Original research publications

To evaluate reproductive outcomes after hysteroscopic myoma resection and septal surgery in women with primary or secondary infertility. This monocentric retrospective cohort study included women with infertility who underwent hysteroscopic myoma resection or septal surgery between 2014 and 2021. Patients with uterine septa were divided into three groups, depending on the extent of the septa (mild, moderate and sub-/total). All procedures were performed by a single experienced surgeon. Pregnancy rates and live birth rates before and after surgery were compared. Of 85 women who underwent hysteroscopic surgery, 65 were available for follow-up. After surgery, 55.4% achieved pregnancy and 44.6% had a live birth ( p = .001). Live birth rates increased after both septal surgery (14.7 vs. 50%; p = .002; n = 34) and myoma resection (16.1 vs. 38.7%; p = .092; n = 31). In women with uterine septa, live birth rates improved significantly after surgery, independent of septum extent (mild: 16.67% vs. 50%; moderate: 13.64% vs. 50%; sub-/total: 16.67% vs. 50%). Postoperative reproductive treatment increased pregnancy rates (44.44% vs. 63.16%) but did not affect live birth rates (44.44% vs. 44.74%). Hysteroscopic treatment of uterine septa and submucosal fibroids was associated with improved live birth outcomes in women with infertility. These findings suggest that, in suitable cases of infertility, hysteroscopic surgery should be considered. Fibroids are harmless growths in the muscle tissue of the womb. These problems can happen to any woman between puberty and the menopause. Uterine septa are abnormalities that are present from birth and can make the space within the uterine cavity smaller. In very severe cases, the uterus is divided into two separate parts. Some patients, such as those with a congenital septum in the uterus or fibroids (myomas), may have difficulty conceiving. This study looked at patients with septa or myomas who went to fertility consultations. The septa and myomas were treated using a hysteroscopy. We looked at how the operation affected family planning in 65 patients. After the operation, slightly more than half of all patients became pregnant (55.4%). In 44.6% of cases, the pregnancy resulted in a baby being born alive. The operation increased the chances of patients with fibroids getting pregnant and having a baby. The treatment for a septum in the womb did not greatly improve the chances of getting pregnant. But this operation greatly reduced the number of miscarriages, meaning that many more patients had a baby. The length of the septum did not affect the improvements. The chances of a successful pregnancy after hysteroscopy were about the same for patients who had fertility treatment as for those who became pregnant without more treatment. This article presents the results of treatment for our fertility patients, as well as findings from other scientific studies.

Genitourinary syndrome of menopause (GSM) is a condition resulting from hypoestrogenism, characterized by symptoms such as vaginal dryness, irritation, urinary urgency, and sexual dysfunction. While conventional treatments include local estrogen therapy and non-hormonal alternatives, evidence suggests a therapeutic role for vitamin D. This study assessed the efficacy of vaginal vitamin D supplementation in alleviating GSM symptoms and evaluated clinical factors. Two cohorts were analyzed: 110 postmenopausal women with GSM symptoms and 39 participants aged 35-85 for age-related analysis. Data were analyzed using SPSS Version 26. Findings revealed associations between age and pelvic exam outcomes, with older women more likely to exhibit atrophic cervix, while younger participants presented with cervicitis. Delivery mode was also significantly correlated with pelvic exam findings ( p = 0.040). Notably, all patients receiving vitamin D (10/10) achieved symptom remission at 3 months versus 34% (10/29) in controls ( p = 0.00044), though limited by the small n and observational design of the study. Extended treatment showed 96.7% remission in vitamin D vs. 62.9% controls (aRR = 1.26, 95% CI 1.05-1.50, p = 0.024. Vitamin D + probiotics yielded 100% remission. These support vitamin D as effective non-hormonal GSM therapy, pending larger RCTs. After menopause, many women experience uncomfortable changes such as vaginal dryness, burning, discomfort during sex, and needing to urinate more often. These changes happen because the body produces less estrogen. Although hormone treatments can help, some women cannot use them or prefer not to.This study looked at whether vitamin D used inside the vagina could help relieve these symptoms. Women who used vaginal vitamin D reported clear improvement in their symptoms within a few months. Older women tended to have more vaginal changes related to menopause. Using vitamin D together with probiotics also appeared helpful for some women, although this was tested in a small number of participants.Overall, these findings suggest that vaginal vitamin D may be a helpful, non-hormonal option for women seeking relief from menopause-related vaginal symptoms, especially for those who cannot or do not wish to use hormone-based treatments.

Jiao-Ai Decoction (JAD), a classic Traditional Chinese Medicine (TCM) formula, has been applied traditionally for treating gynecological conditions such as menorrhagia, post-abortion bleeding, and threatened abortion (TA). Clinically, it yields an efficacy rate of over 90% for TA treatment, yet its associated molecular events have not been characterized. To explore the pharmacology and bioactive constituents of JAD against TA, focusing on angiogenesis, endometrial receptivity and hemodynamics, using three complementary platforms: rat in vivo models, zebrafish vascular functional assays, and in silico molecular binding prediction. A mifepristone-induced progesterone withdrawal TA rat model was established, and rats were treated with JAD at either low, medium, or high doses (6, 12, 24 g/kg). Uterine morphology, embryo loss rate, blood viscosity, and histopathology (H&E staining, immunohistochemistry, immunofluorescence) were assessed. Angiogenic (VEGFA, p-VEGFR2, HIF-1α) and receptivity markers (Integrin β3, LIF, HOXA11) were evaluated by western blot and RT-qPCR. UPLC-Q-TOF-MS/MS was used to identify components distributed in blood and uterus. Molecular docking and molecular dynamics were performed to predict potential binding affinity between core bioactive components and vascular-related target proteins. Zebrafish models (vascular injury, erythrocyte injury and hemorrhage) were utilized to observe pro-angiogenic and hemostatic effects of JAD. JAD reduced embryo loss, restored uterine microvascularization (CD31, α-SMA) and improved hemorheology in rats. These phenotypic changes coincided with elevated VEGFA/p-VEGFR2, suppressed HIF-1α and greater placental angiogenesis. Meanwhile, higher pinopod density and upregulated Integrin β3, LIF, and HOXA11 collectively indicated improved endometrial receptivity after treatment. Molecular docking and molecular dynamics simulations predicted stable binding interactions between 19 major bioactive components of JAD and target proteins FLT1 and VWF. In zebrafish, JAD (12.5-200 μg/mL) and its representative constituents (e.g., adenosine, ferulic acid) stimulated angiogenesis and erythropoiesis while mitigating hemorrhage, correlating with elevated VEGFA/p-VEGFR2 protein and vascular-related mRNA levels (vwf, vegfa, flt1, kdr, kdrl). The anti-abortive effects of JAD are associated with the restoration of uterine vascular homeostasis, endometrial receptivity and hemodynamics. Similar expression trends of VEGF-related angiogenic markers were observed in both rat and zebrafish models after JAD treatment. This work provides experimental evidence linking the traditional use of JAD for pregnancy maintenance to the restoration of uterine vascular homeostasis, thereby bridging classical TCM theory with modern pharmacological insights for mechanistic interpretation.

