Original research publications

Placental site trophoblastic tumor (PSTT) is a rare gestational trophoblastic neoplasm characterized by local invasiveness and marked vascularity. Surgical management may be associated with substantial bleeding risk and loss of fertility, particularly when complicated by uterine arteriovenous fistula (UAVF). High-intensity focused ultrasound (HIFU) may provide a fertility-preserving adjunctive approach in selected cases. A 23-year-old woman presented with persistently plateaued serum human chorionic gonadotropin levels following hysteroscopic management for suspected incomplete abortion. Imaging revealed a deeply invasive hypervascular uterine lesion with UAVF, raising strong suspicion of gestational trophoblastic neoplasia. Given her strong desire for fertility preservation and high surgical risk, ultrasound-guided HIFU was performed as an initial vascular-modulating intervention. Subsequent expert pathological review confirmed PSTT. HIFU achieved significant reduction in lesion perfusion and vascular flow, as confirmed by Doppler ultrasound and contrast-enhanced MRI. Although complete tumor ablation was not achieved due to lesion size and deep invasion, subsequent low-dose chemotherapy resulted in complete biochemical remission accompanied by radiologic regression of residual lesions. No major HIFU-related complications were observed, and normal menstrual function resumed during follow-up. HIFU is a technically feasible and safe fertility-preserving adjunct for vascular modulation in hypervascular PSTT complicated by UAVF. While HIFU alone may not achieve definitive oncologic control in large or deeply invasive lesions, it can serve as a bridging strategy to reduce tumor perfusion and vascularity, facilitating subsequent systemic therapy in carefully selected patients. This approach demonstrates the potential role of HIFU as a bridging vascular-modulating strategy within multimodal fertility-preserving management.

This study aimed (i) to examine symptom burden, health care use, perceived treatment effectiveness and experiences of trivialization among women with chronic pelvic pain (CPP), and (ii) to identify predictors of the number of physician visits and sick days. Cross-sectional online survey among 1204 women aged ≥18 years reporting CPP for ≥6 months. Data were collected via a self-administered questionnaire assessing CPP-related symptoms, illnesses, comorbidities, consulted specialists, perceived symptom trivialization by physicians, perceived treatment effectiveness and CPP-related sick days. Poisson regression and negative binomial regression were performed to identify predictors of the number of consulted specialists and of the number of sick days, respectively. Among the study population, 70.60% (n = 850) reported endometriosis, 63.63% (n = 766) reported to have consulted more than five physicians, and 79.90% (n = 962) reported trivialization experiences. Trivialization and perceived improvement through both pharmaceutical and non-pharmaceutical treatments were associated with a higher number of specialist consultations (incident rate ratios [IRRs] = 1.21, 1.26, ps < 0.001). Among women reporting sick days, trivialization (IRR = 1.20, p < 0.041) and perceived improvement through both treatments (IRR = 1.69, p < 0.001) were related to a higher number of sick days among those with at least one sick day. Experiences of trivialization and greater perceived treatment improvement were associated with a higher number of CPP-related sick days and specialist consultations, emphasizing the need to take CPP seriously from the first consultation.

Extrauterine adenomyoma is an exceedingly rare benign lesion composed of endometrial glands/stroma embedded within smooth muscle bundles and located outside the uterus. The majority of extrauterine adenomyomas occur in the pelvis involving the ovary, rectovaginal space, or broad ligament; hepatic involvement is extremely rare. We present the case of a 47-year-old woman with a subcapsular mass in segment VI of the liver that was detected during the work-up for abdominal pain. Initial core needle biopsy of the mass was suggestive of FNH or hepatic adenoma, with expert consultation favoring parasitic leiomyoma. Finally, the patient underwent surgical resection, and the histopathological exam revealed endometrial glands and stroma, admixed with smooth muscle, confirming the diagnosis of extrauterine adenomyoma. This case highlights the diagnostic challenge of extrauterine adenomyoma and emphasizes the importance of considering this entity in the differential diagnosis of pelvic or extrapelvic masses, particularly in women with a history of gynecologic lesions. Recognizing this rare condition may help prevent misdiagnosis and inappropriate management.

