Why the Five and One?
Health care doesn't fail women because we lack information. It fails because systems are slow to change, and they're rarely built around women's bodies, lives, or timelines. The Five & One exists to make those systems visible.
Every other week, we share five signals shaping women's health, plus one thing just for you.
This week
This week, the theme is science that is moving faster than access and care. The FDA is exploring selling some vaginal estrogen over the counter, while estrogen patches are still hard to find. A large NIH study links two "forever chemicals" to a harder-to-treat breast cancer. A new menopause study points toward a brain test that does not exist yet. The American College of Obstetricians and Gynecologists says to plan ahead if you take a GLP-1 drug and may become pregnant. And the American Heart Association offers one roadmap for a woman's heart, from her first period to menopause and beyond.
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01. Vaginal Estrogen May Move Over the Counter, and Patches Are Still Hard to Find
The FDA is exploring selling some vaginal estrogen without a prescription. HHS said on Oct 30 that the FDA is working with drug companies on it. It would need FDA approval and evidence that women can use it safely without a clinician. USA TODAY reports one source who says it could happen as soon as mid-2027. The same day, the FDA removed boxed warnings from three more estrogen patches.
The Breakdown
Why it matters. Menopause raises the risk of urinary tract infections (UTIs), and in older women they can spread to the blood. Vaginal estrogen is a low-dose cream, ring, or tablet. USA TODAY says studies consistently show it can cut repeat UTIs by more than half.
Few women use it. Only about 1 in 10 menopausal women on Medicare use vaginal estrogen, based on records USA TODAY reviewed. Medical groups already recommend it for repeat UTIs, pain during sex, and vaginal dryness.
A large study points the same way. In a study of nearly 2 million women with repeat UTIs, women 55 and older who were prescribed vaginal estrogen were about half as likely to be hospitalized for a UTI. It was observational, so it cannot prove cause.
Patches are still hard to find. The FDA says patch output has doubled in the past 12 months and it is working with all six makers. It says it is not aware of an imminent nationwide shortage, but patients still report trouble finding patches.
The Breakthrough
Over the counter could mean easier access, but easier access is not the same as easier to afford. A women's leadership expert at NYU told USA TODAY that insurance often does not cover over-the-counter drugs, which can cut use. She suggested better Medicare drug coverage as another path. Nothing changes today, and the mid-2027 date comes from one unnamed source. For now, if you have repeat UTIs, pain during sex, or dryness after menopause, ask your clinician about vaginal estrogen. If your usual patch is out of stock, ask your pharmacist or clinician about an available alternative. Stock can vary by brand, strength, and where you live. Do not stop or change your medicine on your own.
02. Two "Forever Chemicals" and an Aggressive Breast Cancer.
A large NIH study found that women with higher blood levels of two common "forever chemicals" were more likely to develop a harder-to-treat type of breast cancer. The chemicals are called PFAS. They are used in many everyday products and break down very slowly, so they can stay in the body for years. The results were released Nov 5 and reported in the Journal of Clinical Oncology.
The Breakdown
Who was studied. The Sister Study enrolled 50,884 women ages 35 to 74. The PFAS analysis compared 1,609 women who later developed breast cancer with 2,269 women who did not. Blood was collected years before any diagnosis.
The type of cancer matters. The link was with ER-negative breast cancer, which lacks the receptors that let estrogen feed it. These cancers tend to be more aggressive, and scientists know less about what raises the risk.
The numbers. Women with the highest levels of one chemical (PFOA) had a 67% higher rate of ER-negative breast cancer than women with the lowest levels. For another (PFOS), the rate was 93% higher.
What was not found. There was no clear link between these two chemicals and breast cancer overall.
The Breakthrough
This is a signal worth tracking, not a reason to panic. The numbers compare groups of women. They do not tell any one woman her own chance of getting breast cancer. PFOA and PFOS have been largely phased out and replaced with newer PFAS, and the lead author says more research is needed on those. The first author notes that exposure can still be reduced, which could open new paths for prevention. A simple step is to ask your water utility whether it tests for PFAS. And keep up with your regular breast screening.
Source: HHS
03. Menopause Shows Up in the Blood, and It May Say Something About the Brain.
A new study found that menopause changes many proteins in a woman's blood, and some are linked to brain aging and, modestly, to later dementia risk. It was published Nov 2 in Nature Medicine. Researchers from UC Santa Barbara, UC San Francisco, and other schools measured thousands of proteins in women before, during, and after menopause. The changes tracked menopause stage more closely than age.
The Breakdown
Sixteen molecules went up. These molecules rose across the menopause transition and are tied to brain aging and dementia risk.
A second group backed it up. In a UK database of more than 2,800 women, menopause was linked to signs of faster aging across several organ systems.
