Fertility
Clue and Johns Hopkins researchers unveil largest study on menstrual cycle, mood and gastrointestinal symptoms

Clue, the menstrual and reproductive health tracking app, has announced the results of the largest study to date, examining the relationship between gastrointestinal (GI) symptoms, mood and the menstrual cycle.
Led by researchers at Johns Hopkins University, the new study provides important insights into the complex link between GI and mood symptoms across the menstrual cycle, particularly for individuals with premenstrual syndrome (PMS).
The study analysed data from more than 33,000 menstrual cycles over a four year period, across more than 32,000 participants, making it the most comprehensive study of its kind.
Participants used Clue’s menstrual tracking app to identify and track their symptoms and opted-in to share their data anonymously for research.
Key findings:
GI symptoms such as bloating, constipation, diarrhea, and nausea were more frequently tracked in the days leading up to menstruation as compared to the days following it, with a stronger effect observed in those with PMS.
A strong positive association was found between mood symptoms and GI symptoms across all phases of the menstrual cycle, for both PMS and non-PMS groups, indicating that these symptoms often occur together.
Participants with self-reported PMS tracked more GI symptoms throughout their entire menstrual cycle compared to those without PMS.
Amanda Shea, Fractional Chief Science Officer at Clue, said: “At Clue, we’re committed to advancing society’s understanding of menstrual health through data-driven research.
These findings not only validate the experiences of millions of women and people with cycles, but also pave the way for more effective support and treatment during especially difficult times of their menstrual cycle.”
With the Clue app, members can track when they feel bloated or gassy, monitor constipation or diarrhea, and log mood fluctuations throughout their cycle.
By customising additional tags, members can capture their unique experiences, and get a clear overview of how gastrointestinal symptoms and mood changes interact during their cycles.
Shea said: “Reporting your experiences and discomforts to your healthcare provider from memory alone often doesn’t reflect the true condition of your health and might not be the most reliable.
“We recommend tracking both your digestion and feelings daily, and over a longer period, to help you and your healthcare provider analyse cycle-related patterns.”
Liisa Hantsoo, Ph.D. is Assistant Professor in Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine, and Director of Research in the Johns Hopkins Reproductive Mental Health Center.
Hantsoo said: “This study was exciting because it drew from such a large dataset of menstrual cycles, to give a representative look at GI symptoms and mood across the cycle.
“We were able to see a clear relationship between GI symptoms and mood at multiple points in the menstrual cycle.
“Previous studies have found links between GI symptoms and mood in people with major depression, but this had not been assessed in the context of the menstrual cycle or premenstrual mood symptoms.
“We hope this study leads to more research on the gut-brain axis in the context of menstrual health.”
The full study can be found here.
Insight
UK reviews surrogacy firm over rejected insurance claims

The UK government is reviewing a surrogacy firm after complaints that medical insurance claims involving surrogates in Mexico were rejected.
The Department of Health and Social Care (DHSC) is considering whether UK-based provider My Surrogacy Journey should remain listed on gov.uk as one of four domestic surrogacy agencies available to intended parents.
The review follows allegations concerning its Mexican sister company, where surrogates are based.
Health minister Diana Johnson said: “The department is looking into the allegations about My Surrogacy Journey.
“As part of that assessment, the department will consider whether it is appropriate for that company to remain on the gov.uk list of agencies.”
Emails sent by My Surrogacy Journey chief executive Michael Johnson-Ellis and seen by the Guardian suggest multiple surrogate women in Mexico had their insurance claims rejected.
The emails also suggest 300 couples using the company were moved to a new insurance provider because of the increased risk of claims being rejected.
Commercial surrogacy is banned in the UK, where only altruistic arrangements are permitted.
My Surrogacy Journey operates a not-for-profit UK branch alongside for-profit sister companies in Mexico and the US. All three companies have the same owners and chief executives.
The reported insurance issues relate to surrogacy arrangements in Mexico.
One couple told the Guardian they paid tens of thousands of pounds to cover medical costs after their surrogate had a hysterectomy during childbirth and an insurance claim was refused.
The Guardian said it understood that at least five sets of parents said they had to cover medical costs after insurance claims were rejected.
