Tonight: what abortion bans cost the economy, a fertility benefit with a six-figure ceiling, and more.

— Meghan McCarthy

p.s. How many OBGYNs get menopause training in residency? Try your luck on our trivia question below.

ABORTION BANS MAY BE A $68 BILLION DRAG ON THE ECONOMY

The 16 states with abortion bans or severe restrictions cost the US economy about $68 billion a year, according to an Institute for Women's Policy Research analysis. They also found women lost earnings at more than $140 billion in 2025, up $7 billion from its 2024 estimate. The model ties most of the loss to women pushed out of the workforce or into lower-paying work. Lifting the restrictions, it estimates, would draw roughly 325,000 more women into the labor force each year, with Black and Latina women absorbing the steepest costs.

ABORTIONS KEPT RISING AFTER THE BANS

Four years after Dobbs, the count of abortions in America has gone up every year, even as more states banned the procedure, NPR reports on the anniversary of the Supreme Court decision. The driver is medication abortion mailed across state lines under shield laws, which has largely offset the closure of clinics in ban states. The result is a map where the legal status of abortion and the actual availability are quite different.

THE FERTILITY BENEFIT WITH A SIX-FIGURE CEILING

A proposed federal rule would let employers offer fertility coverage as an "excepted benefit," a separate side policy capped at $120,000 over a worker's lifetime. Critics warn that because excepted benefits sit outside the Affordable Care Act, they can implement things like the very dollar cap the ACA bans, leaving patients with fewer protections if a costly IVF cycle blows past the limit. Backers say it gives companies an easier path to add IVF coverage. The rule is open for comment through July 13 and, if finalized, takes effect for 2027 plans.

THE CERVICAL PROCEDURE YOU MAY NOT NEED RIGHT AWAY

Women with moderate cervical precancer often have a procedure known as LEEP, which cuts out a cone of cervical tissue (and is linked later to preterm birth). National Cancer Institute researchers found that cutting it out within six months did not lower three-year cancer risk compared with watchful monitoring. They analyzed data from over 12,000 women. This isn't about skipping colposcopy, which continues either way. It's that for many women, careful follow-up is a reasonable alternative to immediately removing tissue.

MOST IVF EXTRAS STILL LACK GOOD EVIDENCE

Many fertility clinics offer optional IVF "add-ons" — extra tests, procedures, medications, or techniques sold alongside a standard IVF cycle in hopes of improving the chance of having a baby. But a new review of clinical trials found little evidence that most actually work. Researchers found only weak evidence supporting three commonly offered add-ons (EmbryoGlue, endometrial scratching, and physiological ICSI), while the rest either showed no benefit or lacked enough high-quality data to draw conclusions. The authors say patients need clearer, independent information before paying for treatments that can add thousands of dollars to an already expensive IVF journey.

Tonight: a record gender gap in who can afford care, Medicaid's maternity ghost networks, and more.

— Meghan McCarthy

p.s. Trivia is back and it has to do with one of tonight’s stories 👀

FORTY-TWO PERCENT OF WOMEN CAN AFFORD THEIR CARE. FOR MEN, IT'S FIFTY-SEVEN.

Americans' ability to pay for healthcare and medicine fell to a five-year low this spring, and the gender gap is the widest this index has recorded: 42% of women are "cost secure" versus 57% of men. Women dropped six points in a single year. The West Health-Gallup reading, drawn from a 5,660-person panel, found the erosion concentrated among women, lower-income households, and people under 50.

MEDICAID'S MATERNITY DIRECTORIES ARE FULL OF DOCTORS WHO WON'T SEE YOU

A federal watchdog audited Medicaid provider directories and found pregnant patients calling OB-GYNs who had moved, retired, or stopped taking the insurance entirely. These "ghost networks" leave mothers on Medicaid, which pays for more than 40% of US births, hunting for prenatal care that exists only on paper. The HHS inspector general's office flagged the directories as a barrier that states are required to fix, but rarely do.

