5 Things to Pay Attention to During Women's Health Month

Women's health is experiencing a watershed moment in 2026. After decades of underinvestment and overlooked research gaps, the sector is seeing unprecedented clinical innovation and policy scrutiny. From how we treat menopause to how women access abortion care, the evidence landscape is shifting rapidly. Here are 5 critical trends that every health care stakeholder should be tracking.

1. The Menopause Revolution: Evidence Supports Individualized Hormone Therapy

Menopause management is undergoing a fundamental clinical recalibration based on emerging evidence from major randomized trials. The "timing hypothesis"—the proposition that menopausal hormone therapy (MHT) initiated within 10 years of menopause onset or before age 60 may confer cardiovascular benefit—is now reshaping clinical practice guidelines.^1,2

A November 2025 secondary analysis of the Women's Health Initiative randomized clinical trials found that among younger postmenopausal women aged 50 to 59 years, both conjugated equine estrogens (CEE) alone and CEE plus medroxyprogesterone acetate (MPA) reduced vasomotor symptoms without significantly affecting atherosclerotic cardiovascular disease risk.³ In women 70 years and older, risks for atherosclerotic cardiovascular disease were increased in both trials.

The cardiovascular science is nuanced. Newer studies have found that transdermal estrogen doesn't increase triglycerides, coagulation factors, or inflammatory markers,¹ with cardiovascular disease remaining the leading cause of death in women.⁴ Contemporary evidence demonstrates that cardiovascular outcomes vary considerably based on formulation, route of administration, timing of initiation, and patient-specific factors, with the timing hypothesis proposing that hormone replacement therapy initiated within 10 years of menopause onset or before age 60 may confer cardiovascular benefit, whereas later initiation may increase cardiovascular risk.²

A major prospective observational trial is now underway. The CATCH-Menopause trial (NCT07394049), a prospective registry study sponsored by Heinrich-Heine University in Düsseldorf, investigates the impact of new hormone replacement therapy delivery methods, such as creams, gels, and sprays, on cardiovascular risk in postmenopausal women, with enrollment of 2725 women and primary outcomes measured at 10 years.⁵

As evidence-based demand for hormone therapy rises, payers are being urged to recalibrate clinical pathways to prioritize pretreatment cardiovascular assessments. Furthermore, the data increasingly point to a new standard of care that favors transdermal formulations and low-dose regimens to mitigate long-term risks.

2. Women's Brain Health and Alzheimer Disease: A Critical Window for Prevention

Two-thirds of Alzheimer disease cases occur in women, and the scientific consensus is coalescing around estrogen deprivation during menopause as a key mechanism.⁶ Recent systematic reviews and clinical investigations are now defining the optimal timing for preventive hormone therapy.

A 2025 meta-analysis reported an 11.3% reduced risk of Alzheimer disease and dementia associated with menopause hormone therapy, especially estrogen-only MHT initiated during midlife and sustained for longer durations.⁷

The research pipeline is robust. Lisa Mosconi, PhD, director of the Alzheimer's Prevention Program at Weill Cornell Medicine, is leading a new $50 million global women's health research initiative, Cutting Women's Alzheimer's Risk Through Endocrinology (CARE), looking at biomarkers from nearly 100 million women and expected to be the largest analysis of why women are at greater risk of Alzheimer disease.⁶

Critically, the prodromal phase of Alzheimer disease, during which the disease is underway but symptoms are not yet manifest, can start as early as in midlife, proximate to the menopause transition or perimenopause, allowing for the development of primary and secondary prevention programs targeting at-risk individuals before irreversible neuronal dysfunction occurs.⁸

The challenge remains that while observational data support a protective association between hormone therapy and reduced Alzheimer risk, there are currently no randomized controlled trials demonstrating Alzheimer disease reduction effects, and the Women's Health Initiative Memory Study (WHIMS)—the only randomized controlled trial of hormone therapy effects on dementia incidence—reported increased dementia risk, a major limitation being that the trials were conducted on postmenopausal women 65 years and older, who were likely beyond the critical window.

For the managed care sector, the emerging link between menopause and cognitive health necessitates a tactical shift in coverage and care delivery. Payers must prepare for a significant rise in demand for cognitive screenings and hormone therapy consultations for women in midlife. As Alzheimer prevention is integrated into the broader framework of women’s preventive services, the deployment of early identification and risk-stratification tools will be paramount for health systems prioritizing proactive neurological intervention.

