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Sleep-related disorders linked to hypertension in postmenopausal women

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New research suggests sleep disorders in postmenopausal women may raise the risk of hypertension — abnormally high blood pressure.

Postmenopausal women tend to have poorer blood pressure control than men of the same age, partly due to falling oestrogen.

They also report more sleep problems, including short sleep, trouble sleeping or obstructive sleep apnoea (when breathing repeatedly stops and starts during sleep).

A study of more than 3,500 naturally postmenopausal women examined links between sleep-related disorders and the odds of hypertension.

The study found that trouble sleeping and obstructive sleep apnoea were associated with higher odds of hypertension.

It also suggested a U-shaped pattern for sleep duration — both too little and too much sleep were linked with increased risk.

A subgroup analysis indicated body mass index played a role, with stronger effects seen in women with obesity.

The findings highlight the value of sleep health and weight management in reducing hypertension risk in this group.

Dr Monica Christmas, associate medical director for The Menopause Society, said: “Although it isn’t possible to determine causality or which came first—sleep dysfunction or hypertension—the study findings raise awareness around the importance of improving sleep quality and optimal weight management during and after the menopause transition as key factors in mitigating long-term cardiovascular risk.”

Sleep is fundamental to cardiovascular health, and women after the menopause commonly report difficulty getting adequate rest.

Despite a research gap focused specifically on postmenopausal women, evidence increasingly supports sleep disturbance as a substantial, often undervalued, risk factor.

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Self-guided hypnosis significantly reduces menopausal hot flushes, study finds

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Daily self-guided hypnosis cut hot flushes by over 50 per cent in postmenopausal women, a new clinical trial has found.

The multicentre randomised clinical trial tested a six-week, self-administered hypnosis programme against a sham control using white noise.

It enrolled 250 postmenopausal women with frequent hot flushes — sudden heat surges that can disrupt sleep and daily life.

Nearly 25 per cent of participants had a history of breast cancer, a group often unable to use hormone therapies because of safety concerns.

Lead researcher Gary R. Elkins, professor of psychology and neuroscience and director of the Mind-Body Medicine Research Laboratory at Baylor, said the findings offer hope for women seeking non-hormonal options.

Elkins said: “It is estimated that over 25 million women in the United States have hot flushes, with up to 80 per cent of women in the general population reporting hot flushes during the menopause transition, and 96 per cent of women with breast cancer report hot flushes soon after beginning anti-cancer therapy.

He added: “While hormone replacement therapy is highly effective in reducing hot flushes, it is not a safe choice for everyone, and therefore, women need additional safe and effective alternatives.”

After six weeks of daily self-hypnosis audio recordings, participants reported a 53.4 per cent reduction in both frequency and intensity of hot flushes. At the three-month follow-up, hot flushes were reduced by 60.9 per cent, compared with 40.9 per cent for the control group.

Women with a history of breast cancer saw a 64 per cent reduction after six weeks.

The trial is the first to compare self-guided hypnosis with an active control, helping to separate treatment effects from expectancy or the placebo effect — improvement driven by belief rather than the intervention itself.

Elkins said: “This was a major breakthrough and innovation, as almost all prior studies of mind-body interventions have only used wait-list, psycho-education or simple relaxation to compare the active hypnotherapy intervention.”

He added: “Also, all sessions were self-administered hypnosis, which demonstrated that women could learn how to use hypnosis for hot flushes on their own with support and guidance.

“It can be practised at home without needing to travel for doctor visits, and it is relatively inexpensive compared to in-person sessions.

“Once a person learns how to use self-hypnosis to reduce hot flushes and improve sleep, it can be used for other purposes such as managing anxiety, coping with pain and for stress management.”

At 12 weeks, the hypnosis group showed greater gains in sleep, mood, concentration and quality of life. Nearly 90 per cent reported feeling better, versus 64 per cent in the control arm.

Elkins said: “We are very excited about the findings from this important study.

He added: “Our ongoing research aims to further determine how self-hypnosis can significantly improve sleep for breast cancer survivors and women in the peri- to post-menopause transition.”

Through this and other studies, Elkins and colleagues say hypnotherapy is the only behavioural intervention consistently shown to reduce hot flush frequency and severity to a clinically significant level in postmenopausal women and breast cancer survivors.

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FDA removes warning label from menopause drugs

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The FDA will remove the menopause drug warning from hormone therapies, citing updated evidence on stroke and heart risks.

US health officials said Monday they will drop the boxed warning — the strongest safety alert on a drug label — from more than 20 pills, patches and creams with hormones such as oestrogen and progestin, used to ease hot flushes and night sweats.

The 22-year-old warning told doctors that hormone therapy raises the risk of blood clots, heart problems and other issues, based on an influential study published more than 20 years ago.