In an email to the couple whose surrogate underwent a hysterectomy, Johnson-Ellis wrote: “We have already told you that the insurance companies have been declining some of the claims and we are actively working with the broker to get this issue resolved but you should also consider that they may not be paid out and there is nothing we are able to do to change this …
“We appreciate this is not an insignificant sum but this genuinely is out of our control.”
Johnson-Ellis also said the company had switched insurance providers, writing: “We’re also managing this for 300 other journeys, which is a complex position to be in.”
Lawyers acting for My Surrogacy Journey said the company did not comment on individual cases, but that existing insurance policies were in place and claims continued to be accepted and processed.
They said the company understood that a small number of claims had been rejected and was supporting people seeking to resolve those claims with an insurer.
Under the surrogacy arrangements, intended parents are understood to be contractually required to cover medical costs not paid by an insurer.
The couple said they had been recommended the company’s Mexico option. Its website advertises that intended parents using the route can have a baby in “under 18 months”.
They said they were told the UK route could take up to five years and that the US option was much more expensive.
Lawyers for My Surrogacy Journey said prospective parents are given information about typical timelines, costs, legal frameworks and practical considerations, and that the 18-month timeframe is indicative only.
The couple said their surrogate developed placenta accreta, a serious condition in which the placenta attaches to the wall of the uterus.
Emails from Johnson-Ellis acknowledged that the insurance provider investigated the birth after the surrogate experienced health complications.
The parents are considering legal action, while the Guardian said it understood at least four other couples were reviewing their options.
Phil Brickell, MP for Bolton West, raised concerns in parliament about a separate couple who had used My Surrogacy Journey.
He said: “Two of my constituents recently travelled to Mexico, where their children were born by surrogacy.
“Those births were facilitated by a company called My Surrogacy Journey, which is listed on gov.uk.
“While in Mexico, they had repeated traumatic experiences with the company relating to issues including insurance for their children, accusations of bullying towards staff and repeated efforts to silence any constructive criticism.
“I understand that other members of this house have received similar complaints.”
Brickell called for My Surrogacy Journey to be removed from gov.uk pending a review by the Human Fertilisation and Embryology Authority.
Lawyers acting for My Surrogacy Journey said the company was communicating with DHSC and was confident any issues could be resolved.
Fertility
Spain football federation partnership to offer players egg-freezing and fertility treatment

Spain’s football federation will offer national team players egg-freezing and fertility treatment through a clinic partnership running until 2029.
The agreement with the Tambre clinic in Madrid will give Spain’s World Cup winners more options to pursue motherhood when they feel the time is right.
The Royal Spanish Football Federation (RFEF) said the agreement covers all national team players, including the futsal team, as well as Primera Division referees and assistants and all other federation employees.
It is the latest policy introduced by the RFEF as it seeks to lead the way in work-life balance and maternity protection.
The federation has also introduced measures allowing players to travel with their children during major tournaments. The scheme was extended to the men’s team during their successful World Cup campaign in North America this past summer.
RFEF president Rafael Louzán said: “If Spain and its national teams are the best in the world on the pitch, they must also be the best in matters such as work-life balance.
“This is a new, comprehensive and pioneering benefit that extends to all federation employees. Today is a great day for the entire Spanish football family.”
The agreement followed a direct request from players after discussions with national team captains, including London City Lionesses midfielder Alexia Putellas.
Putellas told Spanish outlet El País: “As a group of captains, we had a concern — because experiencing a World Cup is vital for a player — regarding the difficulty of reconciling that with the desire to become a mother.”
“It’s a desire I didn’t originally have but developed some time ago.
“Thanks to the incredible work done by the federation, an agreement has been reached with a clinic allowing us to freeze our eggs while we are still active players, for as long as we wish.
“For me, this is a huge step forward; the federation understands that you are serving your country in a way that runs counter to your biological clock — that you can’t simply pause your career to become a mother because you need your body to do your job.”
The announcement follows Chelsea becoming the first Women’s Super League club to offer similar fertility treatment options to its players.
The move has also drawn criticism.
Spanish triple jumper Ana Peleteiro-Compaoré Brión said on Instagram: “The problem obviously isn’t freezing eggs.
