US Secretary of State Antony Blinken will travel to Beijing this weekend, the State Department announced on Wednesday -- a significant trip that comes as the Biden administration navigates its complicated relationship with China.

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The Republican-controlled North Carolina General Assembly made several last-minute changes to the 12-week abortion ban it passed earlier this year in an effort to stave off a legal challenge. The state’s abortion ban, which is set to take effect on 1 July, is being challenged in court. That lawsuit, attorneys said, was the main factor behind the Republican majority’s decision to introduce an amendment to an unrelated Department of Health and Human Services (DHHS) bill that effectively amends the abortion ban. ”The General Assembly is working to pass and enact, with or without the Governor’s signature, a technical and conforming bill to make changes to clarify and address most, if not all, aspects of Plaintiffs’ claims about the Act,” W Ellis Boyle, an attorney for House Speaker Tim Moore and Senate Leader Phil Berger, wrote in a legal filing on Tuesday. The amendment to the DHHS bill, House Bill 190, directly addresses a number of the concerns outlined in the lawsuit filed by Planned Parenthood of the South Atlantic and a number of other organisations. For instance, the lawsuit argues that a provision of the abortion ban stating that it is illegal “after the twelfth week of a woman’s pregnancy to advise, procure, or cause a miscarriage or abortion” violates the Constitution by preventing people from legally providing information about how a person could get legal abortion care in another state. In response, the amendment to HB 190 removes the word “advise” from the text of the abortion ban. The amendment also seeks to clean up a section on the regulation of medication abortion — which is banned after 10 weeks, not 12 — by deleting language that physicians prescribing medication abortions would have to verify that a pregnancy is no more than “70 days” old. Backers of the lawsuit, who are seeking a Temporary Restraining Order to prevent the abortion ban from taking effect on 1 July, do not believe that the changes to the ban proposed amendment to HB 190 go so far as to eliminate the need for the restraining order. “If those amendments are passed, they may remedy some of the constitutional violations that Plaintiffs allege,” North Carolina attorney general Josh Stein, nominally the defendant in the suit, wrote in a court filing reported by CNN. “But unless and until the current law is repealed or significantly amended, immediate injunctive relief is necessary to avoid a due-process violation.” Mr Stein, a Democrat, has said he does not intend to defend parts of the abortion ban his office believes are unconstitutional. Mr Stein wrote that even if the amendments pass, they would still “fail to make clear that doctors in North Carolina can help their patients obtain abortions out of state.” It is not yet clear whether Gov Roy Cooper, also a Democrat, intends to sign HB 190 or not. Mr Cooper vetoed the abortion ban, but saw his veto overriden by Republican supermajorities in the legislature. The fact that North Carolina is in the position of dealing with a 12-week abortion ban at all is a surprise: when the legislative session started, the Republicans did not have the votes needed to override a veto of an abotion bill. That changed, however, when Rep Tricia Cotham — a Democrat representing a heavily Democratic seat in the Charlotte area — suddenly switched her party affiliation and gave the Republicans the final vote needed to override Mr Cooper’s veto. Read More North Carolina Republicans censure Sen Thom Tillis for backing LGBT+ rights One year after Roe v Wade fell, anti-abortion laws threaten millions. The battle for access is far from over

Passengers on an Austrian train running from Bregenz to Vienna were shocked when they heard a recording of an Adolf Hitler speech play over the train's loudspeaker system on Sunday.