3. The Mifepristone Battle: Medication Abortion Access Remains Available—For Now

The right to medication abortion access remains one of the most contested legal issues in American health care, with the Supreme Court's intervention on May 14 providing only temporary relief in an escalating legal battle.

On May 1, the US Fifth Circuit Court of Appeals granted Louisiana's request to temporarily reinstate an in-person dispensing requirement for mifepristone nationwide, immediately halting telehealth prescribing and mail delivery of the drug.⁹ The ruling would have had catastrophic implications for abortion access across the entire country, not just in Louisiana.

In response, the manufacturers of mifepristone, Danco Laboratories and GenBioPro, filed emergency motions with the Supreme Court. On May 14, 2026, the Supreme Court issued a stay of the Fifth Circuit's order, keeping mifepristone available via telehealth and mail as the case proceeds through lower courts. However, this is not a final ruling; the underlying legal battle will continue.

The stakes are high for health care systems and patients nationwide. Medication abortion accounts for more than 60% of abortions in the US each year, and a quarter of all abortions are now provided via telehealth—a 2-fold increase since Roe v Wade was overturned. Louisiana is the first state to schedule mifepristone as a controlled substance and to criminally indict an out-of-state physician providing telemedicine abortion.

Two Supreme Court justices—Clarence Thomas and Samuel Alito—dissented from the stay, with Alito writing that at stake was "the perpetration of a scheme to undermine our decision in Dobbs." This suggests future litigation could go either way, leaving providers and patients in a state of uncertainty about long-term access.

With reproductive health care access remaining in a state of constant flux, payers are bracing for rapid, unpredictable shifts in coverage policies, network adequacy, and referral protocols across highly fractured state lines. For corporate legal and compliance teams, the escalating legal battle demands continuous, real-time tracking to execute immediate operational pivots as the regulatory landscape evolves.

Tune in next week for more in-depth insights into this issue on our new YouTube series, Beyond the Clinic.

4. Doula Care Goes Mainstream: Clinical Evidence and Medicaid Coverage Expand

Doula support is shifting from a boutique wellness service to an evidence-based standard of maternity care, with Medicaid coverage driving mainstream adoption.

A recent American Journal of Public Health study of matched Medicaid cohorts found that women with doulas had a 47% lower risk of cesarean delivery, had a 29% lower risk of preterm birth, and were 46% more likely to attend a postpartum checkup.¹⁰

A 2026 JAMA Network Open systematic review of 21 studies found doula care was most consistently associated with reduced maternal anxiety and higher breastfeeding initiation, with emerging evidence on better postpartum follow-up.¹¹ A 2025 Obstetrics & Gynecology meta-analysis of 18 trials and observational studies showed a significant effect on cesarean rates with intrapartum doula support.¹² A 2025 scoping review further linked doula care to reductions in cesarean delivery, preterm birth, labor duration, and pain, while enhancing breastfeeding—helping fill a labor-support gap in modern maternity care, where nurses spend only 6% to 10% of their time on labor assistance vs the 53% mothers expect.¹³

The partnership between Birth Root Community Doula in Erie, Pennsylvania, and UPMC Health Plan shows how this evidence is being put into practice for Medicaid populations. Tica Nickson, founder and director of Birth Root Community Doula, noted that community-based doulas are designed to address social drivers of health that clinical care alone cannot reach.

“A lot of the issues that affect a mother's pregnancy are not necessarily only medical, but it's those social drivers of health…transportation, food insecurity, and housing,” Nickson said in an interview with The American Journal of Managed Care^® (AJMC^®).

Birth Root’s model differs from private-pay doula care in its intensity and scope. Doulas engage early in pregnancy, providing home and office visits, prenatal education, accompaniment to appointments, and benefits navigation. For Sarah Elizabeth Morrow, program director for clinical and community programs for UPMC for You and UPMC for Kids, the differentiator is community concordance.

“Tica and her team of community-based doulas also reflect the community,” Morrow said in the interview. “It's a partner who can walk along beside you, who has also experienced what you have experienced.… Nothing can replace the lived experience that a community-based doula brings to the table.”

State adoption has accelerated.¹⁴ Medicaid coverage for doula services has grown from Oregon and Minnesota in 2020 to 26 states and Washington, DC, as of March 2026. As more states move toward fee-for-service reimbursement, UPMC’s experience highlights the value of building community capacity before billing codes exist.

