Women with surgical menopause may exit workforce earlier, but hormone therapy could help

New study suggests that hormone therapy within the early postmenopause years may help women with early or surgical menopause remain in the workforce longer

The Menopause Society

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CLEVELAND, Ohio (October 8, 2025)—Menopause before the age of 45 (known as early menopause) is associated with an increased risk of an array of serious diseases, including cardiovascular disease and osteoporosis. A new study suggests that it may also force women out of the workforce prematurely, although carefully timed hormone therapy may help women remain employed. Results of the study are published online today in Menopause, the journal of The Menopause Society.

Early menopause, whether natural or surgical (removal of both ovaries), has already been considered a risk factor for multiple diseases. Women with early menopause are also at higher risk of experiencing more frequent, severe, and prolonged hot flashes and night sweats, as well as depressive symptoms. Premature morbidity and menopause symptoms can be even more pronounced in women who undergo early surgical menopause, which results in the sudden cessation of ovarian function.

Despite extensive research on the health consequences of early menopause, little is known about how it affects other aspects of women’s lives, including their ability to maintain and build their careers. A new study involving nearly 1,400 women who had undergone natural menopause, premenopause bilateral oophorectomy, or hysterectomy is one of the first known studies to not only investigate the effect of early and surgical menopause on work function but also the effect of hormone therapy as a mediator.

The researchers used sequence analysis of employment histories to define three different 10-year employment trajectories. Regression analysis was then used to assess associations between timing and type of menopause on employment. Women with early menopause were found to have less flexible working arrangements during this sensitive period. However, early natural menopause did not appear to make a woman more likely to exit the labor market earlier than women with later menopause.

Surgical menopause, in contrast, was found to be associated with an increased risk of labor market exit, especially for women aged 45 years or older at the time of surgery. Hormone therapy was shown to help reduce the risk of labor-market exit for women with both early natural menopause and surgical menopause. Based on the results, the researchers advocate for workplace policies that consider women’s diverse menopause experiences.

Study results are published in the article “The associations of early and surgical menopause with 10-year employment trajectories bracketing final menstruation or surgery.”

“This study found that early natural menopause and surgical menopause were linked with women’s employment trajectories and further suggests that hormone therapy within the early postmenopause years may help women remain in the workforce,” says Dr. Stephanie Faubion, medical director for The Menopause Society. “These findings add to the accumulating evidence that menopause-related symptoms can adversely affect women in the workplace and that targeted interventions may minimize the negative effect on employment.”

For more information about menopause and healthy aging, visit www.menopause.org.

The Menopause Society is dedicated to empowering healthcare professionals and providing them with the tools and resources to improve the health of women during the menopause transition and beyond. As the leading authority on menopause since 1989, the nonprofit, multidisciplinary organization serves as the independent, evidence-based resource for healthcare professionals, researchers, the media, and the public and leads the conversation about improving women’s health and healthcare experiences. To learn more, visit menopause.org.

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Journal

Menopause

DOI

10.1097/GME.0000000000002640 

Method of Research

Meta-analysis

Subject of Research

People

Article Title

The associations of early and surgical menopause with 10-year employment trajectories bracketing final menstruation or surgery

Article Publication Date

8-Oct-2025

 

Medicaid expansion linked to improved long-term survival in cancer patients

Certain cancer patients in U.S. states that expanded Medicaid experienced increased survival, especially in rural and high-poverty regions

American Association for Cancer Research

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Bottom Line: Adoption of Medicaid expansion in U.S. states appeared to improve both five-year cause-specific and overall survival in cancer patients.

Journal in Which the Study was Published: Cancer Discovery, a journal of the American Association for Cancer Research (AACR)

Author: Elizabeth Schafer, MPH, associate scientist at the American Cancer Society

Background: In 2014, a provision under the Patient Protection and Affordable Care Act (ACA) went into effect that allowed states to opt into expanding Medicaid eligibility to adults with incomes up to 138% of the federal poverty guidelines. Existing studies have linked Medicaid expansion to increased insurance coverage, access to cancer screening services, and improved two-year survival rates, but its impact on longer-term survival among individuals diagnosed with cancer remains unknown, according to Schafer.

How the Study was Conducted: To answer their question, Schafer and her coauthors used a difference-in-differences (DD) study design that compared data from states during 2007-2008—a period prior to Medicaid expansion—with data from 2014-2015, when many states adopted the expansion. This design allowed the research team to treat Medicaid expansion akin to an experimental intervention with effects that could be measured against a control group of states that had not enacted the expansion.

Using the Cancer in North America Survival dataset, Schafer and her coauthors analyzed data from 1,423,983 cancer cases diagnosed in adults aged 18 to 59 years and compared five-year survival from follow-up data obtained in the years following both the 2007-2008 cohort and the 2014-2015 cohort. The analysis assessed and compared 26 expansion states with 12 states that did not expand Medicaid at that time.

