the four stages of women

October 27, 2026

Tonight: what your periods and pregnancies say about your heart, why surgery on women pays less, and more.

— Meghan McCarthy

For the first time, the American Heart Association, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and the Society for Maternal-Fetal Medicine have issued joint guidance on women’s heart health. It’s built around four “female life stages”: the transition around a girl’s first period, the reproductive years, perimenopause, and postmenopause. The framework treats heavy or irregular periods and pregnancy complications like preeclampsia and gestational diabetes as early warning signs of heart risk. It calls perimenopause a cardiovascular “inflection point.” Cardiovascular disease, including heart disease and stroke, kills more than 400,000 U.S. women a year, yet only about 4 in 10 women recognize it as their greatest health threat, according to the AHA. And only about 60% of women with high blood pressure complications during pregnancy get follow-up care for their blood pressure within six months of delivery. The groups are calling for a national network of centers of excellence for women’s heart care.

In the first three years after the Supreme Court overturned Roe, prosecutors brought at least 902 cases charging women with crimes related to their pregnancies, pregnancy losses or births, according to Pregnancy Justice, a nonprofit that supports abortion rights. Most of the 955 charges alleged some form of child abuse, neglect or endangerment, largely tied to substance use. In 77 cases, not getting prenatal care was cited as evidence of a crime, and 13 included allegations about obtaining, attempting or researching an abortion. South Carolina, Oklahoma and Alabama accounted for most of the cases. In the past two years, lawmakers in about a dozen states have introduced bills to penalize women for having abortions, Stateline reports. “These instances are times when women need healthcare, not handcuffs,” said Madalyn Wasilczuk, a University of South Carolina law professor and a co-author of the study.

Medicare pays surgeons less for many procedures on women than for comparable procedures on men, Vox reports. In a study of 55 pairs of sex-specific procedures, the female procedure received a lower value for the surgeon’s work in 75% of pairs. Male procedures were valued about 30% higher on average. In 2023, Medicare’s standard rate for a penile biopsy was $121. A vaginal biopsy paid about $66. Researchers found no statistically significant narrowing of the pay gap between 2003 and 2023. An American Medical Association committee recommends the values, drawing on doctors’ estimates of the time and work involved. Medicare has the final say. Experts interviewed by Vox say lower payments lead hospitals to give gynecologic surgery fewer resources, limiting operating room access and training opportunities. “I have patients who are waiting for surgery with me for a year at a time,” said Louise King, a gynecologic surgeon and Harvard bioethicist.

Callers posing as patients with Medicaid were offered appointments with Menopause Society–certified practitioners far less often than callers with private insurance, according to Medscape’s report on a secret shopper study presented at the society’s annual meeting. Researchers contacted 216 practitioners’ offices listed in the society’s directory. Private insurance callers were offered an appointment 59% of the time, compared with 38% of Medicaid callers. Forty percent of the offices couldn’t be reached despite three to six attempts. Among practices that did offer an appointment, the median wait was 40 days. Medicaid “often comes with lower reimbursement,” said Penn Medicine OB-GYN Holly Cummings, who wasn’t involved in the study. “Providers are earning less money for the same care provided.”

The American College of Obstetricians and Gynecologists has released long-awaited guidance on GLP-1 weight-loss drugs before, during and after pregnancy. It recommends patients consider stopping the drugs one to two months before trying to conceive, because most take days or weeks to clear the body, and avoid them throughout pregnancy. Human data so far haven’t shown a consistent increase in birth defects, but safety data remain limited. For breastfeeding, ACOG calls for shared decision-making. Early studies of injectable drugs suggest little or no medication reaches breast milk, but ACOG recommends against use while nursing preterm babies or infants in their first 28 days. It also advises against oral GLP-1s while breastfeeding and calls for close monitoring of infant weight gain if treatment is used. As many as 1 in 300 women are exposed to GLP-1s before pregnancy, said lead author Yvette LaCoursiere, and the drugs are “now widely accessible through online providers and medical spas.”