Extrauterine presentation of Mullerian adenosarcoma is rare and thought to either arise from endometriosis or from spread from a primary uterine or ovarian origin. When accompanied by sarcomatous overgrowth, particularly when the epithelial components are limited or obscured, these tumors can be challenging to recognize as adenosarcomas and may be misdiagnosed as primary pelvic or retroperitoneal sarcomas. Diagnostic molecular testing could be valuable but also misleading, if not interpreted in the right context, as some retroperitoneal sarcomas exhibit alterations that can have overlapping molecular alterations with Mullerian adenosarcoma, such as MDM2 amplification in liposarcomas. In this report, we describe three Mullerian adenosarcomas with extrauterine presentation, all exhibiting extensive sarcomatous overgrowth and MDM2 amplification. These tumors underscore the critical importance of integrating clinical history, comprehensive tissue sampling, detailed morphologic evaluation, and molecular analysis to establish an accurate diagnosis.

Endometriosis is a chronic inflammatory condition that can result in chronic pain through complex nociceptive, neuropathic, and nociplastic pathways. This article provides a comprehensive background on endometriosis as well as future directions in diagnosis and management. The diagnosis of endometriosis is explored, including novel imaging techniques, biomarkers, and the integration of artificial intelligence. The medical management of endometriosis is reviewed, including a focus on new nonhormonal treatment options. Surgical treatments are reviewed along with surgical outcomes. We discuss nonpharmaceutical and behavioral interventions with growing interest. Finally, this article reviews future directions in endometriosis care, including precision medicine and AI.

Embryo implantation critically depends on the establishment of endometrial receptivity, which is governed by progesterone-driven stromal decidualization during the mid-secretory phase. In recurrent implantation failure (RIF), this process is frequently disrupted, yet the molecular mechanisms remain unclear. Here, through integrative analysis of bulk and single-cell transcriptomic datasets, we identified nicotinamide N-methyltransferase (NNMT) as one of the most significantly downregulated genes in the endometrium of RIF patients. Temporal profiling of human endometrial samples across the menstrual cycle revealed progressive upregulation of NNMT from proliferative to secretory phase, while in hormonally induced stromal cell differentiation, NNMT expression rose sharply from day 4 onward. Functional assays demonstrated that NNMT knockdown impaired decidualization, as evidenced by reduced expression of PRL and IGFBP1 and attenuated cytoskeletal reorganization. Mechanistically, NNMT deficiency increased intracellular S-adenosylmethionine levels, enhanced the expression of core PRC2 components, and promoted H3K27me3 enrichment at the promoters of decidual genes, consistent with their transcriptional repression. Pharmacologic inhibition of histone methylation by 3-deazaneplanocin A or selective EZH2 inhibition by GSK126 partially rescued both molecular and morphological defects in NNMT-deficient stromal cells. In vivo, uterine NNMT silencing in pregnant mice also increased H3K27me3 level, reduced the expression of decidualization-related genes, and decreased the number of implantation sites. Collectively, our findings identify NNMT as a metabolic-epigenetic regulator of endometrial receptivity, and support its potential as a candidate biomarker for RIF.

Angiomatosis is a rare benign vascular lesion characterised by diffuse, haphazard proliferation of blood vessels, most commonly within adipose and fibrous tissue. This report describes the case of a patient in her early 30s who presented with refractory menorrhagia and pelvic pain. Following total laparoscopic hysterectomy with bilateral salpingectomy, histopathological examination identified angiomatosis of the uterine corpus and cervix. This finding is exceptionally rare, with only five cases reported in the literature. Conventional investigations, including ultrasonography and hysteroscopy, may be inadequate, with definitive diagnosis often established only on postoperative histopathological analysis. Medical management appears largely ineffective in symptom control, with most reported cases resulting in hysterectomy. Given the limited number of reported cases, the natural progression of this condition is largely unknown, and postoperative surveillance may be warranted.

To review the impact of uterine fibroids on women's sexual health and to highlight this often underreported aspect of clinical care. A narrative review of the literature on uterine fibroids and female sexual dysfunction. Uterine fibroids are the most common benign uterine tumors, significantly impacting women's sexual health, yet this issue remains underreported in clinical practice. Symptomatic patients often suffer from heavy menstrual bleeding and progressive anemia, which reduces their overall quality of life and sexual desire. Factors such as severe dyspareunia, pelvic pressure and psychological distress-including fear of pain and low self-esteem-further contribute to impaired arousal and orgasm. Although surgical interventions such as myomectomy and hysterectomy often improve sexual function by alleviating physical symptoms, outcomes can vary depending on the surgical technique and potential nerve damage. Clinicians should use validated tools to assess sexual health in women with uterine fibroids, which would lead to more comprehensive, patient-centered care.