“The problem is: why does the institution these women work for have an interest in financing them to delay their motherhood?
“And here there’s a problem that for me changes absolutely everything.
“Is this measure intended to make it easier for women to be mothers or is it intended to make it easier for them not to be while they’re playing?”
Spain are the current world champions in both the women’s and men’s games.
The women will attempt to defend their title at the 2027 World Cup in Brazil next summer.
Fertility
Paracetamol use may impact future fertility, studies suggest

Paracetamol use in pregnancy was not linked to autism or ADHD, while separate research found reproductive differences in girls exposed before birth.
One study analysed health records from more than 120,000 children and found no increased risk of autism following prenatal paracetamol exposure.
A separate analysis of nearly 100,000 children also found no increased risk of ADHD among those born to mothers who used the painkiller during pregnancy.
Researchers from the Hong Kong Hospital Authority examined electronic health records covering pregnancies between January 2001 and December 2023.
The autism analysis included 124,333 children, who were nine years old on average and split almost evenly between males and females. There were 3,445 autism diagnoses, representing 2.8 per cent of the group.
The ADHD analysis involved 97,285 children, who were seven years old on average and also split evenly between males and females. There were 5,168 ADHD diagnoses, representing 5.3 per cent.
Women prescribed paracetamol during pregnancy were more likely to be older and have pre-existing conditions including psychiatric disorders, as well as reasons for taking the drug such as infection, fever or chronic pain.
No association was found between prenatal paracetamol exposure and either autism or ADHD.
The findings did not differ according to the trimester in which paracetamol was taken or whether use was intermittent or daily. Advanced maternal age, defined as pregnancy in women over 35, did not alter the findings.
The researchers wrote: “Paracetamol remains a safe and essential analgesic [pain reliever] and antipyretic [fever reducer] during pregnancy, whereas alternatives, such as NSAIDs and opioids carry well-documented risks.
“Unwarranted reluctance to use paracetamol could lead to undertreatment of pain and fever, or the use of more harmful alternatives, both posing risks to the pregnancy and developing fetus.”
The authors said women should assess paracetamol use with guidance from their doctor.
A separate study involving 685 pregnant women without pre-existing conditions and 302 infant daughters found associations between prenatal paracetamol exposure and differences in reproductive organs and hormone levels.
Researchers from Copenhagen University Hospital enrolled the women during their first trimester and assessed them during the first trimester, third trimester and again when their babies were three months old.
At around three months, infants experience a temporary rise in reproductive hormones sometimes called mini-puberty.
Pregnant participants completed questionnaires every two weeks about their use of pain medicines including paracetamol. Infant girls underwent ultrasound scans of their reproductive organs and blood tests to measure hormone levels.
Researchers also examined a separate group of 1,210 girls followed from infancy to adolescence whose mothers reported paracetamol use during the third trimester.
Three-month-old girls exposed to paracetamol before birth had an average 40 per cent smaller ovarian volume, 13 per cent smaller uterine volume and 23 per cent fewer ovarian follicles.
Girls exposed during the first trimester also had lower levels of Anti-Müllerian hormone, a marker of ovarian function.
Among the older girls, those exposed before birth were more likely to have smaller uteruses at puberty and smaller ovaries during their teenage years.
Dr Margit Bistrup Fischer, lead study author and postdoctoral researcher in the Department of Growth and Reproduction at Rigshospitalet hospital in Denmark, said: “Animal studies have demonstrated that impaired formation of ovarian follicles can lead to reduced fertility and earlier reproductive aging.
“Whether the differences observed in our study have implications for fertility and age at menopause in humans remains unknown and will require long-term follow-up of the girls in our cohort.”
She cautioned that women who had used paracetamol during pregnancy “should not be alarmed by our findings”, as the study found associations rather than direct causation and outcomes for individual women and children are unclear.
“Importantly, our study does not evaluate whether [acetaminophen] causes reproductive problems, nor does it provide evidence that prenatal exposure affects future fertility or age at menopause,” she said.
“Although we observed similar associations in an independent cohort, long-term follow-up is needed to determine whether these early-life differences have any clinical significance later in life.”
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