FDA commissioner Marty Makary called the current label outdated and unnecessary. Officials pointed to studies suggesting hormone therapy carries few risks when started before age 60 and within 10 years of symptoms beginning.

Health secretary Robert F. Kennedy Jr. said: “We’re challenging outdated thinking and recommitting to evidence-based medicine that empowers rather than restricts.”

Medical guidelines generally advise limited-duration use in younger women going through the menopause who do not have complicating risks, such as breast cancer.

The FDA’s updated prescribing information largely aligns with that approach.

Makary and some other doctors have argued that benefits may extend beyond symptom relief.

Before becoming FDA commissioner, Makary devoted a chapter of his latest book to what he described as the overall benefits of hormone therapy and criticised doctors unwilling to prescribe it.

On Monday he repeated that view, citing figures suggesting hormone therapy reduces heart disease, Alzheimer’s and other age-related conditions.

Makary told reporters: “With few exceptions, there may be no other medication in the modern era that can improve the health outcomes of women at a population level more than hormone replacement therapy.”

The scale of those benefits remains under study. Dr JoAnn Manson of Harvard Medical School said the evidence for overall health benefits is not “as conclusive or definitive” as Makary suggested.

Still, she said removing the warning could help doctors and patients make more personalised decisions.

Manson said: “The black box is really one size fits all. It scares everyone away. Without the black box warning there may be more focus on the actual findings, how they differ by age and underlying health factors.”

In the 1990s, more than one in four US women took oestrogen alone or with progestin, amid assumptions it would cut rates of heart disease, dementia and other problems, as well as treat symptoms.

But a landmark study of more than 26,000 women challenged that, linking two hormone pill types to higher rates of stroke, blood clots, breast cancer and other serious risks.

After the 2002 findings were published, prescriptions fell across age groups.

Makary said: “That study was misrepresented and created a fear machine that lingers to this day.”

A new analysis of the 2002 data, published in September, found women in their 50s on oestrogen-based drugs had no increased risk of heart problems, while women in their 70s did; the data for women in their 60s was unclear.

Since the early 2000s, newer forms have arrived, including vaginal creams and tablets that deliver lower doses than pills and patches.

The original warning language will still be available to prescribers but placed lower on the label.

he drugs will keep a boxed warning that women who have not had a hysterectomy (surgical removal of the uterus) should take a combination of oestrogen-progestin due to the risk of cancer in the uterine lining.

Rather than convening one of the FDA’s standing advisory committees on women’s health or drug safety, Makary earlier this year invited a dozen doctors and researchers who overwhelmingly supported the health benefits of hormone-replacement drugs.

Many of the panellists at the July meeting consult for drugmakers or prescribe the medicines in private practice. Two of the experts also spoke at Monday’s FDA news conference.

Asked on Monday why the FDA did not convene a formal advisory panel, Makary said such meetings are “bureaucratic, long, often conflicted and very expensive.”

Diana Zuckerman of the non-profit National Centre for Health Research accused Makary of undermining the FDA’s credibility by announcing the change “rather than having scientists scrutinise the research at an FDA scientific meeting.”

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Dame Lesley Regan vows to ‘revamp’ UK’s Women’s Health Strategy – “we’ve let women and girls down”

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The Women’s Health Ambassador for England, Dame Lesley Regan, has promised to overhaul the government’s 10-year strategy, as she revealed the scale and cost of the UK’s gender health gap three years on.

Speaking at Women’s Health Week in London earlier this month, Regan revealed that Health Secretary Wes Streeting has tasked her with “revamping” the government’s Women’s Health Strategy, following the publication of his 10-year plan to reform the NHS.

Promising to “rise to the challenge”, Regan also hinted at plans to streamline pathways for innovators, to fast-track solutions into the NHS, and said that the system must stop “admiring the problem” and start redesigning care around women’s lives.

“We are the only country I know in the world with a national health service free at the point of delivery,” said Regan, during her closing keynote speech on Thursday 16 October.

“Yet we’ve got so complacent about the important things in women’s health that we’ve really let girls and women down.”

Major health challenges for women

A Professor of Obstetrics and  Gynaecology at Imperial College London, Regan painted a stark picture of the state of women’s health in 2025.

As well as huge gaps in care for women and girls experiencing menstrual symptoms such as PMS and menopause, women face a raft of wider health challenges.

Contraception has become increasingly difficult to access, resulting in almost half of all pregnancies being unplanned, and as well as having the highest teenage pregnancy rate in Europe, abortion rates are also rising among women over 32.

Meanwhile, cervical screening uptake is at an all-time low, with marginalised women at greatest risk despite cervical cancer being preventable with HPV vaccination and smear tests.

The number of high-profile maternity scandals in recent years reflects a flawed system, where the annual amount spent on litigation costs by NHS Resolution exceeds the allocated total funding for maternity care.

