September 29, 2026
Tonight: how hormone therapy’s clot risks differ between pills and patches, California’s IVF mandate brings more (but not all) patients into fertility clinics, and more.
— Meghan McCarthy
THE PILL AND THE PATCH: SAME DRUG, DIFFERENT OUTCOMES?
Women taking oral menopausal hormone therapy had higher rates of blood clots in the legs or lungs at any dose and any duration, while transdermal patches, gels and sprays showed no general increase in clot risk. That’s according to a study reviewing around 40,000 women who had a first clot, stroke or heart attack, matched to about 200,000 women who hadn't. Increased stroke and heart attack risk was mainly found among women on high-dose oral estradiol, above 1 milligram a day, for more than a year. The absolute numbers are small: one extra clot for every 1,055 women on oral therapy for a year, one extra stroke per 1,642, one extra heart attack per 3,846.
PREECLAMPSIA AND DEMENTIA RISK, TWENTY YEARS LATER
Women who had a hypertensive disorder of pregnancy, meaning preeclampsia or gestational hypertension, had a higher risk of dementia over roughly two decades of follow-up, in a nationwide cohort of around 1.4 million women. That link, however, was not statistically significant once researchers also adjusted for things like chronic high blood pressure or diabetes that developed after delivery. The authors' read is that a hypertensive pregnancy works as an early-life marker of long-term neurovascular vulnerability.
A YEAR AFTER THE C-SECTION, THE PAIN IS STILL RUNNING THEIR LIVES
Among women with chronic pain after a C-section delivery, nearly 70% said it was interfering with their mood a year after giving birth and over 50% said it was interfering with sleep, according to a review of 30 studies covering around 28,000 women across 22 countries. One large study found roughly five times higher odds of significant depressive symptoms at three and six months. Chronic postsurgical pain is estimated to affect 15% to 17% of women three to six months after a C-section, though the review's authors caution that most of the studies were observational.
CALIFORNIA MANDATED (SOME) IVF COVERAGE. BUSINESS IS UP AT CLINICS.
California's IVF mandate took effect in January, but it applies to about 9 million Californians—people working at certain companies with 100 or more employees, and state employees starting in 2027. That leaves out a large chunk of people, including small business employees, Medi-Cal enrollees, and members of the military, who face costs of about $25,000 a cycle in Los Angeles. Still, five LA-area fertility clinics told the LA Times their patient numbers are up about 20% in the nine months since the law took effect.
FORTY-EIGHT BABIES LATER, INSURANCE STILL WON'T COVER IT
Uterus transplants can allow women born without a uterus, or who have had theirs removed, to carry a pregnancy. A Penn-led review of 60 transplants performed at four U.S. centers from 2016 through 2025 documented 48 babies born, including nine women who gave birth twice. But the procedure remains complicated: more than half the babies were born prematurely. And access remains limited, in large part because it is not covered by insurance, putting it out of reach for many women who could benefit.