OREGON IS SPENDING $37 MILLION TO KEEP RURAL DELIVERY ROOMS OPEN

As rural maternity wards close across the country, Oregon lawmakers set aside $37 million to prop up the ones still standing, paying hospitals to keep labor-and-delivery units running in counties where the nearest alternative can be hours away. InvestigateWest reported the state is hoping that direct subsidies can slow a national wave of closures and the Trump administration’s Medicaid cuts. The same pressures have shuttered delivery units in dozens of rural counties.

SEVERE PREGNANCY NAUSEA TRACKS WITH A STRING OF DELIVERY COMPLICATIONS

Hyperemesis gravidarum, the extreme nausea and vomiting that can cause dehydration and dangerous weight loss, is linked to a cluster of pregnancy complications, a Stanford team found in 2.5 million California births. Women hospitalized for it were about 25% more likely to deliver preterm, 37% more likely to be anemic, and 18% more likely to develop preeclampsia. Around 2.2%—some 53,700 women—had the condition, and the researchers argue it should flag a pregnancy for closer monitoring rather than be dismissed as ordinary morning sickness.

AN AI THAT WATCHES YOUR MAMMOGRAMS OVER TIME FLAGS CANCER EARLY

An algorithm that compares a woman's mammograms across years, rather than reading each in isolation, predicted future breast cancer risk more accurately than current risk models, a Radiology study of 54,014 women reported. Tracking subtle changes across 158,807 mammograms, it spotted patterns preceding 817 diagnoses. One caveat worth naming: the senior author runs a company commercializing exactly this kind of AI risk tool.

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

💊 ALABAMA'S MONTHLY PREGNANCY TESTS FOR CANNABIS PATIENTS. Alabama now requires women ages 11 to 50 to pass a pregnancy test in a doctor's office every 30 days to keep accessing medical cannabis. No other state has built routine pregnancy surveillance into medical cannabis access. Patients pay for each test themselves.

🩺 THE MENOPAUSE BOOM HAS A FORGOTTEN WAITING ROOM. As hormone therapy gets marketed online as a midlife fix, women who medically can't take it because of breast cancer, clotting disorders, or heart risks say they feel cut off from the whole conversation. Nonhormonal options exist, including newer drugs fezolinetant and elinzanetant, but many doctors don't raise them and patients don't know to ask.

💪 TWO HOURS OF WEIGHTS, 44% LOWER HEART ATTACK RISK. Women who did at least two hours of strength training a week had a 44% lower risk of heart attack than women who did none, an analysis of around 117,000 nurses found. Each additional hour tracked with led to an additional 14% drop in risk, and the benefit held even among women already meeting aerobic exercise targets.

TOP CLICKED STORIES THIS WEEK

Strength training linked to lower heart disease risk in women // EurekAlert

Millions of Women Are Left Out of Menopause’s Moment // New York Times

The Mysterious History of the Female Body // New York Times

In Alabama, patients are forced to take monthly pregnancy tests for medical cannabis // AL.com

What would it take to stop women from bleeding to death after childbirth? // NPR

A nasal spray reaches a woman's brain differently depending on the week, and it may explain why a promising brain drug looked like a failure // EurekAlert

Tonight: what an abortion ban did to mothers who weren't even pregnant, why lifting weights is a heart story, and more.

— Meghan McCarthy

p.s. Most of you knew how low HRT use is, at just 3.5%. But do you know what the Trump administration tried to burn? Scroll to find out.

FATHERS' MENTAL HEALTH DIDN'T MOVE. MOTHERS’ DID.

After Texas banned abortion in 2021, the share of mothers reporting fair or poor mental health nearly doubled, from 4.6% to 9.3%, far outpacing the rise in states without bans. The Harvard-led analysis of around 157,000 mothers found the effect held whether or not a woman was pregnant or seeking an abortion, and hit mothers on public insurance hardest. Fathers' mental health didn't budge. The authors can't prove cause, but point to a fraying reproductive health system: clinicians leaving, maternity care access shrinking, and reproductive autonomy reduced.

TWO HOURS OF LIFTING, 44% FEWER HEART ATTACKS

Women who did at least two hours of strength training a week had a 44% lower risk of heart attack and a 20% lower risk of major cardiovascular disease than women who did none, an American College of Cardiology journal analysis of around 117,000 nurses found. Each additional hour tracked with a further 14% drop in heart attack risk, and the benefit held even among women already meeting their aerobic exercise targets. The study is observational, but heart disease remains the leading killer of women, and resistance training is still the prevention tool most often left out of the conversation.