Morrow advises payers to “really look at your community-based organizations, even before doula services are available to you as a fee-for-service or true state reimbursement. Take the time, get to know them. Invest in them beforehand… That opportunity will allow you to be a partner with them as they become a billing provider, as they become reimbursable.”

Nickson added that “you can throw money at a situation, but if you don't know what you're throwing it at, it's just going to be wasted.”

Managed care is pivoting to doula coverage as a high-impact strategy to reduce costly cesarean sections and close maternal equity gaps. By integrating community-rooted providers who address social determinants, payers can drive measurable return on investment while improving clinical outcomes. The path forward for managed care organizations requires combining comprehensive doula support with rigorous, data-driven metrics to track long-term maternal wellness.

5. Wearable Technology and Menstrual Cycle Physiology: A Data Revolution in Women's Health

Wearable technology and digital health tools are enabling unprecedented understanding of how menstrual cycle hormonal fluctuations affect cardiovascular and metabolic function, opening new avenues for personalized women's health.

The basic science foundation is strong; acute fluctuations in sex hormones during the menstrual cycle generally coincide with alterations in endothelial cell function and in vivo endothelium-dependent vasodilation, with the timing of these acute fluctuations matching the timing of cardiovascular events in both women and men.¹⁵

Wearable technologies are helping researchers understand women's cardiovascular health by collecting continuous cardiovascular data and correlating it with hormonal fluctuations across the menstrual cycle,¹⁶ with a new metric called cardiovascular amplitude enabling noninvasive monitoring of female physiology and health across the menstrual cycle.¹⁷ Research published in npj Digital Medicine found that cardiovascular amplitude was attenuated in older participants and participants using birth control, suggesting the novel metric may mirror differences in hormonal fluctuations in these cohorts, and that longitudinal tracking of cardiovascular amplitude may offer accessible noninvasive monitoring of female physiology across the menstrual cycle.

A large-scale prospective study from the UK Biobank with a median 11.8-year follow-up found that irregular menstrual cycles were associated with increased risks of cardiovascular disease independent of traditional risk factors including age, race and ethnicity, body mass index, and smoking.¹⁸

Recent neuroscience research adds another dimension. Research published in Science Advances by Max Planck researchers demonstrates that rhythmic changes in women's heartbeat driven by hormonal fluctuations offer a unique window into the connection between the female brain and heart, with these naturally occurring variations potentially influencing stress, mood, and long-term cardiovascular and neurological health.¹⁹

It's important to note that while the physiological evidence is compelling, the clinical interventions remain less certain. Most current research on "cycle syncing," or adjusting diet and exercise to menstrual cycle phases, focuses on elite athletes and specific populations. Large-scale randomized trials testing cycle syncing interventions are limited. The fundamentals of good health—sleep, exercise, and nutrition—remain more evidence-based than phase-specific optimization.

The surge in wearable-derived biometric data presents a new frontier for risk stratification and early intervention for managed care in women's health. Integrating menstrual cycle regularity and continuous cardiovascular metrics into population health strategies could allow payers to flag cardiovascular risks in premenopausal women long before they require costly medical care. However, as commercial interest in consumer cycle-syncing products grows, health systems are maintaining a strict threshold for clinical validation before expanding coverage for phase-specific wellness applications.

A Pivotal Moment for Women's Health

These 5 trends—menopause management as individualized, evidence-based care; brain health as a preventive priority; abortion access policy in flux; doula coverage mainstreaming; and wearable-enabled personalized health monitoring—reflect a fundamental shift in American women's health.

For managed care organizations, the operational imperatives are clear: invest in clinical infrastructure for menopause and brain health screening, develop contingency plans for rapid regulatory change, evaluate doula coverage implementation,and prepare digital health capabilities to leverage emerging wearable data. The next 24 to 36 months will likely reshape how millions of women access evidence-based care.