With the policy of allowing all couples to have three children unveiled in China, the cesarean section rate has increased, leading to a corresponding rise in the number of cesarean scar pregnancy (CSP) cases. Therefore, improving the treatment quality is very important. This article is to compare the efficacy of two different methods treating CSP: Lauromacrogol pericystic injection combined with curettage and uterine artery embolization with curettage. We performed a retrospective study at Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine (Hangzhou, China) of 55 patients diagnosed with CSP between January 2016 and December 2021. Patients were consecutively assigned to treatment groups: the lauromacrogol treatment group ( n = 23) and the uterine artery embolization treatment group ( n = 22). The amount of bleeding during and after uterine curettage, the recovery time of human chorionic gonadotropin (β-HCG), hospitalization time, hospitalization expenses, menstrual recovery time, ovulation recovery time, postoperative ovarian function, postoperative pain scores, and adverse reactions were compared between the two groups. All patients were successfully treated without major intraoperative complications. The amount of bleeding during and after uterine curettage, the recovery time of β-HCG, and menstrual recovery time showed no significant differences between the two groups ( p > 0.05). However, the lauromacrogol group demonstrated significantly shorter ovulation recovery time (96.45 ± 11.64 days vs. 113.76 ± 14.33 days, p < 0.001) and better postoperative ovarian function profiles with lower FSH and LH levels and higher E2 and AMH levels (all p < 0.05). The hospitalization cost in the lauromacrogol group was significantly lower than that in the uterine artery embolization group (¥6863.27 ± 908.22 vs. ¥20747.02 ± 4963.43, p < 0.001), and the incidence of adverse reactions was significantly less than that in the uterine artery embolization group (17.39% vs. 45.45%, p < 0.05). Postoperative pain scores at 2 and 4 weeks were also significantly lower in the lauromacrogol group ( p < 0.05). Lauromacrogol injection around the pregnancy sac combined with curettage and uterine artery embolization combined with curettage demonstrated comparable efficacy in terms of bleeding control, β-HCG recovery, and menstrual resumption for the treatment of cesarean scar pregnancy. However, the lauromacrogol approach offered significant advantages including lower cost, better preservation of ovarian function, faster ovulation recovery, reduced postoperative pain, and fewer adverse reactions, making it suitable for broader adoption in hospitals, particularly those without interventional radiology facilities.

Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide, yet current prediction tools do not fully capture sex differences in risk. Menopause further modifies women's risk of CHD, but underlying molecular mechanisms are not well understood. Proteomic profiling may provide new insights into these mechanisms. We analyzed 4,877 SomaScan™-based plasma proteins in 10,034 Atherosclerosis Risk in Communities (ARIC) participants. Using linear regression, we identified sex- and menopause-related differences in circulating protein concentrations. We performed pathway enrichment analyses to capture underlying biological mechanisms. To evaluate the associations between proteins and incident CHD and differences by sex or menopause status, we applied Cox regression. Finally, we used LASSO regression to identify proteins that improve CHD risk prediction beyond an established clinical model. We observed significant differences in circulating proteins by sex and menopausal status, including early changes during the menopausal transition. We found protein associations with incident CHD differed markedly by sex and menopausal stage: eight proteins were associated with CHD in men, compared with 54 in women, and six and 17 proteins in peri‑ and postmenopausal women, respectively. In risk prediction analyses, adding sex-specific protein panels improved CHD prediction (ΔC-statistic=0.05 in men and 0.03 in women), with similar improvement across menopausal stages. Proteomic profiles underlying CHD risk differ substantially by sex and menopausal stage. These findings suggest potential biological heterogeneity in CHD and support the study of sex- and menopause-related differences in underlying mechanisms.

Hypertensive disorders during pregnancy pose a serious threat to the health of both mothers and infants, yet the range of available clinical treatments is limited. This review summarizes the mechanisms and recent advances in the use of medical gases, such as nitric oxide, hyperbaric oxygen, carbon monoxide and hydrogen sulfide, in the treatment of this condition. These gaseous molecules have unique protective effects, including regulating vascular tone, improving placental blood perfusion and inhibiting oxidative stress and inflammatory responses. However, their clinical application faces major challenges, including precise dose control, optimization of delivery methods and assessment of long-term safety. While this review suggests that medical gas therapy provides new avenues for research and potential applications in the management of hypertensive disorders of pregnancy, it also highlights the need for further basic and clinical studies to clarify their precise mechanisms.

