Tonight: Virginia just made birth control free, what menopause supplements actually work, why endometriosis takes years to diagnose, and more.

— Meghan McCarthy

VIRGINIA MADE BIRTH CONTROL FREE. FOR REAL THIS TIME. // Virginia’s Contraceptive Equity Act, signed by Gov. Abigail Spanberger, requires private insurers to cover a broader range of birth control with no out-of-pocket cost starting in 2027 — including over-the-counter options like condoms and pills, no prescription needed. An amendment from Spanberger lets patients request a specific drug at the pharmacy without going through a longer insurer approval process. The law doesn’t cover Medicaid or Medicare. Advocates say success will depend on whether pharmacists and insurers actually follow it.

THE MENOPAUSE SUPPLEMENT MARKET IS MOSTLY NOISE // Social media is full of powders and capsules promising to fix perimenopause. The Conversation breaks down what the evidence actually supports: magnesium has modest evidence for sleep and anxiety, and some benefit for bone density, but does nothing for hot flashes. Lion’s mane has almost no human trial data in menopausal women, and while creatine shows promise for muscle mass it also hasn’t been studied in menopause specifically. Collagen has no evidence for hormonal symptoms. HRT remains the most effective treatment for most symptoms — the supplement market is filling a gap that exists largely because HRT is still under-prescribed.

ENDOMETRIOSIS TAKES YEARS TO DIAGNOSE. HERE’S ONE REASON WHY. // Two studies found that primary care physicians are generally good at catching endometriosis when it presents with classic gynecological symptoms, but they miss it when symptoms are gastrointestinal, cyclical, or non-specific. There’s also a “diagnostic hierarchy” problem: endometriosis gets considered only after other conditions are ruled out. Stigma around menstruation still affects both whether patients seek help and how doctors assess them. The condition affects around 1 in 10 women of reproductive age.

MEN ARE NOW HAVING FEWER CHILDREN THAN WOMEN // A global analysis from the Max Planck Institute found that 2024 was the first year worldwide that men’s total fertility rate dropped below women’s, driven by rising proportions of men in the population due to narrowing mortality gaps and sex-selective abortions in some countries. The researchers note that men who remain childless face worse health outcomes and growing dependence on care in old age, and call for urgent policy responses. They also flag that strengthening women’s social position — to reduce sex-selective abortions — is one of the proposed fixes.

CDC BURIED A STUDY SHOWING COVID VACCINES WORK // A report showing last winter’s Covid vaccine cut emergency room visits and hospitalizations among healthy adults by about half was blocked from publication in the CDC’s flagship journal, the MMWR, after the agency’s acting director raised concerns about methodology. The paper had already cleared scientific review. Scientists outside HHS say the methodology, which has been widely used in vaccine research and published in NEJM and Pediatrics, is sound, and that HHS hasn’t proposed a realistic alternative.

Tonight: three doctors whose patients died under Texas’s abortion ban are facing (minimal) consequences, proof that women who use Ozempic get judged more harshly, and some good news for ovarian cancer.

— Meghan McCarthy

TEXAS DOCTORS GOT 8 HOURS OF CONTINUING ED. TWO WOMEN DIED. // The Texas Medical Board has disciplined three doctors after ProPublica’s reporting found unnecessary pregnancy deaths under the state’s abortion ban. One doctor sent an 18-year-old home twice while she was actively infected and septic, then required two ultrasounds confirming fetal demise before moving her to the ICU. She died with the fetus still in her womb. Another withheld a D&C from a woman hemorrhaging during a miscarriage; she bled to death. The board’s penalty for each: 8 hours of continuing education. As one of the spouses said: “What kind of justice is this for Porsha?”

MIFEPRISTONE FOUND ITS WAY TO (NON-ABORTION BAN STATE) PHARMACIES. // After FDA removed the requirement that mifepristone be dispensed in person at a clinic, pharmacy fills spiked from roughly 18 users a month to more than 2,700, driven almost entirely by mail order. But 99% of those fills came from states where abortion and telehealth are both legal. In states with restrictions, the policy change barely moved the needle. Researchers say the data shows exactly what would be lost if courts or FDA reimpose the in-person rule.

THE GLP-1 JUDGMENT IS REAL FOR WOMEN // Women who lose weight using GLP-1 medications like Ozempic or Wegovy are judged more harshly than those who lose weight through diet and exercise, according to a study of 402 women. “Shortcut” beliefs drove higher fat phobia, more blame, and greater desire for social distance from the GLP-1 user. The researchers also found that white women using GLP-1s faced more stigma than Black women in the same scenario, an unexpected finding the authors say warrants further study.

WHAT DOULAS ACTUALLY HELP WITH (AND WHAT’S STILL UNCLEAR) // A systematic review of 21 clinical trials in JAMA Network Open found the strongest evidence for doula care improving maternal anxiety and breastfeeding initiation, with emerging data on better postpartum follow-up. Evidence for C-section reduction and pain management was more mixed. The review also flagged that most studies underrepresented Black and Indigenous patients, who are among those facing the worst maternal outcomes, and that few examined doula care beyond birth.

OVARIAN CANCER JUST GOT SOME BETTER NUMBERS // At the Society of Gynecologic Oncology annual meeting, two experimental drugs helped shrink tumors in 62–67% women with ovarian cancer that had already stopped responding to standard chemotherapy — a notoriously hard stage to treat. A third drug, designed to restart a cancer-suppressing protein that mutates in some tumors, shrank tumors in 44% of patients who’d already been through multiple rounds of treatment. All three are moving into larger trials.

Here are the most interesting items we saw this week in women’s health:

🚫 The Trump administration has moved to kill a teen pregnancy prevention program while conservatives publicly complained that teen birth rates are falling. On Fox News, analyst Marc Siegel called it a “problem” that teens are having fewer babies. Anti-contraception messaging, clinicians say, is already reshaping what patients say in exam rooms.

🧬 Male and female brains express thousands of genes differently, and it may explain a lot. NIH researchers found more than 3,000 genes with sex-biased activity across six brain regions. Many overlap with genetic variants tied to ADHD, schizophrenia, depression, and Alzheimer’s — conditions that affect men and women at different rates.

🤰 Montana approved Medicaid reimbursement for doulas, then reversed course. The rollback hit especially hard on the Northern Cheyenne Reservation, where the nearest hospital that delivers babies is 100 miles away. Doulas there are still working, mostly unpaid, filling the gaps the system keeps leaving behind.

TOP CLICKED STORIES THIS WEEK

1. Largest study of pregnancy sickness uncovers six new genetic links — EurekAlert

2. New BSC study reveals, for the first time, that the female immune system changes much more than that of men with age — EurekAlert

3. This Northern Cheyenne Doula Was About To Start Getting Paid — Then Medicaid Cuts Hit — KFF Health News

4. Longer Reproductive Span Linked With Slower Rates of Cognitive Decline — The Menopause Society

5. Recovery of Pregnancy-Related Death Ratios After COVID — Obstetrics & Gynecology

6. Sex differences in human brain gene expression may shape disease risk — EurekAlert