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Hot flushes and night sweats are commonly associated with the menopause – but the vast majority of menopausal women also suffer from mood and emotional problems, such as stress and anxiety. Research recently carried out by GP and menopause specialist Dr Louise Newson, founder of Balance Menopause, found 95% of nearly 6,000 perimenopausal and menopausal women had experienced a negative change in their mood and emotions during the menopause, with stress and anxiety being the most common psychological symptoms. Speaking to mark Mental Health Awareness Week (May 15-21), Newson says: “Because we often frame the menopause in terms of physical symptoms, such as hot flushes and night sweats, psychological symptoms, such as anxiety and depression, can go under the radar. “Every year I see hundreds of women struggling with menopause, and thousands more reach out on social media, looking for advice on symptoms that can impact relationships, social lives, confidence and careers.” Here, Newson, and other menopause and anxiety experts, discuss the link between the menopause and anxiety, and how to deal with it… What causes anxiety during the menopause? Low mood and anxiety can be common features of the perimenopause and menopause due to fluctuating and falling hormones, says Newson. “When oestrogen falls, levels of the mood-boosting hormone serotonin fall, too, while cortisol (the primary stress hormone) rises,” she explains. “In addition, the knock-on effects of physical symptoms, such as fatigue, hot flushes and aches and pains, can affect mood and self-esteem.” How common is menopausal anxiety? Newson’s research shows most women (95%) have some sort of mood dip during the menopausal period. Indeed, Dave Smithson, operations director at Anxiety UK, suggests anxiety is one of the key symptoms, if not the main symptom, affecting women during the perimenopause and menopause. “Often anxiety fails to receive the attention it warrants as a symptom of the menopause among the medical profession and indeed the public, which is concerning given the profound impact it can have,” he stresses. Who is likely to suffer from anxiety during the menopause?Sexual and reproductive health consultant Dr Paula Briggs, chair of the British Menopause Society, says the menopausal period has been described as a ‘window of vulnerability’, explaining: “Some women experience anxiety and low mood or depression in addition to other better-recognised menopausal symptoms. Sometimes these symptoms occur in isolation and the link with menopause may be less clear. “Mood-related changes are more likely in women who’ve had previous mental health problems, and in women experiencing surgical menopause [removal of the ovaries and or womb].” Can you get menopausal anxiety when you’ve never been anxious before? Anxiety caused by the menopause can strike women who’ve never had an anxiety problem before, Smithson points out. “Many women report new-onset anxiety, having never previously experienced anxiety at a level that it could be termed an anxiety disorder,” he says. “Others report a worsening of their pre-existing anxiety condition, as a result of the menopause.” “For women who’ve lived with anxiety for many years, when the menopause hits, they may report finding their anxiety has taken on a whole new identity, becoming more severe, intense, frequent or disabling, and consequently very challenging to manage.” What are menopausal anxiety symptoms? Although there are different types of anxiety, the symptoms tend to be the same irrespective of the underlying cause, explains Briggs. She says they can include feeling tense and nervous, being unable to relax, having difficulty concentrating, feelings of panic and dread, being unable to cope with normal daily activities, being overwhelmed, self-consciousness, and feelings of weakness and fatigue. Physical signs of anxiety include sweating, trembling, rapid heart rate and hyperventilation. “Where there’s no history of mental health problems and the symptoms and signs coincide with the menopause, they are more likely to be related to hormonal variability,” she says. “If there’s a background of anxiety and depression, then the symptoms and signs might be exacerbated by the menopause.” How is menopausal anxiety treated? Smithson says there’s still a taboo around the subject of anxiety, although he admits “great strides” towards breaking it have been made recently. “That said, access to support and treatment remain patchy, with many women left to cope alone and battle on through what can be one of the trickiest phases of their life. “Anxiety is both treatable and manageable and we would urge any women experiencing new-onset anxiety or worsening of pre-existing anxiety to seek support.” Briggs and Newson say HRT, if appropriate, is often the first treatment for menopausal anxiety, although Newson stresses: “HRT is the first-line treatment for all menopause symptoms, including mood-related symptoms. But the first piece of advice I give to any woman struggling with her mental health is to see a healthcare professional to discuss treatment options.” She suggests recording symptoms on the free balance menopause support app symptom tracker. Briggs says if necessary, antidepressant medication can improve outcomes, and talking therapies, such as CBT (cognitive behavioural therapy), are also important to help manage anxiety and depression, irrespective of the underlying trigger. “Some women, particularly those who respond partially to HRT, may need to consider adding an antidepressant, specifically one recognised to help with anxiety,” she says. However, Newson warns: “Often women are incorrectly prescribed antidepressants for menopause-related low mood and anxiety, but these mood changes are very different to clinical depression.” Can lifestyle changes help? The experts stress healthy lifestyles can really help improve anxiety symptoms, and Newson advises: “Beyond HRT, it’s so important to optimise your exercise and nutrition. A balanced diet with lots of fresh fruit and vegetables can help regulate your mood, and watch your alcohol and caffeine intake, as both can increase anxiety. “Regular exercise will lift your mood, and help you sleep, as anxiety can be a real