Evidence on the relationship between age at menopause and depressive symptoms remains limited, particularly among postmenopausal women with depressive symptoms at baseline. This study examined the association between age at menopause and depressive symptom levels over follow-up, including nonlinear and interaction effects. We included 2959 postmenopausal women aged ≥50 years with baseline depressive symptom scores at or above cohort-specific cut-offs from ELSA (waves 4-9) and SHARE (waves 4-8). Age at menopause was categorized as <45, 45-55, or ≥55 years and also modeled continuously. Repeated CES-D (ELSA) and EURO-D (SHARE) scores during follow-up were analyzed using multivariable linear mixed-effects models. Restricted cubic splines assessed nonlinearity, interaction tests assessed effect modification, and multiple imputation addressed missing covariate data. Participants with early menopause had higher depressive symptom scores than those with menopause at 45-55 years in SHARE (β: 0.170; 95% CI: 0.001, 0.340) and ELSA (β: 0.379; 95% CI: 0.043, 0.716). Depressive symptom scores decreased with increasing age at menopause in SHARE (p=0.009) and ELSA (p=0.001). When modeled continuously, a one-year increase in menopausal age was associated with lower depressive symptom scores in SHARE (β: -0.013; 95% CI: -0.025, -0.001) and ELSA (β: -0.035; 95% CI: -0.059, -0.011). No evidence of nonlinearity or interaction was observed. Age at menopause may help identify postmenopausal women at higher risk of persistent depressive symptoms.

Endometrial cancer (EC) is common in postmenopausal women, with early diagnosis critical for prognosis. Traditional tumour markers (CA125, HE4) are limited alone, and the diagnostic value of peripheral blood lymphocyte-related indicators is unclear. This study explored the value of combining these lymphocyte indicators with CA125, HE4 and metabolic factors for early EC diagnosis in postmenopausal women. This is a single-centre case-control study that included 72 postmenopausal women with early EC (FIGO I-II, EC group) and 72 with benign uterine lesions (BL group). Baseline data, immunological markers (lymphocyte count, LYM; lymphocyte-to-monocyte ratio, LMR), CA125 and HE4 were measured. Receiver operating characteristic curves were used to analyse diagnostic performance, and multivariate logistic regression compared model fit. The EC group had higher rates of diabetes, hypertension and dyslipidaemia (all p < .05), lower LYM and LMR (all p < .01) and higher CA125 and HE4 (all p < .001). Among single markers, HE4 had the highest area under the curve (AUC, 0.725) but low sensitivity (45.8%). The combination of CA125 and HE4 achieved an AUC of 0.759; adding LYM and LMR increased this to0.839. Incorporating metabolic factors further increased the AUC to 0.865 (Akaike information criterion, AIC = 144), which was superior to other models ( p < 0.01). Combining lymphocyte indicators (LYM, LMR), CA125, HE4 and metabolic factors significantly improved early EC diagnostic efficacy in postmenopausal women, offering a reliable non-invasive strategy. Endometrial cancer (EC) is a common cancer in women after menopause. Finding it early is very important for treatment and recovery. Currently, relying on just one blood test to detect early EC is not very effective. Our study explored a new combined assessment method. We compared 72 women after menopause who had early EC with 72 women who had non-cancerous uterine conditions. In addition to testing common cancer blood markers, we also analysed other blood cell indicators linked to the immune system and recorded whether the women had health conditions like diabetes or high blood pressure. The study found that combining these immune cell indicators with the traditional cancer markers was better at identifying women with early EC. When the women’s own health conditions related to body metabolism (such as a history of diabetes or high blood pressure) were also included, this combined assessment method became the most accurate. This means that for women after menopause, using a few simple blood tests together with personal health information can help doctors detect signs of EC earlier and more accurately, allowing for earlier treatment.

The postmenopausal period presents a significant challenge to women's health, characterised by vasomotor, psychological, and sleep disturbances. This systematic review and meta-analysis synthesised evidence on aromatherapy for menopausal symptoms. We searched Cochrane Library, Web of Science, ScienceDirect, PubMed, Scopus, SID, and Google Scholar until January 2, 2026. The protocol was registered (PROSPERO: CRD420261303084). Randomised controlled trials and quasi-experimental studies were included. The Cochrane Risk of Bias tool and GRADE approach were used for quality assessment and certainty of evidence. Meta-analyses were performed using RevMan 5.3. Of 4435 records, 21 articles from 17 studies ( n = 1347) were included. Aromatherapy significantly improved sexual function (MD: 7.05, 95% CI: 3.64-10.45), sleep quality (MD: -3.95, 95% CI: -5.94 to -1.97), overall menopausal symptoms (SMD: -1.00, 95% CI: -1.43 to -0.58), vasomotor symptoms (SMD: -0.79, 95% CI: -1.11 to -0.47), physical symptoms (SMD: -0.78, 95% CI: -1.10 to -0.46), somatic symptoms (MD: -1.34, 95% CI: -2.46 to -0.23), psychological symptoms (SMD: -0.59, 95% CI: -0.96 to -0.23), anxiety (SMD: -0.63, 95% CI: -1.10 to -0.16), and depression (SMD: -0.57, 95% CI: -0.85 to -0.28). No significant effect was found for urogenital symptoms. GRADE certainty was 'Very Low' for sexual function and sleep quality, and 'Low' for other outcomes. Preliminary evidence suggests that aromatherapy may be a beneficial complementary therapy for alleviating some menopausal symptoms. However, given the substantial heterogeneity, methodological limitations, and limited number of studies for subgroup analyses, firm clinical recommendations cannot be made at this time. More rigorous, large-scale, multi-centre randomised controlled trials with standardised interventions and consistent adverse event reporting are required before definitive clinical recommendations can be made. Menopause is a natural stage in a woman’s life when monthly periods stop. During this time, many women experience uncomfortable symptoms such as hot flashes, night sweats, trouble sleeping, low mood, anxiety, and changes in sexual desire. Some women look for natural treatments that have fewer side effects than hormone therapy.Aromatherapy uses plant oils (such as lavender) that are either breathed in or used during massage. This study combined the results of 17 scientific studies involving more than 1,300 women to see whether aromatherapy helps with menopausal symptoms.The results showed that aromatherapy helped improve several symptoms. Women who received aromatherapy reported better sleep quality, fewer hot flashes, less anxiety and depression, and improved sexual function. When essential oils were given as a massage, the benefits were greater than when women only breathed in the oils. This suggests that touch adds something extra to the treatment.However, the studies we reviewed were very different from one another. They used different types of oils, different doses, and different ways of giving the treatment. Many studies also had limitations in how they were designed. Also, only a few studies reported on side effects, so we cannot be sure about safety.Because of these limitations, our findings should be seen as early or preliminary evidence rather than final proof. Before doctors can strongly recommend aromatherapy for menopause, larger and better-designed studies are needed. Nevertheless, for women who prefer a natural approach, aromatherapy - especially aromatherapy massage - appears to be a helpful option for managing some menopausal symptoms.

