among servicewomen and veterans, with system-level gaps in menopause care overshadowing positive experiences. Findings highlight deficiencies in anticipatory guidance, workplace support, clinician education, access to care, and continuity of care across health systems. Targeted interventions to improve workplace culture surrounding menopause, menopause-specific clinical competency, and access to evidence-based care are needed to support quality of life and maintain military readiness.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"680-692"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}