The term 'endometrosis', coined in 1992 to describe chronic degenerative changes of the equine endometrium, is descriptively imprecise and readily confused with 'endometritis' and the human gynaecological condition 'endometriosis'. A modified four-round electronic Delphi (e-Delphi) process was conducted with an international panel of eight specialists to achieve consensus on a replacement term. Fifteen candidate terms were evaluated in Round 1 using a 7-point Likert scale and preference rankings; terms were retained if >50% of respondents scored ≥4/7. Round 2 (Refinement) evaluated shortlisted terms plus five panel-proposed new terms against a ≥75% threshold. Round 3 (Consensus Vote) presented six retained terms and four variants for a forced-choice ranking. The primary criterion (≥75% scoring ≥6/7) was not met by any individual term, therefore a pre-specified Round 4 binary vote resolved the outcome. 'Endometrosis' (proposed for retention by one panel member) was near-unanimously rejected in Round 2 (median 1/7; IQR 1-3). In Round 3, Chronic Endometrial Degeneration (CED) achieved the highest support (median 6/7; IQR 5-7; 71.4% scoring ≥6/7) and all seven respondents placed CED or its variant Chronic Equine Endometrial Degeneration (CEED) as their first preference. In Round 4, five of eight panel members (62.5%) selected CED. Chronic Endometrial Degeneration (CED) is recommended as the replacement term for 'endometrosis' in equine endometrial biopsy reporting, clinical practice and scientific publication. CED is well-suited as a consensus term; it is concise, broad and generates a memorable acronym. CEED is an accepted alternative where species specificity is required.

Endometriosis faces diagnostic delays due to the lack of tools for diagnostic evaluation. The value of miR-4677-3p combined with ultrasound in the diagnosis of endometriosis. 110 healthy subjects and 110 endometriosis patients were recruited. miR-4677-3p level was detected by qRT-PCR. Color Doppler ultrasound was used to measure uterine artery blood flow parameters. Pearson analysis was applied to explore the correlation between miR-4677-3p and blood flow parameters. ROC curve was used to evaluate the diagnostic value. Logistic regression analysis was performed to identify risk factors. miR-4677-3p serum expression in endometriosis patients was upregulated, EDV and PSV were decreased, while PI and RI were increased. miR-4677-3p level was negatively correlated with RI and PI, and positively correlated with EDV and PSV. miR-4677-3p has diagnostic value for endometriosis, with an AUC of 0.863. After combination with ultrasound parameters, the AUC increased to 0.925, indicating a superior diagnostic value for endometriosis. Aberrantly expressed miR-4677-3p, dysmenorrhea, and CA125 as risk factors. The combined application of serum miR-4677-3p and ultrasound parameters can improve the diagnostic efficiency of endometriosis, providing a clinical tool for the accurate identification of the disease.

Transgender and gender diverse (TGD) people with endometriosis have unique health needs. Current health research, policy, and clinical practice are developed within a biomedical and cisheteronormative paradigm that structurally excludes the TGD community, whose health needs remain largely unmet. This study aims to set an agenda for future research in the fields of endometriosis and gender diversity and to make recommendations for policy and practice through focus group methods. Twenty community members and professionals gathered for a two-day event at the Brocher Foundation in Switzerland. The group was heterogeneous in terms of gender, age, race, ability status, and professional background. On the first day, the participants gave twelve plenary presentations. On the second day, two plenary sessions and three parallel discussions in subgroups were facilitated. The data were analyzed through content analysis. Three main categories were identified: research, policy, and practice. Future studies should center the experiences of TGD people embodying different intersecting identities through transdisciplinary and community-based methods. The effects of gender-affirming care on endometriosis and the adequacy of endometriosis treatments for TGD people need to be further investigated. The education of healthcare providers is crucial to improve clinical practice, as well as a shift in health policy beyond cisheteronormativity.