Management of women with epilepsy (WWE) requires specialized guidance across different life stages. To inform priorities for future guideline development, we examined the methodological quality and the women-specific content of existing clinical practice guidelines (CPGs) for WWE. We searched OVID Medline, Embase, the Guideline International Network, and KoreaMed for epilepsy CPGs developed de novo, including women's issues, published in English or Korean, between January 2014 and December 2024. Two independent reviewers and an AI-based language model independently assessed the quality of each CPG using the Appraisal of Guidelines for Research and Evaluation II instrument. The coverage of thirteen predefined women-specific topics was assessed for each CPG. Eleven CPGs met the inclusion criteria, all from the United States or Europe. The median overall quality score was 74.9% (IQR, 65.0-85.2%). Editorial independence scored the highest (median 92.5%), followed by clarity of presentation (86.3%), scope and purpose (85.7%), rigor of development (82.8%), stakeholder involvement (61.9%), and applicability (57.3%). Content analysis showed that pregnancy-related topics were well covered, with specific recommendations, whereas adolescence (n = 3), catamenial epilepsy (n = 1), menopause (n = 2), and bone health (n = 3) received limited attention and often lacked actionable guidance. Recommendations also varied across CPGs, most notably for therapeutic drug monitoring during pregnancy and folic acid dosing. Current WWE CPGs generally show high methodological quality but have relative weaknesses in applicability and stakeholder involvement. Significant gaps exist in guidance for non-pregnancy life stages. Future guidelines should adopt a comprehensive lifespan approach, improve applicability, and broaden stakeholder engagement to better meet the diverse needs of WWE.

The menopausal transition is associated with an increased risk of depression. Prior depression is a well-established risk factor, but studies do not distinguish between prior reproductive and non-reproductive depression. We aimed to examine whether prior reproductive (i.e., premenstrual mood disorder and perinatal depression) and non-reproductive (i.e., not related to hormonal transitions) depression were differentially associated with depressive symptoms during the menopausal transition. We analyzed cross-sectional data from menopause outpatient clinics, including a multidisciplinary clinic. Exposures included premenstrual mood disorder assessed with the Premenstrual Symptom Screening Tool, perinatal depression assessed with the Edinburgh Postnatal Depression Scale-Lifetime version, and prior non-reproductive depression recorded in medical records. Current depressive symptoms were measured with the Inventory of Depressive Symptomatology-Self Rated. We used univariable and multivariable linear regression models to examine associations; multivariable models accounted for overlap between exposures. Among 180 participants (median age 51; 61% perimenopausal, 39% postmenopausal), premenstrual mood disorder showed the strongest association with depressive symptom severity (B = 9.0, 95% CI 5.1-12.9, p < 0.001), followed by perinatal depression (B = 7.8, 95% CI 3.4-12.1, p < 0.001) and prior non-reproductive depression (B = 4.7, 95% CI 0.7-8.7, p = 0.021). In multivariable analysis, only premenstrual mood disorder (B = 7.2, 95% CI 2.4-12.1, p = 0.0037) and perinatal depression (B = 5.7, 95% CI 1.2-10.1, p = 0.013) remained associated with depressive symptom severity. Prior reproductive depression, but not prior non-reproductive depression, was associated with greater depressive symptom severity during the menopausal transition. Histories of premenstrual mood disorder and/or perinatal depression may help identify individuals vulnerable to depressive symptoms during this period. Prospective studies in population-based samples are needed.

Myomatous erythrocytosis syndrome (MES) is a rare condition in which erythrocytosis associated with uterine leiomyoma resolves after tumor removal. A 55-year-old woman with a giant uterine mass that had continued to enlarge despite long-term leuprorelin treatment was referred for marked erythrocytosis. Treatment-related amenorrhea made the timing of natural menopause uncertain. Magnetic resonance imaging showed a heterogeneous uterine mass exceeding 30 cm. Hemoglobin was 20.1 g/dL and serum erythropoietin (EPO) was 45.4 mIU/mL. BCR-ABL1 testing was negative, and no JAK2 V617F, JAK2 exon 12, CALR, or MPL mutation was detected, supporting secondary rather than clonal erythrocytosis. Ten weekly therapeutic phlebotomies reduced hemoglobin to 15.8 g/dL. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed after multidisciplinary perioperative planning. Prominent omental collateral vessels and markedly dilated ovarian veins increased surgical complexity. Because the giant tumor restricted posterior pelvic access, hysterectomy was completed using a retrograde approach. The 8060-g specimen was histologically confirmed as a benign uterine leiomyoma, and superficial cystic structures were identified as D2-40-positive dilated lymphatic channels. No thrombotic event occurred. At one-month follow-up, hemoglobin and serum EPO had decreased to 11.4 g/dL and 16.0 mIU/mL, respectively, without recurrent erythrocytosis. Although tumor EPO expression was not evaluated, postoperative normalization of serum EPO and resolution of erythrocytosis supported the clinical diagnosis of MES. MES should be considered in patients with uterine leiomyoma and unexplained erythrocytosis; hematologic evaluation, preoperative phlebotomy, and multidisciplinary surgical planning may enable safe treatment.

Menopausal symptoms are complex psychosomatic experiences influenced by psychological resources and behavioural coping processes, in addition to hormonal changes. Although coping strategies have been widely examined, the factors associated with the implementation of coping behaviours remain unclear. This study examined how psychological hardiness relates to coping strategies, coping behaviour implementation, and menopausal symptoms. This cross-sectional survey of 198 women aged 45-55 years assessed menopausal symptoms, daily stress, hardiness, coping strategies, and coping behaviour implementation. Coping behaviour implementation for menopausal symptoms was defined as self-reporting of practicing at least one coping behaviour. Coping behaviour implementation was evaluated as a behavioural outcome measure. Group comparisons and multiple regression and logistic regression analyses were performed. Women with higher hardiness reported lower psychological and somatic symptom severity and greater use of active coping strategies. Most coping strategies were not directly associated with symptom severity. Logistic regression showed that coping behaviour implementation was positively associated with psychological symptoms and commitment, and negatively associated with responsibility shifting. Psychological hardiness, particularly commitment, is associated with coping behaviour implementation rather than directly reducing symptoms. These finding suggest that psychological engagement may be relevant to adaptive self-management during menopause.