THE WOMEN ON HORMONE THERAPY ARE HEALTHIER. BUT THE HORMONES MIGHT NOT BE WHY.

A survey of more than 10,000 women found that menopausal women on hormone therapy ate more produce, slept better, and were likelier to strength train than women who'd never used it. But the study's own society medical director, Stephanie Faubion, says the explanation is mostly "healthy-user bias": women who choose hormone therapy tend to be more proactive about their health to begin with, with greater access to care and more resources. It's the same confound that made early hormone studies look heart-protective before randomized trials said otherwise.

PREECLAMPSIA'S WARNING DOESN'T END AT DELIVERY

Women who had preeclampsia with moderate to severe protein in their urine were about five times as likely to develop chronic kidney disease within a decade as those with little or none, roughly 1 in 20 versus 1 in 100, a Danish population study found. They also had higher rates of lasting high blood pressure. The only cure for preeclampsia is delivery, and monitoring typically stops at delivery, right when the long-term risk is just beginning.

A HISTORY OF THE FEMALE BODY, WRITTEN IN THE MARGINS

In "Presence," historian Erin Maglaque reconstructs what it felt like to inhabit a woman's body in Europe from 1500 to 1800: beauty ideals that swung from fertility to restraint, pregnancy cravings believed to shape the fetus, and "greensickness," the period's name for teenage longing with nowhere to go. Her problem is the archive itself, which preserved almost nothing of women's interior lives. Much of what the modern West treats as natural about the female body, the review argues, was invented in those centuries.

Tonight: Alabama wants monthly proof you're not pregnant before you can fill specific prescriptions, the forgotten waiting room of the menopause boom, and more.

— Meghan McCarthy

P.S. Think you know menopause? Scroll to answer this edition’s Women's Health Trivia question 🤔

ALABAMA WANTS MONTHLY PROOF YOU'RE NOT PREGNANT

Alabama now requires women ages 11 to 50 to pass a pregnancy test in a doctor's office every 30 days to keep using medical cannabis, unless they can prove they've had surgery that makes pregnancy impossible. No other state has built this kind of routine pregnancy surveillance into medical cannabis access. Physicians are barred from certifying anyone pregnant, breastfeeding, or "attempting to conceive," and patients pay for each in-office test themselves. Alabama leads the country in jailing pregnant women over drug use and is one of three states that apply child-endangerment laws to pregnancy.

THE MENOPAUSE BOOM HAS A FORGOTTEN WAITING ROOM

The New York Times reports that as hormone therapy gets marketed online as a midlife miracle, the women who medically can't take it, because of breast cancer, clotting disorders, or heart risks, say they feel cut off from the whole conversation. The frustration is compounded due to a lack of provider knowledge: nonhormonal options exist, including the newer drugs fezolinetant and elinzanetant, cognitive behavioral therapy, and vaginal estrogen, but many doctors don't raise them and patients don't know to ask. The Menopause Society's medical director says the toolkit is far bigger than the marketing suggests. Hormone therapy is only approved to treat hot flashes, night sweats, and bone loss, not the longer list influencers attach to it.

WE KNOW HOW TO STOP THE LEADING CAUSE OF MATERNAL DEATH. WE OFTEN DON'T.

Postpartum hemorrhage kills around 43,000 women a year and remains the leading cause of maternal death, yet a three-part Lancet series argues most of those deaths are preventable with tools that already exist. NPR dives into how it could work, starting with measuring blood loss in a calibrated drape instead of eyeballing it, which misses roughly half of hemorrhages. The next step is moving fast on a bundle of uterine massage, medication, and IV fluids. Across a trial of more than 200,000 women in four African countries, that approach sharply cut severe bleeding. One WHO author's estimate: used consistently, what we have now could prevent more than 95% of these deaths.

