Tonight: Congress finally puts menopause on the calendar, signs of maternity units closing, and more.
— Meghan McCarthy
CONGRESS HAS NEVER HELD A HEARING ON MENOPAUSE. THAT ENDS WEDNESDAY.
The Senate Special Committee on Aging holds the first congressional hearing ever on menopause tomorrow, entitled “Half the Country, Zero Hearings." Nine of the 13 members of the committee are men. Sen. Kirsten Gillibrand (D-NY) said it was "absolutely disgraceful" that the committee has never held a hearing specifically focused on menopause, and she is asking for increased research funding and physician training. More than half of states have introduced or passed menopause legislation in the past two years, but nothing has been seriously considered on the federal level beyond research funding.
THE MATERNITY UNITS STILL OPEN LOOK A LOT LIKE THE ONES THAT CLOSED
Among the US hospitals that still delivered babies in 2023, 41% had high-risk factors for losing that service, according to a study that analyzed 3,108 hospitals from 2010. Low birth volume predicted closures everywhere, but the financial picture split along rural and urban lines. Being unprofitable raised a rural hospital’s predicted risk of closing its maternity unit by 12 percentage points, while in urban areas it was more strongly tied to the entire hospital closing. For-profit ownership also carried a much larger risk of maternity-unit closure in rural communities, leading researchers to argue the two need different policy responses.
58% OF MEDICAL TEXTBOOKS DON’T REALLY COVER MENOPAUSE
A white paper from Calla Lily Clinical Care and ABIG Health makes the economic case for teaching menopause in medical school. The numbers are bleak: 58% of medical textbooks worldwide don’t adequately cover menopause, and in a study of 20 US residency programs, more than 20% of residents got no menopause training at all and just under 7% felt prepared to treat it. Menopause symptoms account for roughly $25 billion a year in direct medical costs among US women aged 45 to 60, with the cost of treating cardiovascular disease in postmenopausal women on track to top $200 billion a year.
A PROVEN C-SECTION ANTIBIOTIC FINALLY CAUGHT ON. INFECTIONS DROPPED.
Doctors used the antibiotic azithromycin in just over 2% of unscheduled c-sections before a 2016 trial showed that it prevents infections. In 2024, the drug was used in nearly 60% of cases. As doctors adopted the drug, postpartum infections after c-sections fell from around 9% to 8%, even as they rose among vaginal births. Researchers analyzed around 1.7 million US deliveries from 2013 to 2024. Doctors perform more c-sections than any other surgery in the country, and the procedure poses the greatest risk for infection after childbirth. But even eight years after the trial, four in 10 unscheduled c-sections still did not include the drug.
AMERICAN DOCTORS MAKE ONE KIND OF CUT. IT'S THE ONE LINKED TO WORSE TEARING.
More than one in five of the 5,277 US women who delivered babies with forceps or a vacuum suffered a severe tear. An episiotomy, a surgical cut used to widen the vaginal opening, generally increased the odds of this injury, but the direction of the cut made a crucial difference. Midline episiotomies, which accounted for more than three quarters of those performed, raised the odds of severe tears during vacuum deliveries. Episiotomies that angle away from the anus lowered the odds for women who had never delivered vaginally, whether doctors used forceps or a vacuum. The observational study cannot prove that either cut caused the outcomes, but it points to a group that may benefit from the less commonly used approach.