Relugolix monotherapy for uterine fibroids is approved in Japan for only 180 days, and almost all long-term evidence concerns relugolix combination therapy with estradiol and norethisterone acetate. We evaluated surgery avoidance, transition to menopause, symptom control, and bone mineral density (BMD) beyond 180 days. We retrospectively reviewed 83 women with uterine fibroids given relugolix 40 mg monotherapy for at least 180 days at a single center between January 2015 and December 2024. Continuous variables are presented as median [interquartile range]; paired comparisons used the Wilcoxon signed-rank test, and group comparisons used the Mann-Whitney U test and Fisher's exact test (two-sided α = 0.05). Median treatment duration was 327 days [239.5-420.0] (maximum 1030) and median age was 43 years [37-47]. Overall, 55.4% (46/83) avoided fibroid surgery and 8.4% (7/83) reached menopause without surgery; symptoms resolved or improved in 60.2% (50/83). Among women not wishing surgery, 90.0% (27/30) avoided it, whereas 77.3% (34/44) of those wishing surgery underwent it (Fisher's exact test, p < 0.001). Uterine volume fell from 658 to 502 cm 3 (median within-patient reduction 19.0%, p < 0.001) and maximum fibroid diameter by 7.8% (p = 0.001). BMD trended downward at every site without reaching significance (lumbar spine -3.0%, p = 0.11). In addition, the median duration of the drug-free period for patients who measured bone mineral density was evaluated was 726 days (range: 7-2359 days). Long-term relugolix monotherapy frequently enabled surgery avoidance and transition to menopause in women who declined surgery and controlled symptoms in most. Because estrogen add-back is absent, BMD monitoring and a prespecified exit strategy are essential.

Pregnancy loss during the first month of gestation remains a major limitation to reproductive efficiency in dairy cattle, yet the biological stage at which losses occur after the onset of conceptus-derived signaling remains poorly understood in nulliparous heifers. We evaluated cervical interferon-stimulated gene (ISG15, IFI44, OAS1, and RSAD2) expression, circulating progesterone (P4), and pregnancy-associated glycoprotein (PAG) concentrations in grazing Holstein heifers to characterize molecular and endocrine patterns associated with subsequent pregnancy outcomes. Cervical cytobrush samples and blood were collected on d16 after insemination from 103 heifers. Pregnancy status was determined by transrectal ultrasonography on d28 and d33, whereas PAG concentrations were measured on d28. Pregnancy outcomes were subsequently monitored until calving. Based on PAG concentrations, ultrasound determinations and ISG15 expression, heifers were classified as Nonpregnant (n = 10), Early pregnancy loss (EarlyPL; n = 38), Late pregnancy loss (LatePL; n = 7), or Pregnant (n = 48). Evidence of conceptus-derived interferon signaling was detected in 90.3% of inseminated heifers at d16, whereas only 53.4% were pregnant at d28 and 46.6% remained pregnant at d33, indicating that a substantial proportion of losses. All four ISGs were markedly upregulated in EarlyPL, LatePL, and Pregnant heifers relative to Nonpregnant heifers, confirming robust conceptus signaling in most inseminated animals. Among the genes evaluated, ISG15 exhibited the greatest dynamic range and uniquely differentiated all pregnancy outcome categories. P4 concentrations at d16 were similarly elevated in EarlyPL, LatePL, and Pregnant heifers relative to Nonpregnant heifers, indicating that many losses occurred despite adequate luteal support during maternal recognition. In contrast, PAG concentrations at d28 were lower in LatePL than Pregnant heifers, suggesting impaired progression through attachment and early placental development. Collectively, these findings indicate there although embryo signaling is detected and P4 concentrations are elevated on d16, a substantial proportion of losses occur before or shortly after the establishment of early placentation. Cervical ISG15 provided the greatest biological resolution across pregnancy outcomes, whereas PAG concentrations offered complementary insight into progression beyond maternal recognition, supporting a stage-specific model of pregnancy loss in which peri-attachment and early placental processes represent critical determinants of pregnancy maintenance.

Endoplasmic reticulum (ER) stress compromises cellular homeostasis in multiple cell types, gametes and early embryos are particularly susceptible, with negative consequences for developmental competence. This study investigated the effects of ER stress and its attenuation by TUDCA at specific developmental stages of bovine embryos and evaluated ER stress-modulating compounds in a commercially in vitro embryo production (IVEP) system. To induce ER stress, embryos were exposed to tunicamycin (TN; 0.1, 1, and 10 ng/mL) during in vitro culture (IVC). Stage-specific sensitivity to ER stress was assessed by treating embryos 1 ng/mL TN during periods associated with embryonic genome activation (EGA): pre-EGA (days 1-3), EGA (days 3-5), and post-EGA (days 5-7). The ability of the bile acid tauroursodeoxycholic acid (TUDCA) to alleviate ER stress was then examined. Embryos received combined TN and TUDCA treatments either throughout culture or specifically during EGA, and outcomes were compared with TN alone. Finally, TUDCA supplementation was tested under commercial IVEP conditions. TN at 1 and 10 ng/ml dose-dependently reduced embryo development during in vitro culture (Days 1-7). Embryo development and total cell number were also decreased by 1 ng/ml TN during EGA (Days 3-5). TUDCA supplementation (100 μM) increased total cell number and the proportion of expanded blastocysts compared to controls and effectively mitigated TN-induced damage. In commercial IVEP, TUDCA supplementation increased blastocyst yield by ∼11% in beef cattle and improved pregnancy rates by 24.1% in dairy cattle. These results highlight the importance of ER stress during key embryo developmental stages and support the use of TUDCA as a beneficial supplement to enhance outcomes in commercial bovine IVEP systems.