TURNS OUT IT WAS NEVER ABOUT CYSTS

Washington Post’s Leana Wen looks at why polycystic ovary syndrome is being renamed polyendocrine metabolic ovarian syndrome, or PMOS—a change 56 medical societies signed onto. The old name was a double misnomer: the "cysts" are actually normal ovarian follicles, and the disorder originates in the endocrine system, not the ovaries. That reframing matters because the condition, which affects roughly one in seven women of reproductive age, drives insulin resistance and raises the risk of diabetes, heart disease, and endometrial cancer. Advocates hope the new name finally pushes doctors to screen for those risks starting in adolescence.

THE DRUG THAT "FAILED" MAY HAVE JUST BEEN AVERAGED AWAY

An investigational brain drug delivered as a nasal spray reached the brain in different amounts depending on sex and, in women, on where they were in their menstrual cycle, Tel Aviv University researchers found in mice and a small group of healthy adults. Female mice absorbed more when estrogen peaked. The authors argue that averaging results across men and women can bury a real effect, one reason a promising therapy can look like a flop in trials. Their point: hormones and cycle timing belong at the center of how brain drugs are designed and dosed, not treated as noise.

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

📊 Birth control has ranked as the single most morally acceptable behavior Gallup tracks every year it's been polled. This year it's at a record low: 83% of Americans call it acceptable, down from 90% last year. Independents drove the slide, losing 11 points in a single year.

🏛️ Rep. Marie Gluesenkamp Perez told the House she lost a pregnancy at 11 weeks, and the medication to pass the miscarriage left her in pain "worse than" delivering her son four years ago. Her amendment directing the NIH to study better pain management for miscarriage passed unanimously.

💉After the CDC dropped its COVID-in-pregnancy recommendation last year, ACOG issued its own immunization schedule for pregnant and postpartum patients, endorsed by 13 medical groups. ACOG said it withdrew from the CDC's vaccine committee over "concerns about recent changes that undermine the committee's scientific integrity."

— Meghan McCarthy

p.s. Thanks to those who participated in our trivia question! Yes, it really did take until 2024 to scan a pregnant brain. Here’s the story, and we’ll be back Tuesday with another (tough?) question.

TOP CLICKED LINKS THIS WEEK

Moral Acceptability Falls for Several Behaviors // Gallup

FDA Launches Study of Abortion Pill Safety as Opponents Push for Limits // The Wall Street Journal

Apple's Health app can now tell you if you're in perimenopause // TechCrunch

Democratic lawmaker calls to improve 'medieval' women's pain management // ms.now

Menopause is burning up senior-level women’s careers // Fast Company

Expecting poor sleep is associated with worse postpartum sleep quality // EurekAlert

Tonight: a congresswoman turns her miscarriage pain into getting one step closer to federal research, why everyone may need to move to one drink a day, and more.

— Meghan McCarthy

p.s. Our first trivia question awaits you at the bottom of this edition. Just how much do you know about pregnancy brain?

MISCARRIAGE PAIN IS BARELY STUDIED. A CONGRESSWOMAN IS TRYING TO CHANGE THAT.

Rep. Marie Gluesenkamp Perez told the House she lost a pregnancy at 11 weeks, and that the medication to pass the miscarriage left her in pain "worse than" delivering her son four years ago. Her amendment directing the NIH to study better pain management for miscarriage was passed unanimously. The issue is complicated — Republicans want to take away telehealth prescribing for the abortion pill (despite its record of safe use) and may see this as bolstering their argument. But the congresswoman is focused on a common refrain in women’s health: why doesn’t our pain matter?

OB-GYNS BREAK WITH THE CDC ON VACCINES (FOR OBVIOUS REASONS)

It’s not a shock, but for the American College of Obstetricians and Gynecologists issued its own immunization schedule for pregnant and postpartum patients instead of following CDC guidance (or lack thereof). This comes after the agency replaced its COVID-in-pregnancy recommendation with "no guidance" last year. Endorsed by 13 medical groups, ACOG urges flu, Tdap, COVID, and RSV protection at any point in pregnancy or breastfeeding. ACOG said it withdrew from the CDC's vaccine committee this year over "concerns about recent changes that undermine the committee's scientific integrity."

NO AMOUNT OF ALCOHOL IS PROTECTIVE. AND THE GUIDELINES FOR MEN AND WOMEN ARE CONVERGING.