In the context of Schafer’s study, results presented as percentage points (ppt) in DD are the subtraction of the difference between expansion states and nonexpansion states in 2007-2008 from the difference between expansion and nonexpansion states in 2014-2015. DD of survival measurements shows whether Medicaid expansion correlates with the trajectory of survival rates relative to states where it was not adopted.

Results: After adjusting for covariates, the researchers observed that, among cancer patients living in rural areas, Medicaid expansion was associated with significant DD improvements in cause-specific and overall survival of 2.55 ppt and 3.03 ppt, respectively. Similarly, patients living in high-poverty areas in states with Medicaid expansion experienced significant DD improvements in cause-specific and overall survival: 1.54 ppt and 1.69 ppt, respectively.

Patients with cancers associated with higher mortality also experienced significant improvements in both cause-specific and overall survival if they lived in Medicaid expansion states.

Overall survival among non-Hispanic Black individuals was also significantly higher in Medicaid expansion states, with a DD of 1.05 ppt. Expansion was associated with significant increases in both cause-specific and overall survival in non-Hispanic Whites as well, with DDs of 0.37 ppt and 0.57 ppt, respectively. In expansion states, an adjusted cause-specific survival improvement was observed for all cancer patients irrespective of individual variables, but the improvement was not statistically significant.

Author’s Comments: “Studying the impact of Medicaid expansion on longer-term survival outcomes among individuals diagnosed with cancer is important for guiding evidence-based decision-making by policymakers and advocates for maintaining and expanding Medicaid,” Schafer said.

“The evidence supporting Medicaid expansion in improving outcomes for cancer patients is clear,” she added. “Research has shown that Medicaid expansion can increase cancer screening prevalence, early-stage diagnosis, short-term survival, and now—according to our own analysis—five-year survival. These findings underscore the importance of protecting and expanding Medicaid in the remaining 10 nonexpansion states to improve outcomes for all individuals.”

Study Limitations: Limitations of the study include the possible confounding factor of the ACA’s general broadening of health insurance coverage, as more people with health insurance and access to early cancer detection and treatment could skew the data. Additionally, the dataset also excluded individuals with missing cause-of-death and sociodemographic information.

Funding & Disclosures: The study was supported by the Intramural Research Department of the American Cancer Society. Schafer reported no conflicts of interest.

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Journal

Cancer Discovery

Article Title

10.1158/2159-8290.CD-25-1244

Article Publication Date

8-Oct-2025

COI Statement

The study was supported by the Intramural Research Department of the American Cancer Society. Schafer reported no conflicts of interest.

 

Birds thrive despite pollution from ‘forever’ chemicals

Oxford University Press USA

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A new paper in Environmental Toxicology and Chemistry, published by Oxford University Press, indicates high levels of exposure to “forever” chemicals in the environments of many tree swallow bird groups in the United States. Despite this, chemical exposure did not seem to affect the reproductive health of the birds.

Manufactured materials made of per- and polyfluoroalkyl substances, often referred to as “forever chemicals,” are a worldwide environmental contaminant. These chemicals come into ecosystems through manufacturing plant discharges or areas where workers use such chemicals to suppress fires. They can also come from wastewater treatment plants that emit reside from common consumer products, including stain-resistant fabrics, nonstick cookware and utensils, and food packaging.

These chemicals are extremely durable and resistant to environmental breakdown. Researchers have found forever chemicals in soil, water, plants, animals, and humans across all continents. While researchers have linked forever chemicals to serious health issues, including various cancers and reproductive problems, their ecological effects remain poorly understood. While numerous laboratory researchers have investigated chemical exposure levels in various animals, scientists are less clear on the impact of these chemicals on wild populations. Field studies, which could fill this gap, are rare because they require considerable time and financial resources.

Researchers here examined chemical levels in the tissues and diet of tree swallows, a migratory bird native to North America, at sites with differing contamination histories. They also assessed how exposure affected the birds’ reproductive success.

The researchers investigated tree swallow health at various miliary bases at sites including Willow Grove, Pennsylvania; Lakehurst, New Jersey; Camp Springs, Maryland; Chesapeake Beach, Maryland; Laurel, Maryland; Ashumet Pond, Massachusetts; Lake Elmo, Minnesota; Grey Cloud Island, Minnesota; Gibson City, Illinois; and Scanlon, Minnesota.

The researchers found much higher concentrations of forever chemicals at sites treated with firefighting foams, as well as those closer to urban areas. Researchers noted the high concentration of forever chemical perfluorohexane sulfonate at a site whose sources include residual from the manufacturing plant near Cottage Grove, Minnesota, and associated waste disposal sites, but also from other numerous other household and industrial sources originating in the Minneapolis/St. Paul metropolitan area.

The investigators found that despite differences in exposure levels to these chemicals, there was no statistically significant association between chemical exposure and reproductive outcomes such as whether birds hatched or grew to the point where they could take flight. The health of the bird chicks appeared unaffected by levels of chemical exposure.