To study the effect of the traditional Chinese medicine Gushukang on bone mineral density (BMD) in perimenopausal and postmenopausal women. In this randomized trial, 156 women were assigned to three groups ( n = 52 each): hormone therapy (HT), Chinese medicine (CM, Gushukang capsules), or combination therapy. Interventions lasted 6 months. Height, weight, and BMD were measured, and blood samples were taken to assess FSH, LH, E2, P , AST, ALT, BUN, and CRE levels before and after treatment. Changes in these indicators were compared. Of the 156 participants, 142 completed the study (HT: 49, CM: 42, combination: 51). The median ages (Q1, Q3) of the three groups were 51.00 (47.00, 53.50), 53.00 (49.00, 57.00), and 51.00 (45.25, 54.00) years, respectively, with no significant difference. Pretreatment BMD values (mg/cm³) were 115.10 (102.90, 118.80), 107.40 (88.50, 114.65), and 113.25 (100.20, 118.98) for the HT, CM, and combination groups, respectively. After 6 months of treatment, the combination group showed a significant increase in BMD after treatment compared with before treatment ( p < 0.01). In the hormone therapy and combination groups, FSH and LH levels decreased significantly, while E2 levels increased significantly after treatment ( p < 0.05), whereas no significant differences in these indicators were observed in the Chinese medicine group. No significant differences in liver or kidney function were found in any of the three groups before and after treatment. Both Gushukang and menopausal hormone therapy for 6 months can increase BMD in perimenopausal and postmenopausal women; however, combination therapy yields superior results.

Adverse pregnancy outcomes (APOs) are recognized cardiovascular risk enhancers, yet their association with coronary microvascular dysfunction (CMD) has not been systematically quantified. To evaluate the association between APOs and CMD and to provide pooled estimates of CMD prevalence and severity in women with APO history. PubMed, Embase, Cochrane Library, and Web of Science were searched through December 2025. Observational studies evaluating coronary microvascular function using PET, Doppler echocardiography, stress CMR, or invasive physiology in women with APOs versus controls were included. Multivariate random-effects meta-analysis was performed to account for non-independent effect estimates arising from shared control groups. Risk of bias was assessed using NOS; certainty of evidence using GRADE. Five studies (1,183 participants; 583 APO, 600 controls) were included. Women with APO history demonstrated significantly reduced CFR (SMD -0.94; 95% CI, -1.43 to -0.45; p<0.0001; I²=88.2%) and elevated CMD prevalence (OR 6.74; 95% CI, 1.55-29.42; p0.011; I²=92.2%). An exploratory graded pattern was observed, with combined preeclampsia and gestational diabetes associated with the largest CFR reduction (SMD -1.27); however, this was driven primarily by a single study with shared controls. Publication bias assessment was non-significant for CFR (p0.312) but borderline for CMD prevalence (p0.078). APOs are associated with reduced CFR and elevated CMD prevalence, suggesting CMD may represent a plausible intermediate phenotype linking pregnancy complications to long-term cardiovascular disease. Given low to very low certainty evidence and substantial heterogeneity, these findings are hypothesis-generating and support further prospective research.

Vulvovaginal dryness affects women of all ages and is particularly prevalent after menopause. Hyaluronic Acid (HA)-containing products may improve hydration and lubrication of the vulvovaginal mucosa. To assess the performance and safety of HA-based vaginal ovule (MucoGYNE), in relieving symptoms of vaginal dryness and dyspareunia. This prospective, multicentre, open-label, single-arm post-market clinical follow-up study enrolled women aged ≥18 years with vaginal dryness and a Vaginal Health Index (VHI) score <15. Participants inserted one ovule intravaginally twice weekly for 5 weeks. The primary outcome was change in VHI score from baseline (Day 0) to Day 35. Secondary outcomes included vulvovaginal symptoms, Female Sexual Function Index (FSFI), global impression of change, satisfaction, and safety. Twenty-nine women were included in the analysis, with high treatment adherence (96.8%). VHI scores increased significantly (mean change +6.1 ± 3.1; p < 0.0001). Vulvovaginal symptoms improved significantly. FSFI scores improved. Investigators reported clinical improvement in 89.7% of participants, and 79.3% perceived improvement. Most women (86.2%) were satisfied with treatment. Three non-serious adverse events were reported. Use of MucoGYNE Ovules was associated with improvements in vaginal dryness and related symptoms and a favourable safety profile, suggesting that it may represent a promising and well-tolerated non-hormonal option for women experiencing vaginal dryness. Clinical Trial : ClinicalTrials.gov (NCT06282614).

Intra-uterine adhesion (IUA) frequently recurs after hysteroscopic adhesiolysis, undermining menstruation and fertility. We aimed to determine whether baseline serum anti‑Müllerian hormone (AMH)‑to-follicle‑stimulating hormone (FSH) ratio and menstrual pattern independently and jointly predict IUA severity transitions after adhesiolysis using a multi‑state Markov model. We conducted a single-center prospective study of 210 women (18-45 years) undergoing first adhesiolysis for moderate-to-severe IUA. Baseline serum AMH and FSH were measured and menstrual pattern was classified as normal, hypomenorrhea, or amenorrhea. Hysteroscopy at 3, 6, 12, and 24 months defined four severity states (none, mild, moderate, severe) and two absorbing outcomes (pregnancy ≥ 12 weeks, repeat surgery). Continuous-time multi-state Markov models estimated transition-specific adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), controlling for age, body-mass index (BMI), baseline adhesion severity, and adjuvant therapy. Internal validation used 200-bootstrap c-index and calibration. Of 210 participants, 83 women (39.5%) had any recurrence and 28 (13.3%) progressed to severe adhesions. Pregnancy ≥ 12 weeks occurred in 54 (25.7%) and repeat surgery in 36 (17.1%). Each one-standard-deviation decrease in AMH/FSH increased hazards from mild to moderate (adjusted HR 1.81, 95% CI 1.29-2.54) and from moderate to severe (HR 2.15, 95% CI 1.41-3.28), with a non-significant trend from none to mild (HR 1.20, 95% CI 0.95-1.52). Amenorrhea versus normal was associated with higher hazards for none to mild (HR 1.88, 95% CI 1.23-2.99) and mild to moderate (HR 1.55, 95% CI 1.10-2.18). An interaction suggested that amenorrhea amplified the adverse effect of a low AMH/FSH ratio on progression to severe disease (HR 1.39, 95% CI 1.03-1.88). The model showed good performance, with bootstrap‑corrected C‑index 0.78 (95% CI 0.74-0.82), optimism‑corrected C‑index 0.76, and optimism‑corrected calibration slope 0.94. Baseline endocrine status summarized by the AMH/FSH ratio and menstrual pattern independently and jointly predict IUA dynamics after adhesiolysis. A biomarker-based, multi-state risk tool may help personalize severity-anchored surveillance and re-intervention after adhesiolysis.

