Mind & Body · Saturday, 17 October 2026
US women's doctors update menopause advice for the first time since 2014, calling hormone therapy safe for most women under 60
A co-author of ACOG's new guidance calls hormone therapy probably the best option for women with symptoms who are under 60 or within 10 years of their last period, 22 years after a US warning drove most women off it.
46%
drop in US hormone therapy use within six months of the 2002 trial results
The FDA added its strongest warning the next year, in 2003.
27% to 5%
of US women past menopause using hormone therapy, 1999 to 2020
The figures come from a 2024 study in JAMA, a US medical journal.
10 years
after the last period: the window in which a co-author of the guidance calls hormone therapy probably the best option
The average age at menopause is 49.9, the guidance says.
2 million
US women who begin menopause each year
Symptoms can start years before the last period.
The lead story — what happened
-
ACOG, the main US group of doctors who care for women in pregnancy and menopause, released new guidance on treating menopause symptoms on Thursday, its first since 2014.
[1] -
Robert Kauffman, a co-author, said hormone therapy is probably the best option for women with symptoms who are under 60 or within 10 years of their last period.
[1] -
Catherine Cansino, who chairs ACOG's guideline committee, said the safety of hormone therapy is now well established.
[1] -
Hormone therapy gives back estrogen, the hormone whose fall mainly drives menopause.
[4] Women who still have a womb also take a second hormone, progestogen, because estrogen alone can thicken the womb lining and raise the risk of cancer there.[1] -
Women who have had certain cancers of the reproductive organs, blood clots, a stroke, a heart attack or liver disease are told to avoid it.
[1] -
The guidance also lists two newer medicines with no hormones in them, fezolinetant and elinzanetant, approved in the US in 2023 and 2025.
[1] They block chemical signals in the part of the brain that controls body heat and sleep.[1] -
Talking therapy, exercise, hypnosis and acupuncture can ease some symptoms, ACOG says, but the evidence for them is weaker than for hormones.
[1] -
The fear of hormones began in 2002, when a large US trial called the Women's Health Initiative linked them to more breast cancer, heart disease and stroke.
[2] [3] -
Hormone use fell by 46% within six months.
[2] In 2003 the FDA, the US medicines regulator, put its strongest warning, a black box, on every estrogen product for menopause.[2] -
Later studies found most women in that trial were 60 or older, and the risks were much lower for women who started earlier.
[1] [3] In women under 60, long follow-up found no clear rise in heart disease.[5] -
The FDA removed the black box warning in November 2025.
[2] [4] [7] Some menopause doctors said the decision skipped the usual public expert review and overstated the benefits.[6] -
Demand is already rising, and estrogen skin patches have been hard for US pharmacies to keep in stock.
[1]
Who is involved
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ACOG
the American College of Obstetricians and Gynecologists, the main US group of doctors who care for women; it wrote the new guidance
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Catherine Cansino
an obstetrician in California who chairs ACOG's guideline committee; she co-wrote the guidance
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The Women's Health Initiative
a large US study of women's health that began in 1991; its 2002 results set off the warning
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The FDA
the US medicines regulator; it added the warning in 2003 and removed it in November 2025
How it unfolded
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2002 The Women's Health Initiative links hormone therapy to more breast cancer, heart disease and stroke
[2] -
2003 The FDA puts a black box warning on all estrogen products for menopause
[2] -
2014 ACOG's last menopause treatment guidance
[1] -
Nov 2025 The FDA removes the black box warning
[2] [4] -
This week ACOG publishes new guidance backing hormone therapy for most women under 60
[1]
Where this points
The next test is whether US pharmacies can keep estrogen patches in stock as demand rises, and whether doctors follow ACOG's age limits rather than the wider benefits US officials claimed last year.
What is pushing on the whole day
The bar and the word are our reading of how hard each one is pushing today. The arrow is where it is heading. The evidence is in the stories below.
ACOG rewrote its menopause advice for the first time since 2014.
Doctors in the United Arab Emirates say more children are losing sleep to late-night screen use.
In better-off rural districts of Germany, each extra hot day brought about 18 more emergency hospital admissions per 10,000 people.
In China, more than 200 children were poisoned by lead at their kindergarten in Tianshui.
The rest of the day
15 more stories on this beat.
Each with its own sources. None of these is a link to the story above.
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02
UK will review its vaccine injury payments
The UK government said this week it will review the Vaccine Damage Payment Scheme, which pays people badly harmed by a vaccine.
[9] In April the UK Covid Inquiry, the official investigation into the pandemic, called the scheme not supportive enough.[9] [12] By September, 24,260 claims linked to Covid jabs had been made, and 264 had been paid.[10] Each payment is a one-off 120,000 pounds, only for people judged at least 60% disabled.[9] Running the scheme has cost 83 million pounds, against 32 million pounds paid out.[10] Paid to people harmed32 m poundsCost of running the scheme83 m poundsMoney paid out by the UK's vaccine damage scheme, beside what it has cost to run, in millions of pounds. Why it matters — Vaccine Injured and Bereaved UK, a campaign group, says the UK government gave no timetable and named no changes.