A new analysis found alcohol's health risks start climbing at relatively low levels for both men and women, with almost identical thresholds for increased mortality risk. Researchers estimated that drinking more than about 6.5 drinks per week for men and 7 drinks per week for women pushed lifetime alcohol-related death risk above 1 in 1,000, while risks exceeded 1 in 100 at roughly 8.5 drinks per week for both sexes. The findings challenge the long-standing U.S. dietary guidelines that allow men up to two drinks per day but women only one. The authors argue future guidance should recommend no more than one drink daily for everyone.

WHAT NEW MOTHERS EXPECT OF THEIR SLEEP MAY SHAPE WHAT THEY GET

Among around 430 pregnant women, those who expected the worse sleep after delivery ended up actually having worse sleep, measured by both wrist trackers and self-report. And that is after researchers accounted for prior sleep problems and psychiatric history. Postpartum anxiety deepened the effect. Researchers say sleep beliefs and anxiety, unlike most postpartum risk factors, could be addressed during pregnancy, before the sleepless months arrive.

MENOPAUSE IS HITTING WOMEN RIGHT WHEN THEY'D REACH THE TOP

Menopause arrives around 52, and the average CEO is hired at 54. Fast Company reports that senior women said menopause is quietly pushing them out: lost confidence, a blazer thrown off mid-boardroom meeting, careers abandoned. Only 11% of companies offer menopause benefits, the same share of Fortune 500 CEOs who are women. Half of women say their workplace never discusses it at all.

Tonight: Americans suddenly find birth control less acceptable, the FDA's progress against the abortion pill, what your iPhone now knows about menopause, and more.

— Meghan McCarthy

p.s. Please check out our new poll below! We will be asking some fun trivia questions in the future…email [email protected] if you’ve got a good one to share.

AMERICANS ARE COOLING ON BIRTH CONTROL

The share of Americans who say birth control is morally acceptable fell to 83%, a record low since Gallup started asking in 2012. Last year, approval was 90%. Independents drove the slide, with their acceptance down 11 points in a single year. Birth control has ranked as the single most morally acceptable behavior Gallup tracks every year it's been on the list, which is what makes the dip worth watching.

THE FDA REOPENS MIFEPRISTONE'S SAFETY QUESTION

The FDA launched the safety review of mifepristone they had promised for months, a drug that accounts for about two-thirds of U.S. abortions. Former FDA Commissioner Marty Makary had allegedly said the study would be delayed because it would be unpopular to release before the midterm elections. The agency still says the drug is safe and effective when used as directed, and HHS insists it has been reviewing the drug's safety rules for months, disputing that anything new just began. Preliminary results are expected in July; the full review likely won't land until after the November midterms.

YOUR PHONE MAY FLAG PERIMENOPAUSE?

At its developer conference Monday, Apple said the Health app will start alerting women 40 and older when their logged cycle patterns suggest perimenopause, then steer them toward symptom tracking and educational material to bring to a doctor. It's the company's deepest move into women's health since it launched period tracking in 2019.

A BREAST-CANCER SIGNAL IN THE WEIGHT-LOSS DRUGS

A study found that around 110,000 women ages 45 to 80 carrying extra weight were 30% less likely to be diagnosed with breast cancer while taking GLP-1 drugs like Ozempic and Wegovy. The study was observational, so it can't prove the drugs deserve the credit, and the team is now standing up a clinical trial to test the link directly. Obesity after menopause is a known breast cancer risk factor, but researchers suspect the drugs' effects on weight *and* inflammation may be doing the work.

BEING FEMALE MAY NOT BE THE AFIB STROKE RISK WE THOUGHT

For years, simply being a woman has counted as a stroke risk factor in atrial fibrillation, the most common heart-rhythm disorder. That earned female patients an automatic point towards being put on blood thinners. A Tulane analysis of roughly 950,000 patients found that may be too blunt: under age 75, women and men faced essentially the same one-year stroke risk, with the added risk showing up mainly in women 75 and older. Because blood thinners carry real bleeding risks, the authors argue the call should be individualized and point to a newer scoring system that drops sex as a standalone factor.