Cardiovascular disease (CVD), specifically atherosclerotic CVD (ASCVD), remains the leading cause of death among women globally and persistent cardiovascular disparities exist for women compared to men. The menopausal transition represents a critical cardiometabolic inflection point during which women experience accelerated adverse changes in lipid profiles, body composition, vascular function, and metabolic parameters independent of aging alone. Traditional ASCVD risk factors such as diabetes, hypertension, smoking, and obesity may exert disproportionately greater cardiovascular effects among women compared with men. In conclusion, a lifespan approach that recognizes menopause as a critical inflection point for ASCVD prevention is essential.

This study compared the effects of transumbilical single‑port laparoscopic myomectomy (SPLM) and multi‑port laparoscopic myomectomy (MPLM) on stress response, immune function, and incision cosmetic outcomes in patients with uterine fibroids (UFs). A total of 146 UF patients were randomized to receive SPLM ( n = 73) or MPLM ( n = 73). Outcome measures included perioperative indicators, stress markers, immune parameters, ovarian function, incision cosmetic outcomes, postoperative complication rate, menstrual normalization, and recurrence. The SPLM group had longer operative time and shorter postoperative exhaustion and hospitalization than the MPLM group ( P < 0.05). At 3 days postoperatively, the SPLM group showed higher SOD, CD3 + , and CD4 + /CD8 + levels and lower MDA and ROS levels than the MPLM group ( P < 0.05). At 3 months postoperatively, no significant differences were observed in AMH, LH, or FSH levels between the two groups ( P > 0.05). The SPLM group showed higher CS scores and lower BIS scores compared with the MPLM group ( P < 0.05). The rates of complications, menstrual recovery, and recurrence were comparable ( P > 0.05). Compared with MPLM, SPLM showed better effects in reducing oxidative stress, maintaining immune function, and improving incision cosmetic outcomes for patients with UFs.

Iron deficiency is the most common micronutrient deficiency worldwide, negatively affecting quality of life and health. Young women are at particularly high risk due to increased iron demands during growth, menstrual blood losses, and dietary habits. There are no official guidelines recommending screening for iron deficiency in healthy young women. This study aimed to develop a screening instrument (IRON-5) to predict iron deficiency in this group, with relevance for use in primary care and school health services. In 2023, a cross-sectional study was conducted to assess the prevalence of iron deficiency and associated factors in high school girls. A questionnaire assessing dietary habits, menstrual bleeding patterns, iron supplement use, and hormonal contraceptive use was administered. Iron deficiency was defined as serum ferritin <15 µg/L. A post-hoc analysis identified the strongest predictors of iron deficiency and incorporated them into a risk-scoring model. The final instrument included five predictors: a non-omnivorous diet, heavy menstruation causing discomfort, avoidance of activities due to menstruation, no iron supplementation, and non-use of hormonal contraceptives. A scoring system (0-5) was developed. Using a threshold score of ≥ 3, the model achieved a sensitivity of 74% and specificity of 57% for detecting iron deficiency. The IRON-5 is a concise and user-friendly screening instrument designed to identify young women at risk of iron deficiency. It demonstrated good sensitivity and may serve as a cost-effective method to prioritize individuals for blood testing. IRON-5 could support identification and prevention strategies in school-based and primary care settings.

Clear cell carcinoma arising from ovarian endometrioma is well documented; however, its origin from uterine adenomyosis is exceptionally rare. A 60-year-old postmenopausal woman with long-standing adenomyosis and no gynecologic follow-up for approximately 10 years presented with a 7 cm pelvic mass detected on routine health screening. Magnetic resonance imaging revealed an intramural mass with mixed cystic and solid components, restricted diffusion, and contrast enhancement. Despite the absence of uterine bleeding and negative cervical and endometrial cytology, malignancy was suspected. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology confirmed clear cell carcinoma arising in adenomyosis, with transition foci from benign adenomyosis to carcinoma. This case highlights that clear cell carcinoma arising in adenomyosis should be considered when a long-standing cystic uterine lesion enlarges and develops suspicious imaging features, even in the absence of uterine bleeding or cytological abnormalities.

Ramadan fasting is a central religious practice for Muslims, yet women are exempt during menstruation. Despite this exemption, many still face physical, emotional, and social challenges. To explore the impact of Ramadan fasting on menstrual cycle patterns, women's perceptions, and coping strategies. We conducted a mixed-methods study using structured questionnaires that were circulated on social media platforms and in the clinic after Ramadan 2025. Convenience sampling was used as 154 Lebanese women aged 13-45 years took part in the study. Participants with regular cycles were included; those with amenorrhea or menstrual abnormalities were excluded. Both quantitative and qualitative data were analyzed to capture physical, psychological, social, and spiritual dimensions. Over 60% of participants reported fatigue and cramps during menstruation. More than half had cycles lasting 6-7 d, while 28% noticed irregularities during Ramadan. Emotionally, 70% expressed difficulty with not fasting. Social stigma was reported by about one-third, while 55% felt awareness around menstruation in Ramadan was lacking. Of 18% admitted using medication to delay menstruation, and 90% called for health education in religious spaces. Ramadan fasting affects menstrual patterns and psychosocial wellbeing. Community-based awareness and culturally sensitive guidance are essential to support women's health and spirituality. This study explored how Ramadan fasting can affect menstrual cycle patterns among Lebanese women. It also highlights how women feel about not fasting during their period, especially during this period. We surveyed 154 Lebanese women aged 13–45 years. This was achieved by using an anonymous questionnaire. The latter included multiple-choice and open-ended questions. Many women reported fatigue and menstrual cramps during Ramadan. About one in four noticed changes in their menstrual cycle during the month. In addition, a large number of participants shared feelings of sadness, guilt, or spiritual difficulty because they could not fast while menstruating. These findings were elucidated even though Muslim women are religiously permitted not to. Some women also reported experiencing social stigma or discomfort when others noticed they were not fasting. One of the most important findings is that, most participants expressed a strong desire for better education about women’s health. This initiative is especially relevant in religious and community spaces.