The paper, “Tree Swallows as Indicators of Per- and Polyfluoroalkyl Substance (PFAS) Exposure and Effects at Selected Department of Defense Sites along the East Coast and at Sites with Other PFAS Sources in the Upper Midwest, USA,” is available (at midnight on October 8th) at https://doi.org/10.1093/etojnl/vgaf207.

Direct correspondence to: 
Christine M. Custer
US Geological Survey
Upper Midwest Environmental Sciences Center
La Crosse, WI
custerandcuster@accegroup.cc

To request a copy of the study, please contact:
Daniel Luzer 
daniel.luzer@oup.com

 

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Journal

Environmental Toxicology and Chemistry

DOI

10.1093/etojnl/vgaf207 

Method of Research

Observational study

Subject of Research

Animals

Article Title

Tree Swallows as Indicators of Per- and Polyfluoroalkyl Substance (PFAS) Exposure and Effects at Selected Department of Defense Sites along the East Coast and at Sites with Other PFAS Sources in the Upper Midwest, USA

Article Publication Date

8-Oct-2025

 

Deadwood brings wild orchids to life

Kobe University

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image: 

Close-up of Cremastra variabilis seedlings (white) entwined with fungal hyphae near decaying wood, illustrating how wood-decomposing fungi sustain seedling growth.

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Credit: INUI Kazuki

Deadwood-decomposing fungi feed germinating orchids, providing the carbon their tiny seeds don’t have. The Kobe University finding not only closes a gap in our understanding of wild orchid ecology but also uncovers an important carbon flux in the ecosystem.

Orchid seeds are as small as dust and do not provide any nutrients for the young plant to grow. The adult plants are known to rely on a certain type of fungi that develop structures within the plant’s roots, but whether these same fungi also help with germination has not been established. “Studying orchid germination in nature is notoriously difficult. In particular, the painstaking methods required for recovering their seedlings from soil explain why most earlier studies focused only on adult roots, where fungi are easier to sample,” explains Kobe University plant evolutionary ecologist SUETSUGU Kenji.

During fieldwork, Suetsugu’s team noticed a strange pattern. He says: “We repeatedly found seedlings and adults with juvenile root structures near decaying logs, not scattered randomly in the forest. That recurring pattern inspired us to test whether deadwood fungi fuel orchid beginnings.” These juvenile root structures are coral-shaped rhizomes and have been interpreted as a seedling’s organ retained into adulthood — and they are often associated with wood-decaying fungi rather than with those found in adult orchids without these structures. Being experts in orchid ecology and evolution, Suetsugu’s team took on the challenge to find out who feeds the young orchids.

In the journal Functional Ecology, the Kobe University team report that amongst seeds of four model orchid species they buried in various forest locations, they observed germination only near decaying logs, and that the seedlings virtually exclusively associated with wood-decaying fungi. “We were struck by how exclusive and consistent these fungal partnerships were. There is an almost perfect match in the fungi that seedlings of a given orchid species associate with and the fungi on adult plants with coral-shaped rhizomes of the same species. We think that the plants without coral-shaped rhizomes shift to other fungi as their nutritional needs change during growth and the carbon source offered by rotting logs dries out,” says Suetsugu.

Among the relatives of the orchids the Kobe University team studied, there are many species that have independently evolved full mycoheterotrophy, that is, they have abandoned photosynthesis and instead feed on fungi throughout their lives. “The propensity of these orchids to maintain their association with wood-decaying fungi into adult life probably facilitated their evolution of full mycoheterotrophy,” Suetsugu says.

In the paper, the team writes, “As woody debris represents a major carbon source in forests, associations with wood-decaying fungi may enhance carbon acquisition, especially in warm, humid habitats.” Suetsugu adds: “For conservation, our results mean that protecting orchids in the wild is inseparable from protecting deadwood and its fungi. For ecological sciences, they reveal a hidden carbon route from deadwood to green plants, explaining how seedlings can establish themselves on dark forest floors. And they show that deadwood is not dead — it is a cradle of new life.”

This research was funded by the Japan Science and Technology Agency (grants JPMJPR21D6, JPMJFR2339), the Japan Society for the Promotion of Science (grant JP25H00944) and the Research Institute for Humanity and Nature.

Kobe University is a national university with roots dating back to the Kobe Higher Commercial School founded in 1902. It is now one of Japan’s leading comprehensive research universities with nearly 16,000 students and nearly 1,700 faculty in 11 faculties and schools and 15 graduate schools. Combining the social and natural sciences to cultivate leaders with an interdisciplinary perspective, Kobe University creates knowledge and fosters innovation to address society’s challenges.

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Journal

Functional Ecology

DOI

10.1111/1365-2435.70181 

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

The nexus of decay and birth: Ecological and evolutionary significance of wood-decaying fungi in green Calypsoinae orchid germination