The sleep complaint that is not a hot flush

The edition in brief

Today's obstetrics and gynaecology desk opens with sleep in the menopausal transition. A narrative review covering literature from 2015 to March 2026 sets out four primary sleep disorders that become commoner across perimenopause and postmenopause - insomnia, obstructive sleep apnoea, restless legs syndrome and periodic limb movement disorder - and argues that reported prevalence depends heavily on menopausal stage, on whether vasomotor symptoms are present, and on whether sleep was measured by questionnaire or objectively. A randomised trial in Ecuador tested a locally adapted ancestral dietary pattern from 12 weeks' gestation to birth in 215 women. Fetal corpus callosum length was greater by 0.19 cm (95% CI 0.02 to 0.35) and gangliothalamic ovoid height by 0.15 cm (0.03 to 0.26) between 21 and 35 weeks, while femur length was shorter by 0.10 cm. A triple-blind pilot trial of astaxanthin 12 mg daily for six weeks before oocyte retrieval in 44 women with polycystic ovary syndrome found higher total and mature oocyte yields and better embryo quality after adjustment, with pregnancy outcomes numerically higher but not significant. A meta-analysis of 17 aromatherapy studies in 1,347 women reports improvement across vasomotor, psychological and sleep outcomes, with no effect on urogenital symptoms and GRADE certainty rated low or very low throughout. The edition closes on 915 fetoscopic laser procedures for twin-twin transfusion syndrome over 25 years: dual survival at six months was 65.2%, and three pre-procedure findings predicted dual demise - cervical length of 15 mm or less, abnormal donor umbilical artery Doppler, and earlier gestational age at intervention. All three are available before the woman is counselled.