Members of Flo’s partnerships, medical affairs, and science teams attended the ACOG Annual Clinical & Scientific Meeting (ACSM) in Washington, D.C., from May 1–3, 2026. Marking ACOG’s 75th anniversary, this year’s event drew thousands of clinicians, researchers, and industry leaders to discuss the latest developments in obstetrics and gynecology.
At our booth, we engaged in hundreds of conversations with clinicians.
This year, many of our conversations focused on perimenopause — exploring how digital health tools can support symptom pattern awareness, patient education, and self-management of symptoms across the transition.
Misinformation around perimenopause emerged as a recurring theme, both at the booth and across the conference more broadly. Clinicians described patients arriving with confusion shaped by social media and unvetted online sources and were keen to discuss what evidence-based resources exist to address this.
Because many were looking specifically for tools they could direct patients to with confidence, our most engaging conversations were about the clinical and scientific evidence underpinning digital health options.
The meeting’s keynote was a moderated conversation with former First Lady Michelle Obama, who spoke with honesty and purpose about health, legacy, and the importance of normalizing conversations that have long been kept quiet.
She spoke candidly about generational silence around female health, recounting that when she asked her mother about menopause, the response was simply: “I don’t remember having that — don’t worry about it.”
It was a striking illustration of how much has gone unspoken and how much work remains.
Her message to clinicians and patients alike was direct: Take charge of your own health, model healthy behavior, and talk about these things openly. She called for greater focus on nutrition, access to primary care, and open conversations with daughters about what to check and when. On the broader landscape, she was equally plainspoken, explaining that rising above misinformation requires offering accessible, credible alternatives.
A well-attended didactic session reviewed ACOG’s latest guidance updates across three clinically significant areas.
On postmenopausal bleeding evaluation, the session made a clear case for moving away from the traditional approach of deferring biopsy when endometrial thickness is 4 mm or less. The data underpinning that threshold are largely pre-2000 and non-US. Since then, endometrial cancer incidence has risen from 23.5 to 28.8 per 100,000 women per year (2000–2022), and the 4 mm cutoff’s sensitivity is now estimated at only 88% to 95%, meaning up to 12% of cancers could be missed if biopsy is omitted. The updated recommendation is to perform both transvaginal ultrasound and endometrial tissue sampling in the initial evaluation of most patients. Speakers also highlighted that non-Hispanic Black women have more than twice the mortality of non-Hispanic white women and that high-grade cancers can present with a thin endometrium, making ultrasound alone insufficient in higher-risk populations.
On cervical cancer screening, primary high-risk HPV (hrHPV) testing for people aged 30 to 65 is now the preferred approach. HPV-based screening detects more than 90% of CIN3+ lesions, compared with 50% to 70% for cytology alone. The session addressed patient self-collection, explaining that FDA-approved, clinician-ordered self-collection kits are an acceptable option specifically to reach those who would otherwise go unscreened, but not as a blanket replacement for clinician-collected testing. Appropriate ordering, counseling, and follow-up infrastructure remain essential. The audience raised concern about missing non-HPV-mediated cervical cancers. In response, speakers noted that more than 99.9% of cervical cancers are HPV-mediated, and those that are not tend to be slow-growing.
On screening for fetal chromosomal abnormalities, the session confirmed that cell-free DNA (cfDNA) is now the recommended standard for common aneuploidies (trisomies 21, 18, and 13) across all patient populations. The ACOG Practice Bulletin has been withdrawn, and Society for Maternal-Fetal Medicine Consult Series #74 now serves as the primary reference. Speakers emphasized that pretest counseling is essential and that, with only one genetic counselor available per approximately 9,000 patients, OB-GYNs need to be well versed in explaining this. The positive predictive value of cfDNA is heavily age-dependent and often lower than patients expect. For trisomy 21 at age 20, it is just 48%, rising to 93% at age 40.
A three-part session on adolescent gynecology covered menstrual and structural disorders in younger patients — a population whose presentations frequently differ from adults in clinically important ways.
Dr. Kate McCracken, clinical associate professor at the University of Michigan, addressed abnormal uterine bleeding, highlighting bleeding disorders, such as von Willebrand disease, as an underrecognized driver of heavy menstrual bleeding, and emphasizing iron deficiency screening regardless of cause.
