The cardiovascular cost of surgical menopause falls hardest on women under 45

The edition in brief

Today's obstetrics and gynaecology edition leads on the long-term cardiovascular cost of iatrogenic menopause. A meta-analysis of 36 studies and 2.6 million women found raised stroke, coronary and mortality risk after surgery-induced menopause, with the mortality excess confined to women reaching menopause before 45 — making age at oophorectomy a cardiovascular risk marker, not only a bone or vasomotor one. Reassuring pooled data on glucagon-like peptide-1 receptor agonist exposure around conception showed no rise in maternal complications, supporting calm counselling when a woman conceives on these drugs. A network meta-analysis raised a high-dose vitamin D signal for pre-eclampsia prevention, but the certainty is low and the authors call it hypothesis-generating; low-dose aspirin remains the evidence-based prophylaxis. A clinic pearl reaffirms the copper intrauterine device as the most effective emergency contraception and a same-day route into ongoing contraception. The practice-changer: across 87 trials, mifepristone was more effective than levonorgestrel for emergency contraception, offering a stronger oral option where it is available, though the copper device still leads overall.