Maternal mortality is three times higher in Black women and twice as high in Asian women, with suicide now a leading cause of direct maternal death, one in four among teenage girls.

According to Regan, many of those are known to mental health services.

“In the last maternal mortality report, every single woman who died was known to mental health services,” she said.

“I have to conclude that we let them down.”

Regan also highlighted gender disparities and inequalities in chronic health conditions, which often go undetected or misdiagnosed in women.

Conditions like Parkinson’s and Alzheimer’s, for example, present differently in females, who are twice as likely to be diagnosed with dementia.

And while women are twice as likely to die from cardiovascular disease as from cancer (52 per cent deaths annually), they are often diagnosed later than men, due to a lack of understanding of their symptoms.

Major causes of morbidity and mortality, frailty and osteoporosis, also disproportionately affect women.

More than a fifth of females (21 per cent) are affected, compared to six per cent of men, with women typically experiencing twice as many fractures.

There are vast geographical inequalities, too.

Every year, 500,000 fragility fractures occur throughout the UK, but less than 53 per cent of the population can access Fracture Liaison Services in the community, with quality and standards varying significantly.

“Until very recently, most politicians across the globe viewed women’s health as maternity,” said Regan.

“But women spend most of their lives post-reproductive, and we have never really catered for that… We’ve got to look after women’s health across their life course.”

Delivering on women’s health hubs

The Women’s Health Strategy, first published in 2022, was shaped by the largest ever call for evidence in a Department of Health consultation, gathering a total of 100,000 responses. Out of these, 84 per cent of women reported not being listened to by healthcare professionals.

In response, the strategy set out a six-point plan which promised to address these inequalities, including through the establishment of women’s health hubs.

Regan believes hubs are crucial for delivering on the promises of the 10-year plan, including shifting from hospital to community care, moving from analogue to digital, and pivoting from treatment to prevention.

Successful case studies from hubs in some of the most deprived areas of England have demonstrated early benefits of these hubs, including reduced secondary-care referrals, shorter waiting lists, improved access and equity, workforce retention, more specialised training, and fewer adverse outcomes.

But not all Integrated Care Boards across England are offering all core services.

Delivering more Women’s Health hubs is part of a five-point plan moving forward, according to Regan, which also includes improving maternity and menstrual care, tackling inequalities and funding more research.

“We’ve continued to admire the problem, but that’s what we’ve got to stop,” Regan said.

“The most important thing to be able to do things better is that you have to be willing to do it differently.”

A “front door” for change

Building on this, Regan expressed her “frustration” at some of the challenges faced by startups trying to bring solutions to market, hinting at plans for a hub or a “big front door” to streamline regulatory approval processes.

“Almost every time I talk to entrepreneurs or investors, they tell me the same story: ‘We’ve been knocking on the door of government, and we always get pushback’,” she said.

“I want to paint that door bright yellow so you’ll never miss it, and when it opens, I want people to be welcoming. We need to stop sending people off to navigate endless pathways. There should be a hub that sorts it.”

Benefit to the UK economy

There’s a strong economic argument for the UK government to deliver on these promises.

Global life expectancy is increasing, and while women typically live longer than men, they spend more of their lives in poor health.

A woman will experience ill health for an average of nine years throughout her life, impacting her ability to be present and/or productive at home, in the workforce, and in the community.

Regan shared analysis from McKinsey Health Institute, which shows that more than half of the women’s health gap affects women during their working-age years, significantly impacting the UK’s GDP.

At least 56 per cent of Disability-Adjusted Life Years stem from conditions which impact women differently or disproportionately.

Taking this into account, closing the gender health gap in the UK could generate more than £36bn in annual GDP by 2040, a figure that could exceed $1 trillion globally.

A 2024 report published by the NHS Confederation estimates that the economic cost of absenteeism due to severe period pain and heavy periods, alongside endometriosis, fibroids and ovarian cysts, is nearly £11 billion per year, while 60,000 women are thought to be unemployed due to menopause symptoms.

The findings suggest that for every additional £1 invested in obstetrics and gynaecology per woman in England, the return on investment is estimated at £11.

Dutch collaboration

Regan has now been invited to the Netherlands to help officials there develop their own Women’s Health Strategy.

In conversation with Dutch Minister Judith Tielen, Regan highlighted the need for international collaboration to accelerate wider global change when it comes to women’s health.

The Netherlands is already collaborating across ministerial department’s including employment and social security, with education next.

Tielen shared the outcomes from an initiative at Amsterdam University Medical Centre, which offered free gynaecology consultations to female staff to reduce sick leave.

“Hundreds of women signed up in days, and sickness absence dropped significantly,” she said.

“It’s a societal question, not one for women to solve alone.”

Regan agreed, adding: “We cannot afford for women not to be part of the solution.”

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