[9] Most claims are about the AstraZeneca jab, which is credited with saving millions of lives.[10] -
03
Therapy in pregnancy and the baby's brain
A new study in Nature Communications, a science journal, followed 234 pregnant women with symptoms of depression.
[13] By chance, one group was given MOMCare, eight 50-minute sessions of talking therapy about their relationships and support.[13] An earlier report from the same trial found 36% of the women had depression before the therapy and 6% after.[13] Scans a few weeks after birth found the hippocampus, a brain part used for memory and feelings, was 5% smaller in their babies.[13] Why it matters — At six months, babies with a smaller hippocampus reacted less badly to a strange, noisy toy, a reaction earlier studies tie to less anxiety later on.
[13] The team says it does not yet know how the therapy reaches the baby's brain, or whether the difference lasts.[13] -
04
Australia moves to let users switch off feeds
Australia's government put a bill to parliament this week that would make social media firms let users turn off suggested posts and see only accounts they follow.
[14] The switch would stay on unless each user turns it off.[14] The wider Digital Duty of Care bill would make online services protect children from harmful posts, such as ones that push eating disorders, with fines of up to 100 million Australian dollars.[14] Australia already bars under-16s from social media, since December 2025.[15] Why it matters — Instagram's boss says feeds without suggestions would show fewer posts from friends, and the Trump administration says the bill risks censorship.
[14] More than 20 countries are looking at bans for children, and early research doubts that bans alone help young people's mental health.[15] -
05
UAE doctors see more children losing sleep to screens
Doctors in the United Arab Emirates say more children are coming to them with trouble sleeping and concentrating, linked to heavy screen use, The National reported on 17 October.
[16] Sudha Rao, a children's doctor in Dubai, said late-night use upsets children's body clocks and harms their eyesight.[16] She pointed to a study of 500 children aged 6 to 12 in Saudi Arabia.[16] Of those on screens more than four hours a day, 66.7% struggled to fall asleep, against 9.5% of those on under an hour.[16] Over 4 hours a day66.7%Under 1 hour a day9.5%Children in a Saudi study who had trouble falling asleep, by daily screen time. Why it matters — One Dubai school keeps pupils' phones out of sight all day, and school heads say sleep lost at home still shows up in class.
[16] The doctors are describing what they see in clinics, not a count of cases, and the Saudi study shows a link, not a cause. -
06
US flu tests turn positive six times as often
The share of US flu tests coming back positive reached 3.6% in the 9 October report of the CDC, the US public health agency, against 0.6% a year earlier.
[17] In the region covering Arizona, California, Hawaii and Nevada it was 9.5%.[17] Almost all positive tests, 98.4%, were H1N1, one type of flu.[17] That H1N1 has drifted a little from the strain in this year's vaccine, said Andrew Pekosz, an immunologist at Johns Hopkins.[17] Why it matters — Experts say an early start does not show how severe the winter will be.
[17] US flu usually peaks between December and February, and it is too early to know how well the vaccine will match.[17] -
07
Hot days fill German emergency wards unevenly
Researchers matched 112.9 million emergency hospital admissions in Germany, from 2005 to 2021, to each district's weekly temperatures.
[18] The study is published in a Nature journal this week.[18] In the least deprived rural districts, each extra hot day brought about 17.6 more emergency admissions per 10,000 people.[18] In the most deprived rural districts there was no rise.[18] Among people 65 and older, middle-income districts saw the biggest rise.[18] Why it matters — The authors say the pattern only shows when districts are compared on several things at once, such as wealth, age and how rural they are.
[18] They say health services and other public bodies need to plan for heat together.[18] -
08
Sheltering from heat could raise radon exposure
Radon is a radioactive gas that seeps from the ground into homes, and it causes an estimated 3% to 14% of lung cancer deaths worldwide.
[19] A study in a Nature journal modelled people adapting to hotter weather by running air conditioning, staying indoors and moving to cooler basements.[19] With all three, it estimated 46 extra lung cancer deaths per 10,000 people by age 85 in the US.[19] For France, Germany and Italy together, the figure was 42.[19] Why it matters — These are modelled scenarios, not counted deaths.
[19] The authors say the extra risk comes if known fixes for radon in homes are not used.[19] -
09
What patients need after being restrained
Mental health hospitals sometimes hold patients down, lock them alone in a room or sedate them quickly when staff fear harm.