To review recent evidence on the association between progestin exposure and meningioma risk and to propose practical recommendations for hormonal management in women requiring progestin therapy. A narrative review of studies published between 2015 and 2025 evaluating the relationship between exogenous progestins and meningioma development, growth, or progression was performed. Evidence regarding different progestin compounds, cumulative exposure, reversibility after discontinuation, and implications for gynecologic practice was analyzed. Meningiomas account for more than one-third of intracranial tumors and occur two to three times more frequently in women, supporting a potential hormonal influence mediated by progesterone receptors, which are expressed in most tumors. The increasing use of MRI has led to more frequent detection of incidental meningiomas in premenopausal women using progestins for contraception or gynecologic conditions such as endometriosis and heavy menstrual bleeding. Consistent associations with increased meningioma risk were observed for high-dose or prolonged exposure to cyproterone acetate, chlormadinone acetate, nomegestrol acetate, and medroxyprogesterone acetate. Risk appeared to increase with cumulative exposure and decrease after treatment discontinuation. Evidence for other progestins, including desogestrel, dienogest, levonorgestrel, and the levonorgestrel-releasing intrauterine system, remains limited and less conclusive. Women's health specialists should systematically assess a history of meningioma before prescribing progestins. In patients with incidental meningioma, discontinuation of high-risk progestins should be considered, followed by MRI reassessment within 3-6 months. When hormonal treatment remains necessary, the lowest effective dose and regular neuro-oncologic monitoring are recommended. Increased awareness and individualized counseling are essential to optimize hormonal management in women at risk of meningioma.

Endometriosis is a chronic inflammatory condition that causes significant physical and psychological distress. This study aimed to evaluate the therapeutic efficacy and safety of a combined oral contraceptive containing estetrol (E4, 14 mg) and drospirenone (DRSP, 3 mg) in managing endometriosis-related pain. A retrospective cohort study was carried out at the Endometriosis Center, Federico II University Hospital, Naples, from January 2024 to November 2024. Forty patients with diagnosis of endometriosis and significant pain symptoms (VAS > 6) were included and received E4/DRSP under a continuous regimen for 6 months. Chronic pelvic pain, dyspareunia, dysmenorrhea, and patient quality of life were assessed at baseline, after 3 and 6 months. In the group of patients with endometrioma, reduction in size was evaluated. E4/DRSP significantly reduced chronic pelvic pain and dyspareunia. Dysmenorrhea was resolved entirely due to amenorrhea induction. Endometriomas decreased in size by 30% on average after 6 months. Adverse effects were mild and occurred in 13/40 of patients (32.5%). E4/DRSP demonstrated efficacy and tolerability for managing endometriosis-related pain, offering a promising option for long-term treatment. Further research is needed to confirm its impact on lesion regression and disease progression.

To investigate whether ovarian endometrioma is associated with disruption of the endocrine-regulated transition between the anti-adhesive modulator podocalyxin (PCX) and the adhesive modulator leukemia inhibitory factor (LIF) in the endometrium. This cross-sectional study included 42 women (32 infertile, 10 fertile controls). Among infertile participants, 17 had ovarian endometrioma (EOC), seven had non-endometriotic cysts, and eight had prior infertility treatment failure. Endometrial tissue obtained via laparoscopy or hysteroscopy was analyzed in 30 women with mid- or late-luteal endometrium. PCX mRNA, PCX protein, and LIF mRNA levels were assessed using qRT-PCR and ELISA. LIF mRNA expression was significantly lower in the EOC group compared to all other groups (p < 0.001), while PCX mRNA and protein levels were higher (p < 0.001). Progesterone levels negatively correlated with PCX mRNA (r = -0.48, p = 0.007) and protein (r = -0.45, p = 0.012). LIF expression showed strong negative correlations with PCX mRNA (r = -0.81) and protein (r = -0.82) (p < 0.001). No associations were found with cyst characteristics. Ovarian endometrioma is associated with disruption of the PCX-LIF transition, suggesting impaired endometrial progesterone responsiveness.

This study aimed to investigate the mechanism of the involvement of USP33 in autophagic ferroptosis in endometriosis (EMs). Endometrial stromal cells (ESCs) were isolated from 15 healthy controls and 30 patients with EMs, which were designated NESCs and EESCs, respectively. Real-time PCR and Western blotting were utilized to determine USP33 expression as well as GPX4, LC3II/LC3I, NCOA4, FTH1, LAST1, p-LAST1, YAP, and p-YAP levels. Immunofluorescence was used to detect the colocalization of ferritin and LAMP2, as well as that of LC3 and ferritin. The levels of ROS, Fe 2+ , MDA, and GSH were measured to assess ferroptosis. An LDH assay was performed to evaluate cell death. A co-IP assay was implemented to identify the interaction between USP33 and LAST1 and detect the level of LAST1 ubiquitination. The stability of the protein was also detected via a cycloheximide (CHX) assay. USP33 was underexpressed in EMs patients. Loss of USP33 conferred resistance to ferroptosis in EESCs, as evidenced by increased proliferation; decreased levels of ROS, Fe 2+ , and MDA; elevated levels of GPX4 and GSH; and reduced cell death. In addition, USP33, which is localized in autophagosomes, was suggested to promote the degradation of ferritin in autophagosomes. Furthermore, USP33 repressed the Hippo-YAP pathway by suppressing LATS1 ubiquitination, thereby contributing to the reduced resistance of EESCs to ferroptosis. USP33 impedes the ubiquitination of LAST1 and represses the Hippo/YAP pathway, thus facilitating ferritinophagy and ferroptosis in EMs.