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

🤰 Tylenol is still safe in pregnancy, whatever the president said. After Trump and RFK Jr. warned against acetaminophen without strong evidence, the Society for Maternal-Fetal Medicine reaffirmed it as the first-line treatment for pain and fever, finding no causal link to autism or ADHD. Two in three pregnant women use it, and untreated first-trimester fever is tied to birth defects and miscarriage.

🩺 Hormone therapy works. Almost no one is taking it. Use among women 40 and older HRT use fell to under 2% by 2023, and just 3.5% of women ages 50 to 59 (the group most likely to benefit), per a Mayo Clinic analysis. The evidence shows it's safe and effective for many women under 60, and recent changes to “black box” warnings could increase usage.

📊 Real money is finally flowing to midlife health. Melinda French Gates committed $215 million to women's reproductive and midlife health, her first major bet on perimenopause and menopause. She partnered with the Menopause Society to expand training for the clinicians most women struggle to find.

TOP CLICKED STORIES THIS WEEK

• NC GOP lawmaker removes name from anti-abortion bill after social media outcry // NC Newsline
  

• Ferguson signs executive order to support working women experiencing menopause in WA // KUOW
  

• Financial, Psychological Burden of Abortion Care in US Raises Calls for Expanded Insurance // AJMC
  

• Hormone therapy use for menopause declines despite proven benefits, study finds // Mayo Clinic News Network
  

• SMFM Reaffirms Acetaminophen as First-Line Medication for Treating Pain and Fever During Pregnancy // Society for Maternal-Fetal Medicine
  

• OPTIMA: Genetic Test–Determined Chemo Is Noninferior to Chemo + Endocrine Therapy in Selected Patients With Early Breast Cancer // ASCO Daily News

Tonight: a $215 million push for menopause care, the proven treatment almost no one was using in 2023, and more.

MELINDA GATES BETS $215 MILLION ON MIDLIFE Gates announced $215 million in new funding for women's reproductive and midlife health, her first major investment focused on perimenopause and menopause. It is part of a broader $600 million women's health commitment her organization has made over the next two years. She's partnering with the Menopause Society to expand menopause training in OB-GYN residencies, primary care, and nursing programs, addressing a gap that leaves many women struggling to find clinicians who understand the transition.

ILLINOIS PASSES A SHIELD FOR ABORTION RECORDS Illinois lawmakers passed the Reproductive Health Privacy Act, which allows patients to block abortion care and gender-dysphoria diagnoses from the electronic records hospitals routinely share across state lines. Sponsors said some patients who traveled to Illinois for abortions were later dropped by home-state physicians after the procedure appeared in their charts. The records aren't deleted, only shielded from out-of-state access without patient consent. Gov. JB Pritzker has said he'll sign the bill.

HORMONE THERAPY WORKS. HARDLY ANYONE WAS TAKING IT IN 2023. Hormone therapy for menopause fell from more than 4% of women 40 and older in 2007 to under 2% in 2023. Among women ages 50 to 59 (the group most likely to benefit), only about 3.5% used it, according to a Mayo Clinic analysis. Usage remains near its lowest point since the 2002 Women's Health Initiative study triggered widespread fears about hormone therapy, despite strong evidence that treatment is safe and effective for many women under 60. The FDA recently removing the black box warning on HRT, which may increase use in more recent years.

THE FERTILITY AND ALCOHOL MESSAGE ISN'T COMPUTING. Ninety percent of women of childbearing age know drinking during pregnancy is unsafe, up from 82% a year earlier. But only about two-thirds know they should stop drinking before conception, according to an Annenberg survey of around 1,600 adults. The gap matters: federal data show more than one in eight pregnant adults reported drinking in the past month.

LIFT THE MALPRACTICE CAP, LOSE THE MIDWIFE? After Georgia and Illinois removed caps on malpractice damages, physician-attended births in rural counties rose by nearly 3 percentage points even though overall birth rates didn't change, according to a Harvard analysis of more than 20 million births. The likely explanation is liability risk: hospitals facing larger potential lawsuits appear more likely to favor physician-attended deliveries over midwife-attended ones. Researchers found no corresponding change in C-sections, inductions, or infant outcomes, suggesting the shift reflected risk management rather than better care.