The link reached memory and thinking. In four groups with nearly 12,000 older women combined, higher levels were linked to poorer thinking and memory results. In the largest group, the signal was tied to a modestly higher chance of Alzheimer's dementia over the next 16 years.
It is not a cause. One author said the findings do not mean menopause causes Alzheimer's disease, and most women do not get it. The meaning of individual protein changes in midlife is still unclear.
The Breakthrough
The goal is a blood test that could flag brain risk early, but that test does not exist yet. One author said menopause may be a powerful time to step in. Another noted that women spend about a third of their lives after menopause, yet little is known about how it links to brain health. For now, keep your own timeline. Write down the age of your last period, your symptoms, any surgery that removed your ovaries, and any hormones you have taken. Bring it to your next checkup.
Source: UCSB
04. GLP-1 Drugs and Pregnancy: What ACOG Now Advises.
The American College of Obstetricians and Gynecologists (ACOG) now advises against using GLP-1 drugs during pregnancy, and says to plan ahead if you take one and might become pregnant. GLP-1s are the injectable and oral drugs used for weight loss and type 2 diabetes. ACOG issued the guidance in October and announced it Oct 23. The lead author says as many as 1 in 300 women are exposed to these drugs before pregnancy.
The Breakdown
Planning a pregnancy. Because safety data in pregnancy is lacking, ACOG says to talk with your clinician about stopping the drug 1 to 2 months before you try to conceive.
During pregnancy. ACOG advises against use, except in a clinical trial. It calls for more studies and registries to track mothers and babies.
Breastfeeding. ACOG suggests a shared decision and a plan to closely watch the baby's weight gain. It does not recommend the drugs for mothers of preterm infants or newborns. Early data suggest the drugs are unlikely to be in breast milk, but safety data is limited.
Birth control matters. Weight loss on these drugs may increase fertility. So ACOG says to talk about reliable contraception if you do not want to become pregnant.
The Breakthrough
This guidance gives millions of women a clear starting point, but it also shows how much is still unknown. ACOG says there is not enough data to know what these drugs do to a pregnancy or a fetus. An ACOG committee chair also noted that regaining lost weight after stopping is common and may raise the risk of problems. So the step is to plan, not guess. If you take a GLP-1 and may become pregnant, talk with your prescriber before you stop or before you start trying. Do not change a medicine on your own.
Source: Healio
05. One Roadmap for a Woman's Heart, From First Period to Postmenopause.
Leading health groups just published one shared way to think about a woman's heart health across her whole life. The American Heart Association released three papers on Oct 26 in its journal Circulation. Heart disease takes more than 400,000 women's lives in the U.S. each year. Only about 4 in 10 women (41%) see it as their biggest health threat.
The Breakdown
A map of four life stages. Around the first period (about ages 8 to 15), the years of monthly cycles (15 to 44), perimenopause (45 to 51), and postmenopause (51 and older).
Pregnancy is a window. Heart conditions account for more than one-third of maternal deaths in the U.S. Only about 60% of women who had high blood pressure in pregnancy get a follow-up visit within six months of delivery.
High blood pressure is rising. The share of U.S. women 20 and older with it is projected to grow from about 49% in 2020 to 59% in 2050.
The years after menopause matter most. They can make up to 40% of a woman's life. Most heart attacks and strokes happen then. The American Heart Association says more than 80% are preventable if action is taken early.
The Breakthrough
Doctors now have a shared roadmap for heart care that follows a woman through every stage of life. The lead author says women's care is often split across specialties and feels disconnected. A common framework gives those doctors a common language. If you had high blood pressure or another complication in pregnancy, tell every new doctor. Then ask, "How does my pregnancy history change my heart risk, and when should I be checked?"
Source: Newsroom
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Your+1: National Family Caregivers Month
November is National Family Caregivers Month, and if you are caring for a child, a parent, or both, you count. A short thank-you to yourself, or to the person in your life who carries the load, is a good place to start. Caring for others rarely comes with a day off, so even one small break on the calendar helps.
Pick one small thing to take off your plate this week. It does not have to be big. Ask a sibling, a neighbor, or a friend to take one task, like a pharmacy run or a school pickup. A specific ask is easier to say yes to than a general "can you help?"
Put your own care on the calendar too. The people who look after everyone else are often the last to book their own checkup. If you have been putting off a visit, make this the week you schedule it.
If you want company in it, AARP lists caregiving events this month. The ones on its page are "Caregiving in Rural America" on Wed, Nov 18 at 7:30 p.m. ET, "Holiday Caregiving Conversations" on Thu, Nov 19 at 1 p.m. ET, and "Rising Costs and Caregiving" on Mon, Nov 30 at 1 p.m. ET.
Source: AARP
P.S. You made it to the bottom, which makes you the best-informed person in your group chat. Please use this power for good. Book the checkup.