This scoping review aimed to systematically map the available evidence on the association between Mediterranean diet adherence and female sexual health and to explore potential biological and psychological mechanisms underlying this relationship. The review was conducted according to the methodological frameworks of Arksey and O'Malley, Levac et al., and the Joanna Briggs Institute. MEDLINE, Scopus, Web of Science, Embase, PsycINFO, and CINAHL were systematically searched, supplemented by manual reference screening. Reporting followed the PRISMA-ScR guideline, and methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Seven studies met the inclusion criteria. Overall, higher Mediterranean diet adherence was associated with more favorable female sexual health outcomes. Greater adherence was linked to lower rates of female sexual dysfunction and higher Female Sexual Function Index scores among women with type 2 diabetes; reduced deterioration in sexual function in randomized evidence; and improved lubrication, orgasm, and sexual satisfaction among women with severe obesity undergoing bariatric surgery. Favorable associations were also reported in women with inflammatory bowel disease and endometriosis, whereas in chronic liver disease, the initially observed associations were no longer statistically significant after multivariable adjustment. Proposed mechanisms included improved vascular and metabolic health, reduced inflammation and oxidative stress, and enhanced psychological well-being. Higher Mediterranean diet adherence was generally associated with more favorable female sexual function and well-being; however, the predominantly observational and cross-sectional nature of the evidence precludes causal inference. The limited evidence base highlights the need for high-quality longitudinal and interventional studies.

Endometriosis is a common gynecologic condition, characterized by the growth of endometrial-like epithelial and stromal cells at ectopic sites, most commonly within the peritoneal cavity. Disease symptoms associate poorly with lesion burden, and severe symptoms of endometriosis can occur in patients in whom lesions cannot be detected by surgical inspection or pathologic examination of excised biopsies. Anxiety and depression are prevalent in patients with confirmed endometriosis. Additionally, recent evidence highlights an increasing prevalence of cannabinoid-containing products for management of pelvic pain. This study aimed to examine these comorbid traits and cannabinoid-containing products use in patients with "clinically suspected endometriosis with negative pathology" (CSENP). This study used data collected through The Biologic and Epidemiologic Markers of Endometriosis (BEME) clinic-based study at a quaternary hospital in Los Angeles, California. 454 patients were included. After multivariable regression analysis, CSENP patients were at higher risk of depression compared to confirmed cases [adjusted odds ratio (aOR) 2.27; 95% confidence interval (CI) 1.03-5.03, p = .043]. Compared with women with endometriosis, controls were less likely to use cannabis for pain (aOR 0.32, 95% CI 0.16-0.64). Compared with patients with endometriosis, CSENP patients were also more likely to use cannabis for depression (aOR 1.92, 95% CI 1.01-3.65). Even in the absence of histopathologic confirmation of lesions, patients with pain symptoms similar to those found in endometriosis have similar patterns of anxiety and depression which may require long-term management. Long-term follow-up of CSENP patients will be valuable to optimize the best strategies for clinical care. Data presented for cannabis use should be interpreted with caution due to the observational nature of the data, lack of information on dosage, and concerns about known side-effects of long-term use.

Estrogen-only menopausal hormone therapy (MHT) is prescribed after hysterectomy; however, occult or residual endometriotic tissue may remain hormonally responsive. We report 2 women in whom endometriotic lesions were identified during or after long-term transdermal estrogen-only MHT after hysterectomy and bilateral salpingo-oophorectomy. The first patient was a 48-year-old woman treated for International Federation of Gynecology and Obstetrics 2009 stage IA, grade 1 endometrioid endometrial carcinoma at 44 years of age. Her estrogen-progestogen MHT for treatment-related premature ovarian insufficiency was changed to transdermal estrogen-only MHT. About 3 years later, she developed a progressively enlarging ileocecal mass, with resection revealing endometriosis. The second patient was a 54-year-old woman who had undergone hysterectomy and bilateral salpingo-oophorectomy for endometriosis at 46 years of age. She received transdermal estrogen-only MHT for approximately 6 years and was diagnosed with atypical endometrial hyperplasia in vaginal cuff endometriosis 1 year after estrogen withdrawal. These observations do not establish a causal relationship between estrogen-only MHT and lesion development. Occult disease, residual disease, or iatrogenic implantation remain plausible explanations. Nevertheless, these cases highlight that new abdominal masses or posthysterectomy vaginal bleeding during or after MHT warrant careful evaluation with histopathologic confirmation. MHT should be individualized according to current clinical guidelines.