Dr. Nichole Tyson, chief of pediatric and adolescent gynecology at Stanford University, spoke about endometriosis, where diagnostic delays averaging 6–10 years are common in this population. Younger age does not mean milder disease, she said. Imaging is frequently normal in early peritoneal endometriosis; thus, a negative scan should not close the diagnostic pathway. GnRH agonists should only be used postoperatively as second-line therapy in adolescents, given the impact on bone density during a critical window of skeletal development.
Dr. Krista Childress, associate professor at Cincinnati Children’s Hospital, closed with obstructive Mullerian anomalies. Her central message was to fully evaluate before you intervene. A renal anomaly on imaging should always prompt evaluation for a uterine anomaly.
Dr. Jill Liss, MSCP, associate clinical professor of obstetrics and gynecology at the University of Colorado Anschutz, opened with a reframe of vasomotor symptoms (VMS) that sets the clinical stakes clearly. VMS affect the majority of people during the menopausal transition, with a mean duration of 7.4 years. Approximately 30% of women report symptoms beyond 10 years, and 10% continue to experience them beyond age 70. VMS are not merely uncomfortable, as there is growing evidence linking untreated VMS to adverse cardiovascular, cognitive, and bone health outcomes.
The pathophysiology, she explained, is driven by declining estrogen leading to unopposed neurokinin B signaling in the hypothalamus, which dysregulates the thermoregulatory center — a mechanism that now underpins several targeted nonhormonal treatments.
On treatment, Dr. Liss’s position was clear: Menopausal hormone therapy (MHT) remains first-line pharmacotherapy for moderate to severe VMS and is FDA-approved for this indication. The risks associated with combined estrogen-progestogen therapy are rare in absolute terms — fewer than 10 per 10,000 women per year — and the benefits are substantial. Crucially, there is no mandatory stopping point. Continuing MHT beyond age 65 is reasonable with shared decision-making for patients with persistent symptoms. Compounded bioidentical hormone preparations should be avoided, and FDA-approved bioidentical options exist across a full range of formulations and delivery routes.
For patients who cannot or prefer not to use hormones, the 2023 from The Menopause Society (formerly the North American Menopause Society) nonhormone position statement provides a clear evidence hierarchy. Cognitive behavioral therapy, clinical hypnosis, SSRIs/SNRIs, gabapentin, and the NK3 receptor antagonists fezolinetant and elinzanetant all carry Level I evidence. Weight loss and stellate ganglion block have Level II–III support. Supplements, herbal remedies, and many lifestyle interventions — including yoga, mindfulness, and paced respiration — are not recommended due to limited or inconsistent evidence.
Dr. Liss closed with a practical lifestyle framework: resistance training, adequate protein and fiber intake, sleep prioritization, and a strong support network as foundations for midlife health regardless of treatment choice.
Dr. Rajita Patil, assistant clinical professor in obstetrics and gynecology at UCLA Health, opened her lecture with a reframe that set the tone for everything that followed: Menopause is not simply a reproductive transition — it is a neuroendocrine one. She presented data on a range of symptoms, including mood, sleep, and cognition.
Individuals are twice as likely to experience depression during the menopausal transition with perimenopause — not postmenopause — representing the highest-risk window for new-onset depression. The drivers are hormonal fluctuations, particularly in estradiol levels, as well as anovulatory progesterone deficiency. Data from the Study of Women’s Health Across the Nation, known as SWAN, showed a 22% increased risk for anxiety symptoms and an odds ratio of 1.3 for frequent irritability during perimenopause. The clinical implication, as Dr. Patil put it, is that missing perimenopause means missing the intervention window.
On sleep, she described the multiple hypothalamic pathways disrupted during the transition. Rising follicle-stimulating hormone independently disrupts sleep maintenance, reduced progesterone reduces sleep efficacy, and reduced estrogen makes it harder both to fall and stay asleep. Cognitive behavioral therapy for insomnia (CBT-i) was presented as first-line treatment. NK3 antagonists improve VMS-driven sleep symptoms, and MHT may also help when sleep disruption is driven by VMS. Obstructive sleep apnea was highlighted as an important differential that is frequently missed around this time.