barrier to a good night’s sleep.” She says studies suggest mindfulness can help with symptoms of anxiety and depression in menopausal women, and stresses: “Find time to focus on yourself and find some coping mechanisms you can turn to when you need them. If talking to a good friend helps with anxiety, give them a call. I find writing lots of lists helps me feel in control and calmer.” And Briggs adds: “Many women have unrealistic expectations about HRT, and it’s important to stress that lifestyle management is also an important aspect of managing the menopause, along with considering things such as cognitive behavioural therapy, hypnotherapy and mindfulness.” Read More Charity boss speaks out over ‘traumatic’ encounter with royal aide Ukraine war’s heaviest fight rages in east - follow live How to encourage green-fingered kids Cost of sunscreen could be increasing risk of skin cancer, charity suggests Ukraine Eurovision winners Kalush Orchestra invite Princess Kate to join them on tour

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In the fallout from last year’s overturning of Roe v Wade, the legislation that secured abortion rights in the US, a great many young American men simultaneously did a quite radical thing. They took to social media to intimately document themselves getting a vasectomy, to prove it was a simple and painless act. One was vegan bodybuilder and influencer Brian Turner, who was certain from around the age of 22 that he’d never want children. He acted on his stance, aged 30, and made some genuinely great content in the process. “The reaction was positive,” he tells me. “A few people commented in disbelief, calling me crazy names or saying, ‘You’re no longer a man – you chopped your balls off.’ But they don’t bother me. I have a thick skin.” It started a global discussion on vasectomies, chiefly around how men can step up and take the burden of contraception away from their female partners forever. Adam, a 35-year-old father of two from Brighton, had the same desire around the same time: “I had a growing guilt about never really fully taking responsibility for contraception. Apart from condoms, all the solutions are for women, and they all seem to have pretty gnarly side effects. It seemed like the decent thing to do, to try to take on the responsibility.” But what of younger British men, who absolutely, definitely don’t want children, who know they want to be what I call “none and done”? For them, although the hurdles are curiously higher and their reasoning more diverse, the same desire to make an informed decision about their body exists. Britain has never had a big national conversation about the vasectomy, the way America – a place where some states even offered them for free in the wake of the Supreme Court’s historic verdict – clearly has in recent years. “The vasectomy was thought to be illegal here until around the Sixties, and only came on the NHS in the early Seventies,” explains Dr Georgia Grainger, a historian of vasectomy. Before this, the concept of men choosing to sterilise themselves was – in her words – “murky”, owing to many of the key doctors and campaigners evangelising the process also being supporters of eugenics. It was actually the beloved broadcaster Michael Parkinson who, in Grainger’s eyes, did the most to burst bubbles on the subject. “He was open about having a vasectomy back in 1972 when it was still very uncommon. He did an interview about it that was on the front page of the first issue of Cosmopolitan magazine. It definitely brought awareness and also dispelled some myths – that it would affect a man’s masculinity or even cause things like a higher-pitched voice”. While the procedure has undoubtedly become more common, I’m not sure that we as a society know a huge amount more about it than in the Seventies. The good news for men is that the procedure is more successful than ever. Doctors reported in March this year that, after surveying 94,000 patients, only 0.2 per cent of men get what’s known as “chronic scrotal pain”. It is generally seen as being more than 99 per cent effective as a form of birth control. The bad news is that there’s still a lot of misinformation around it – from daft macho ideas that it decreases your testosterone levels or sex drive (it doesn’t) to the more assimilated notion you hear a lot: that, similar to an intrauterine device (IUD) with women, it’s easy to undo (it isn’t sadly, not all reversals work, they get less successful over time plus they’re significantly more expensive too). In reality, a vasectomy is quick, carried out under local anaesthetic and takes around 15 minutes. Today, most are what’s known as “scalpel-free”, meaning the incision is so tiny (only 2-4mm) that it doesn’t require stitches. The two tubes that carry sperm from your testicles are severed (hence the colloquial term “the snip”) and closed. Post-surgery, men are encouraged to rest for a couple of days, to apply ice packs to their scrotum and – if possible – wear a jock strap that’s slightly too small to ease any swelling. And that’s it. “The most common question I get asked is, “Do you still cum?’”, says Gregory, who had a vasectomy in January. “It’s funny how so many people think you’ll never ejaculate again after a vasectomy. The truth is: the difference isn’t noticeable.” In fact, sperm is still produced, but it’s discharged internally and absorbed by the membrane around the epididymis (the coiled tube behind each testicle) in a totally natural process. The body still produces semen, which is ejaculated but it no longer contains sperm – although it’s said that a man needs to ejaculate on his own a good number of times before the presence of sperm totally vanishes. “I did hear rumours about ‘40 w***s’,” confirms Gregory, “but I just stuck with the doctor’s deadlines and the sperm test came back clear four months later.” Yet, while the procedure has some fringe areas of conjecture, one important aspect is dramatically less well known: men – especially young men – won’t automatically be granted a vasectomy if they choose to have one. There’s huge variation in the UK, based on regional NHS procedures and resources, plus, “a lot depends on the individual doctor, unfortunately” according to Grainger. Some areas don’t offer them, meaning