[20] Researchers examined 35 research papers and policies from 46 NHS mental health trusts, the groups that run those hospitals in England.[20] NHS guidance says patients should get support afterwards, but the policies describe and organise it very differently.[20] Patients said a talk offered straight after can feel like one more demand.[20] Why it matters — A patient who turns down that first talk may get no second chance, the researchers found.
[20] Some patients have nightmares or symptoms of post-traumatic stress long afterwards, and fear of being restrained can stop people asking for help.[20] -
10
Inquest hears a sick girl's case was not a priority
Elizabeth Struhs, eight, died in Toowoomba, Queensland, in January 2022 after her father stopped giving her insulin for her type 1 diabetes.
[21] He had joined a religious group that rejects medicine.[21] At the coroner's inquest on 16 October, the child safety officer on her case said it was not treated as a priority.[21] She had 25 to 28 children in 15 families.[21] Child safety had returned her to her father's sole care against specialist doctors' objections, then ended its help after 17 weeks.[21] Why it matters — Elizabeth first came to child safety's attention in 2019, after she was taken to hospital in a coma.
[21] The officer said the family's well-off home may have swayed her, and the inquest continues.[21] -
11
Life sentence over lead poisoning at a kindergarten
A court in Gansu province, China, jailed six people on Friday over lead poisoning at the Peixin Kindergarten in Tianshui.
[22] More than 200 children were poisoned, in what the South China Morning Post calls the country's worst food safety scandal in almost two decades.[22] The owner, Li Huifang, was jailed for life and fined 500,000 yuan, about 75,000 dollars.[22] The principal, Zhu Jinglin, was jailed for 15 years.[22] Why it matters — The six were convicted of making or selling harmful food.
[22] Lead harms how a child's brain grows, which is why poisoning in young children is treated so seriously. -
12
Welsh school escorts pupils to the toilet
Ebbw Fawr Learning Community, a school in Blaenau Gwent, Wales, has begun escorting some older pupils to the toilet during lessons.
[23] It says vandalism has cost thousands of pounds and pupils spent too long out of class.[23] After meeting 50 pupil representatives, it limited the rule to pupils high on its behaviour scale or often late, in the lessons either side of lunch.[23] Why it matters — Molly Fenton, who campaigns on periods, says pupils who need the toilet for periods or other health reasons may simply stop going.
[23] The Welsh government says councils set toilet rules, and they must meet pupils' basic needs.[23] -
13
About 1 in 16 pet cats carries a gut parasite
Researchers tested more than 157,000 stool samples from pet cats across the US and Canada for Giardia, a gut parasite that can cause diarrhoea and stomach pain.
[24] They found it in 6.3%, about one cat in 16.[24] Kittens carried it far more often than cats aged 10 or older, 10.7% against 1.3%.[24] Rates were higher in winter than in summer, because the parasite survives longer in cool, damp places.[24] The study is in PLOS One, a science journal.[24] Why it matters — Only about 1.2% of samples held kinds that can also infect people.
[24] The authors suggest routine checks for cats living with young children, older people or people with weak immune systems.[24] -
14
Why brain stimulation for depression is uncomfortable
Transcranial magnetic stimulation, or TMS, treats depression and obsessive-compulsive disorder with magnetic pulses from a coil held against the head.
[25] Researchers in Denmark gave 20 people the pulses used in approved treatments and asked what hurt.[25] Most discomfort sat under the coil, and it was worse over one spot at the left front of the head.[25] How loud the clicks sounded tracked the discomfort, but how hard face muscles twitched did not.[25] Why it matters — The team says quieter machines and better-shaped pulses could make treatment easier to bear.
[25] Twenty people is a small group, so the finding needs checking in more. -
15
7 in 10 nursing mothers short of food in one Ethiopian district
A study in a Nature journal surveyed 464 breastfeeding mothers in Ankesha Guagusa, a district in northwest Ethiopia, in July and August 2025.
[26] Using a standard eight-question scale, it found 70.9% were short of food.[26] Food insecurity means not being sure of getting enough safe, nourishing food.[26] Mothers in the countryside, and mothers who had been ill, were more likely to go short.[26] Why it matters — A breastfeeding mother needs extra food, and too little can mean less milk and poor nutrition for her.
[26] The survey covers one highland district, not the whole country.[26] -
16
Most dental students in a Turkish study faced patient abuse
A survey of 129 dental students treating patients at Tokat Gaziosmanpasa University in Turkey found 76% had faced violence from patients during training.
[27] Most of it was spoken abuse, reported by 51.2%, and physical violence was rare, at 0.8%.[27] Women reported it far more often than men, 85.6% against 53.8%.[27] It happened most during treatment, and root-canal work was the most common setting.[27] Why it matters — Students suggested stronger laws, better patient education and more security.
[27] One university and 129 students is a small sample, so the figures may not hold elsewhere.
Whatever is already in place stays until someone does the work to change it
A rule stays as it is until someone gathers proof against it, and that slow work falls on whoever wants the change.