Regarding cognition, Dr. Patil’s message was carefully balanced. Brain fog is real, but mostly transient. About 60% of perimenopausal women report subjective cognitive complaints, with most returning to baseline by two years postmenopause. The distinction to make in clinic is between the word-finding difficulties and slowed processing speed typical of perimenopause and episodic memory loss or disorientation, which should prompt further evaluation. MHT is not recommended for treating or preventing cognitive symptoms, except in premature ovarian insufficiency or surgical menopause until the age of natural menopause.
Dr. Pelin Batur, professor of obstetrics and gynecology and reproductive biology at Cleveland Clinic, opened with a striking figure: Around 90% of people experience responsive rather than spontaneous desire, meaning arousal follows stimulation rather than preceding it. This reframes a significant proportion of what patients present as dysfunction as normal variation, which is particularly relevant for those whose desire patterns have shifted during the menopausal transition.
She described the cognitive and emotional burden of midlife as a direct suppressor of desire and argued that addressing stress is part of sexual health treatment, not separate from it. On testosterone for hypoactive sexual desire disorder, her guidance was to use hormone levels to monitor treatment rather than to diagnose, expect mild side effects such as acne and hair growth, and avoid compounded topical testosterone on the vulva. Vaginal DHEA is a useful alternative given its androgenic properties. She also noted that medications licensed only for premenopausal individuals are not necessarily unsafe for those who are menopausal; the studies were simply never done in that population, a useful framing for off-label conversations with patients.
Throughout, the talk pushed against shame and assumptions, normalizing the use of sexual devices, reframing desire patterns, and acknowledging research gaps honestly.
Flo medical experts board member Dr. Sameena Rahman, clinical assistant professor of obstetrics and gynecology at Northwestern Feinberg School of Medicine, and Dr. Kudzai Dombo, board-certified OB-GYN and director of advocacy and outreach at Alloy Health, asked clinicians to examine their own assumptions.
The SWAN study findings framed the scale of the problem. Black women experience menopause on average 1.2 years earlier than white women, have more severe and longer-lasting vasomotor symptoms (up to 10.1 years compared with 6.5), and are less likely to receive MHT or cardiometabolic treatment despite higher risk. Black women also experience premature menopause at three times the rate of white women (15.5% versus 4.8%).
These disparities are driven primarily by socioeconomic factors and structural racism, not biology. Southeast Asian women face a different but overlapping set of challenges, including earlier average menopause, more musculoskeletal and vulvovaginal symptoms, higher cardiovascular risk, and cultural taboos that can delay help-seeking.
Data presented on medical gaslighting in vulvovaginal patients were particularly sobering. In a study of 447 patients, more than half had considered stopping care, and 39.4% reported being made to feel their symptoms were imagined. The speakers also highlighted adverse pregnancy outcomes — preeclampsia, gestational hypertension, preterm birth, and gestational diabetes — as underused markers of future cardiovascular risk, and called for routine incorporation of obstetric history into midlife cardiovascular risk assessment.
An informal session in the ACOG central area tackled a challenge that is increasingly shaping what clinicians encounter in the consultation room: patients arriving with health information or misinformation shaped by social media algorithms and AI tools.
Speakers noted that 1 in 6 adults now regularly consult AI chatbots for health information. In the menopause space specifically, harmful content is proliferating with AI deepfake “doctors” promoting unproven cures, posts claiming menopause does not exist, and TikTok videos pushing unvetted supplements. The core problem is structural. Algorithms reward attention, not accuracy, and the supplement industry remains largely unregulated by the FDA.
The session offered a practical framework for managing patients who arrive with misinformation. Acknowledge the instinct to research and the mistrust of medical professionals that often underlies it, validate what is accurate, gently correct what is not, and offer structured, trusted alternatives rather than telling patients to stop looking.
Clinicians were also reminded to explain the limitations of social media and AI rather than simply dismissing them.
It is a challenge that is close to our hearts at Flo. Providing clinicians with evidence-based tools they can confidently recommend to patients is central to what we do — and conversations like this one remind us why that work matters.