having to go private and pay an often prohibitively expensive £600. But even simply having the autonomy to choose is also a grey area. “A lot of younger men, especially if they’re unmarried or don’t have children, really have to push to get a doctor to take them seriously,” says Grainger. “We often think of that kind of pushback as being something women get within their reproductive healthcare, but I’ve heard a lot of men share their experiences of having to go to multiple doctors to find one to agree to refer them for a vasectomy, just because they ‘might change their mind’.” This seems like quite a significant flashpoint, given that all the urologists we spoke to confirmed a definite movement of younger people wanting the snip. “Traditionally, the typical age of a man seeking a vasectomy would be 35-40 years old,” states Dr Peter Quinn who performs the procedure for Vasectomy NI. “However we are finding more and more younger men in their twenties are looking for a permanent method of contraception.” Luckily, I didn’t encounter a single man who had any regrets or who had “changed their mind”. What I found instead were more men making an informed choice around their own reproductive health, from a variety of backgrounds, viewpoints and life situations. Some for example, like Simon, are single and dating. He had his tubes snipped aged 28, while in a long-term relationship that subsequently ended. Does he have any regrets? “Absolutely not – I really want to make that clear.” Despite being from a big family with plenty of cousins whom he loves, he’s felt like he’s known he never wanted children himself “from as far back as my teens”. Now aged 30, he’s starting to date again. He doesn’t declare his snipped status on the dating app he uses, but does bring it up quickly, in case there’s any awkward confusion. “Not wanting to have kids is a pretty big part of who I am, I feel like I talk about it all the time anyway without needing to advertise it.” Ray, who is also young, single and snipped feels “it’s a flex” when it comes to being on the dating scene. Aside from being a talking point and a sign of emotional maturity, crucially it “finalises that aspect of ‘maybe he’ll change his mind’. which I have experienced in relationships in the past. I’ve been very clear I don’t want children previously, but nobody fully believes that when you tell them. They might put it to one side and say ‘let’s think about that later’.” Ray also has no regrets. Dr Nick Demediuk has performed more than 50,000 vasectomies in his career. The name of his clinic in Australia says it all: Dr Snip. His perspective over 34 years of performing a life-changing operation is thus pretty unique and his recommendation is unequivocal: “It’s the simplest and easiest form of permanent contraception that responsible men can use to contribute to their relationships and the planet.” For him, one of the key reasons behind the growth in younger men taking up vasectomies has been “issues related to climate change”, with a significant subgroup of “hard-line vegans”. There’s not enough resources for people alive on earth today – it feels almost a bit selfish for us to contribute to that scenario Nat and Charlie* This chimes with Nat and Charlie*, a male/female couple who moved from a big city to the English countryside this year, in part motivated by a desire to give their beloved trio of cats more space. Having been on the fringes of eco-activism since university, their decision – raised initially by Nat and enthusiastically supported by Charlie – to have the procedure when Nat was 29 was very much informed by the climate emergency. “We both feel like we’re loving people and capable of lots of love,” says Charlie “but we both felt inside of ourselves that we never wanted to have children, especially in the world as it is today.” Citing the extreme weather events all over Europe this summer as just one example, they fundamentally worry about the world being safe enough to bring kids into, as well as the feeling that “there are not enough resources for people alive on earth today – it feels almost a bit selfish for us to contribute to that scenario.” They stop short of endorsing the emerging philosophy of anti-natalism, a controversial belief first advanced by South African philosopher David Benatar that sees all human reproduction as immoral, in part due to the climate emergency but also because life is inevitably tinged with suffering and pain. But, in choosing not to have children out of concern for the environment, they find themselves at one end of an extreme and widening political spectrum. The same week I speak to them, Hungary’s leader Viktor Orban was holding the fourth of his biannual Demographic Summits, which – with Italy’s leader Georgia Meloni, religious leaders and right-wing thinkers in tow – aimed to solve what’s seen as a crisis in underpopulation in Europe. Encouraging more babies via defence of traditional family values feels a world away from the outlooks of Nat, Charlie and the many others taking up the vasectomy as a way of definitely not having kids on principle. As if we didn’t have enough 50-50 splits in society today, an increasing number of people believe we need fewer children while an equal number believe we need more. Britain in 2023 therefore seems conflicted between two worlds – the privatised freedom of America where a young, non-parent like Brian Turner is waved through (“I talked to my GP and she said, ‘All good’ and referred me straight away”) and a more prohibitive or simply untrusting mindset that looks at a young man and says, “Hmm, go away and think about it a while.” Perhaps if we want young men in society to play a more positive, active role, maybe they need to be trusted with their own bodily autonomy first? *Names have been changed Read More No music, no ball games, no fun: society is wiping out play ‘I was really struggling to get it up’: Why younger men are turning to Viagra I couldn’t climax, so I let ‘big testosterone’ take me for a ride Woman prepares hamper basket as her husband’s vasectomy gift Why taking a mental health day could be bad… for your mental health What the world’s happiest children tell us about where Britain is going wrong

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