The twist
One alarming trial in 2002 put the warning on hormone therapy within a year. Taking it off took 22 years of follow-up studies and a decision by the regulator.
The picture
- 1Trial results2,002
- 2Warning added2,003
- 3ACOG's last guidance2,014
- 4Warning removed2,025
- 5New ACOG guidance2,026
How it works
- A rule or warning is set after an alarm
- Changing it needs new evidence, a review or a vote
- Whoever wants the change has to do that work
- The work takes years, or never gets done
- Meanwhile the old rule keeps shaping what people do
The same force, elsewhere today
Where this chain is also running, in today's other stories.
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The UK's vaccine injury payments
Each claimant has to show they are at least 60% disabled by a vaccine, so 264 of 24,260 Covid claims have been paid while the rules wait for a review.
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Australia's feed switch
Suggested posts stay on unless each user turns them off, because Australia's government chose not to make off the starting setting.
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Support after restraint
A patient who turns down the first talk after being held down may get no second offer, so asking again is left to the patient.
Where you've seen this
Organ donation
countries where people must opt out tend to have more donors than countries where people must opt in
Courts
a person is treated as innocent until the side bringing the case proves guilt
Workplace pensions
workers signed up automatically mostly stay in, while many who must sign up themselves never do
The catch
The starting rule is not always wrong. When the first alarm is right, slow change keeps people safe, and some doctors say the hormone warning came off too fast.
And the whole of it
A woman of 50 deciding about hormones, a doctor reading a drug label and a family filing an injury claim each live under a rule set years ago by people they never met. None of them can see the whole record of why it was set, or what has been learned since.
What is really going on
ACOG has told US doctors that hormone therapy is safe for most women under 60, 22 years after a US warning drove most women off it.
Why it works on us — One frightening result, like more breast cancer, is easy to remember, while the later studies that showed who it applied to are long and hard to follow.
Who gains
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Makers of estrogen products
— The warning that steered women away is gone, and ACOG now backs the treatment for most women under 60 while demand is rising.
[1] [4] -
Makers of the new pills without hormones
— ACOG's guidance lists fezolinetant and elinzanetant as ways to treat hot flashes without hormones.
[1] -
Crawford & Company, a firm that assessed UK vaccine claims
— It was paid nearly 50 million pounds, eight times the first estimate, because claims far outran what was expected.
[11] -
Social media firms, for now
— Australia's switch leaves suggested posts on unless each user turns them off.
[14]
Who pays
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Women who went without treatment
— Hormone use among US women past menopause fell from about 27% to about 5%, and a Harvard doctor says many who stopped were good candidates.
[3] -
People harmed by Covid vaccines in the UK
— Only 264 of 24,260 claims have been paid, and each claimant must be judged at least 60% disabled.
[10] [9] -
Children in Dubai losing sleep
— Doctors link late-night screen use to broken sleep and tiredness at school.
[16] -
Patients restrained in mental health hospitals
— Support afterwards depends on which hospital they are in, and turning down a first talk can end it.
[20] -
Breastfeeding mothers in Ankesha Guagusa
— Seven in ten were short of food in the survey.
[26]
What nobody knows yet
Open questions from across today’s stories — ours included.
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01
How many US women will now start hormone therapy, and whether supply can keep up.
Estrogen skin patches have already been hard for pharmacies to keep in stock, and nobody has said when that will ease.
[1] -
02
Whether the wider benefits US officials claimed for hormones are real.
US health officials said hormones could prevent heart disease and dementia, and menopause doctors said the evidence does not show that.
[6] [4] A review of more than a million women found hormones neither raised nor lowered the risk of dementia.[8] -
03
What the UK's review of vaccine injury payments will change, and when.
Vaccine Injured and Bereaved UK says the UK government gave no timetable and named no changes.
[9] -
04
Whether the brain difference in MOMCare babies lasts, and how therapy reaches the baby.
The babies were scanned weeks after birth and tested at six months, and the team says the cause is not yet clear.
[13] -
05
Whether Australia's switch will change what people actually see.
The switch stays on unless users turn it off, and Meta, TikTok, Snap, X and Google declined to comment on the bill.
[14] -
06
How well this year's flu vaccine will match the H1N1 now spreading in the US.
The strain has drifted a little from the vaccine, and experts say it is too early to tell what that means.
[17] -
07
Whether radon in homes really rises as people adapt to heat.
The figures come from modelled behaviour, not from measuring homes or counting deaths.
[19]
In one trial, 36% of pregnant women with symptoms had depression before eight sessions of talking therapy, and 6% after. Scans then found a difference in their babies' brains a few weeks after birth.
Also true today
- Women with hot flashes now have two medicines that work without hormones, approved in the US in 2023 and 2025, and ACOG's new guidance names both.
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