References

1. Penn State. Can hormone therapy improve heart health in menopausal women? ScienceDaily. April 22, 2025. Accessed May 15, 2026. https://www.sciencedaily.com/releases/2025/04/250422131542.htm
2. Khalifey HT, Mahereen R, Adwan R, et al. The impact of hormone replacement therapy on cardiovascular health in postmenopausal women: a narrative review. Front Reprod Health. 2026;8:1745210. doi:10.3389/frph.2026.1745210
3. Rossouw JE, Aragaki AK, Manson JE, et al. Menopausal hormone therapy and cardiovascular diseases in women with vasomotor symptoms: a secondary analysis of the Women’s Health Initiative randomized clinical trials. JAMA Intern Med. 2025;185(11):1330-1339. doi:10.1001/jamainternmed.2025.4510
4. D'Costa Z, Spertus E, Hingorany S, et al. Cardiovascular risk associated with menopause and menopause hormone therapy: a review and contemporary approach to risk assessment. Curr Atheroscler Rep. 2025;27(1):100. doi:10.1007/s11883-025-01343-6
5. Heinrich-Heine University Düsseldorf. CATCH-Menopause Trial: Cardiovascular Assessment Under Current Hormone Replacement Therapy in Menopause (NCT07394049). ClinicalTrials.gov. Accessed May 15, 2026. https://clinicaltrials.gov/study/NCT07394049
6. Syal A. Doctors looking into estrogen therapy to prevent dementia in women. NBC News. November 27, 2025. Accessed May 15, 2026. https://www.nbcnews.com/health/womens-health/estrogen-dementia-prevention-hormone-replacement-women-perimenopause-rcna245664
7. Melville M, He L, Desai R, et al. Menopause hormone therapy and risk of mild cognitive impairment or dementia: a systematic review and meta-analysis. Lancet Healthy Longev. 2025;6(12):100803. doi:10.1016/j.lanhl.2025.100803
8. Nerattini M, Jett S, Andy C, et al. Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer’s disease and dementia. Front Aging Neurosci. 2023;15:1260427. doi:10.3389/fnagi.2023.1260427
9. Sobel L, Salganicoff A, Donelson R. Louisiana v. FDA: access to mifepristone back at the Supreme Court. KFF. May 6, 2026. Accessed May 15, 2026. https://www.kff.org/womens-health-policy/louisiana-v-fda-access-to-mifepristone-back-at-the-supreme-court/
10. Falconi AM, Ramirez L, Cobb R, Levin C, Nguyen M, Inglis T. Role of doulas in improving maternal health and health equity among Medicaid enrollees, 2014-2023. Am J Public Health. 2024;114(11):1275-1285. doi:10.2105/AJPH.2024.307805
11. Groves P, Williams H, Salter CL, et al. Doula care and health outcomes: a systematic review. JAMA Netw Open. 2026;9(4):e268416. doi:10.1001/jamanetworkopen.2026.8416
12. Dias Y, Achebe NE, Doering MM, et al. Intrapartum doula support and cesarean delivery rates: a systematic review and meta-analysis. Obstet Gynecol. 2025;146(1):73-84. doi:10.1097/AOG.0000000000005937
13. Chaudhary P, Rech JP, Kumar G, Snyder K, Rosen A, Dinkel D. Role of doulas across the pregnancy care continuum on maternal and child health: a scoping review. NPJ Womens Health. 2025;3:63. doi:10.1038/s44294-025-00109-4
14. Hasan A. State Medicaid approaches to doula service benefits. National Academy for State Health Policy. March 31, 2026. Accessed May 15, 2026. https://nashp.org/state-tracker/state-medicaid-approaches-to-doula-service-benefits/
15. Turner CG, DuPont JJ. The effect of transient sex hormone fluctuations on vascular endothelial function. Am J Physiol Heart Circ Physiol. 2025;329(1):H217-H232. doi:10.1152/ajpheart.00174.2025
16. Heydari K, Enichen EJ, Li B, Kvedar JC. A new metric to understand the association between heart rate variability and menstrual regularity. NPJ Digit Med. 2025;8:123. doi:10.1038/s41746-025-01517-1
17. Jasinski SR, Presby DM, Grosicki GJ, Capodilupo ER, Lee VH. A novel method for quantifying fluctuations in wearable derived daily cardiovascular parameters across the menstrual cycle. NPJ Digit Med. 2025;8:373. doi:10.1038/s41746-024-01394-0
18. Huang C, Lin B, Yuan Y, et al. Associations of menstrual cycle regularity and length with cardiovascular diseases: a prospective study from UK Biobank. J Am Heart Assoc. 2024;13(20):e035316. Accessed May 15, 2026. doi:10.1161/JAHA.122.02902
19. Prinsen J, Villringer A, Sacher J. The monthly rhythm of the brain-heart connection. Sci Adv. 2025;11(10):eadt1243. doi:10.1126/sciadv.adt1243