This study aimed to retrospectively evaluate the efficacy and safety of high-intensity focused ultrasound (HIFU) versus uterine artery embolization (UAE) as pretreatment prior to ultrasound-guided suction curettage in the management of cervical pregnancy. A retrospective review was conducted on 41 patients diagnosed with cervical pregnancy. Among them, 20 patients underwent UAE and 21 received HIFU treatment, both followed by ultrasound-guided suction curettage. None of the 41 patients required additional interventions due to active uterine bleeding following curettage. No significant differences were observed between the two groups in terms of age, number of previous abortions, days of amenorrhea, pretreatment serum β-hCG levels, average diameter of the gestational sac/mass, or blood loss during curettage ( p > .05). Compared to the UAE group, the HIFU group exhibited significantly lower hospitalization costs, shorter hospital stays, and less pain intensity ( p < .05). In the UAE group, 7 out of 20 patients experienced reduced menstrual flow; among them, 5 patients with fertility intentions underwent hysteroscopic adhesiolysis, resulting in 2 successful pregnancies. Of the remaining 13 patients in the UAE group without menstrual changes, 2 patients with fertility intentions achieved pregnancy. In the HIFU group, no patients reported alterations in menstrual volume. Among 10 patients with fertility intentions, 9 patients had pregnancies. In this pilot retrospective study, both UAE and HIFU demonstrated efficacy as pretreatment modalities prior to ultrasound-guided suction curettage for cervical pregnancy. HIFU showed potential advantages in pain reduction, hospitalization days, hospitalization expenses, and fertility preservation. These preliminary findings warrant validation in larger, prospective, multi-center trials.

Primary dysmenorrhea is a common condition characterized by cramp-like menstrual pain in young women. Recently, its effects on the cardiovascular system have garnered attention. Endothelial dysfunction is an early indicator of cardiovascular risk; however, its relationship with primary dysmenorrhea remains unclear. This study aims to evaluate endothelial function in individuals with primary dysmenorrhea using post-ischemic flow-mediated dilation (FMD) and volumetric flow (VolFlow) methods, and to compare the results with healthy controls. This study included 31 women with a clinical diagnosis of primary dysmenorrhea and 31 healthy control women. Endothelial function was assessed using Flow-Mediated Dilation (FMD) and VolFlow methods. FMD measures the dilation of the brachial artery, while VolFlow evaluates arterial blood flow volume. Differences between the groups were analyzed using SPSS, and a p-value of < 0.05 was considered statistically significant. Normality was assessed using the Shapiro-Wilk test, and between-group comparisons were performed using appropriate parametric and non-parametric methods. The FMD values were significantly lower in the dysmenorrhea group (5.97 ± 5.29 vs. 10.95 ± 3.78, p < 0.001), and the proportion of individuals with endothelial dysfunction was higher (%51.6 vs. %6.45, p < 0.001). In the dysmenorrhea group, the baseline VolFlow value was 77.4 ± 24.1 ml/min, which increased to 81.4 ± 25.1 ml/min after cuff inflation ( p < 0.001). In healthy controls, the VolFlow increased from 69.8 ± 15.3 ml/min to 92.0 ± 15.3 ml/min, but this change was not statistically significant ( p = 0.08). The change in VolFlow (ΔVF) was significantly lower in the dysmenorrhea group ( p < 0.001). Our findings indicate a significant impairment of endothelial function in the primary dysmenorrhea group compared to the control group. Specifically, individuals with primary dysmenorrhea exhibited lower flow-mediated dilation (FMD) and Δ vascular function (ΔVF) values. To further investigate this relationship, large-scale studies are needed.

Suppression of an LH surge is fundamental to successful oocyte retrieval after controlled ovarian stimulation. This study evaluates the efficacy and cost-effectiveness of progestin-primed ovarian stimulation (PPOS) using oral medroxyprogesterone acetate in fertility preservation cycles. The design is a retrospective single-centre study (January 2022-August 2023) comparing two ovarian stimulation protocols: PPOS and the gonadotrophin-releasing hormone antagonist (GnRHant) protocols. Cycles began at any time of the menstrual cycle. The primary outcome was the number of metaphase II oocytes retrieved. Secondary outcomes included total oocytes retrieved, maturity ratio, stimulation duration, incidence of premature LH rise/ovulation events, and the cost of medication used to prevent ovulation. The study included 125 fertility preservation cycles: 54 in the PPOS group and 71 in the GnRHant group. Median body mass index, antral follicle count, and anti-Mullerian hormone levels were comparable between the two groups. The median age was younger in the PPOS group; 28 years vs. 32 years, p = 0.03. Mature oocyte retrieval was similar; mean 9.33 [SD 5.87] vs. 8.97 [SD 5.44], p = 0.73. No premature LH rises occurred in either group. Secondary outcomes showed no significant differences, except for the cost of medication used to prevent ovulation. The PPOS protocol was considerably more cost-effective, by achieving a 98.06% cost reduction (medroxyprogesterone acetate, mean £4.38 [SD, £1.10] vs cetrorelix acetate £226.2 [SD £64.36], p = <0.0001. PPOS is a practical, cost-effective strategy for fertility preservation. Its appeal lies in its patient-centric focus, with a less invasive injection-based administration, while maintaining comparable effectiveness and significant cost reduction compared with the GnRH antagonist ovarian stimulation protocol.