Endometriosis (Ems) is a benign disease characterized by invasion and migration. Abnormally expressed mRNAs regulate its progression. In this study, we analyzed GEO datasets and identified significant upregulation of PDLIM3 in ectopic endometrial tissues. Our aim was to explore the role of PDLIM3 and its regulatory mechanisms in Ems progression. Using bioinformatics, we analyzed differentially expressed genes and treated endometrial stromal cells (ESCs) with modified PDLIM3 and PRMT1 expression vectors to assess their impact on Ems. We measured macrophage polarization markers and the secreted cytokines as well as the percentage of CD206-positive macrophages to evaluate the PDLIM3/NAA40/PRMT1 axis's influence on macrophage polarization. Also, we tested the impact of THP-1-derived macrophages (THP-1-DM) under different conditions on ESCs. An animal model was developed to study the effects of PDLIM3 carried by exosomes from ectopic ESCs (ecESCs-Exos) on macrophage M2 polarization and Ems progression. M2 macrophages enhance ecESCs proliferation and migration, with PDLIM3 delivered by exosomes from ecESCs inducing M2 macrophage polarization. Mechanistically, PDLIM3 binds to NAA40 to suppress its ubiquitination and thus stabilize its protein. Then, the enhanced NAA40 binds to PRMT1 promoter and promotes asymmetric dimethylation of H4 histone to activate PRMT1, hence driving M2 macrophage polarization. In turn, in vitro data showed that ecESCs-Exos-induced M2 macrophages via PDLIM3/PRMT1 axis further accelerates ESCs proliferation and migration. Moreover, in vivo data demonstrate that exosomal PDLIM3 accelerates Ems progression via contributing to macrophage M2 polarization. Exosomal PDLIM3 from ecESCs contributes to Ems progression by inducing M2 macrophage polarization. The findings provide new clues regarding the progression of Ems, which might be beneficial for developing new therapeutic targets for Ems patients.

Endometriosis-associated ovarian cancer is uncommon and is most often represented by endometrioid and clear cell carcinomas. Synchronous contralateral borderline ovarian tumours are uncommon and may be missed when gross intraoperative assessment is reassuring. A 43-year-old woman with a confirmed diagnosis of endometriosis for approximately 5 years presented with worsening pelvic pain and menstrual symptoms. A left ovarian endometrioma increased from 6.1 × 6.8 × 5.2 cm in April 2024 to 8.8 × 9 × 9.5 cm in April 2025, with subsequent MRI showing a complex mass with solid components (O-RADS MRI 5). CA-125 was 408.6 U/mL and CA 19-9 was 643.58 U/mL; RMI-I was 1225.8 (U = 3, M = 1, CA-125 = 408.6). Staging laparotomy was performed. Histopathology demonstrated grade 2 endometrioid adenocarcinoma arising in an endometriotic cyst of the left ovary, FIGO stage IC1, while the grossly normal-appearing right ovary contained a borderline seromucinous tumour with endometrioid differentiation. The omentum, peritoneal cytology, and all 31 sampled lymph nodes were negative for malignancy. Immunohistochemistry supported endometrioid carcinoma. This case highlights the importance of interval change and suspicious imaging features in an endometrioma, the limitations of gross intraoperative assessment of the contralateral ovary, and the value of complete histopathological examination in identifying synchronous bilateral ovarian pathology.

Cesarean-section scar endometriosis (CSSE) is an uncommon complication in which endometrial-like tissue develops along the route of prior cesarean delivery. Abdominal wall CSSE is the most recognized presentation, whereas involvement of the uterine cesarean scar is less well-characterized. This report describes the case of a 37-year-old woman (gravida 2, para 2) with two prior cesarean deliveries who presented with cyclic left lower quadrant pain and a tender abdominal wall mass. She underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingectomy, and excision of the abdominal wall mass. Histopathologic examination confirmed endometriosis involving both the abdominal Pfannenstiel scar and the lower uterine hysterotomy scar. This case demonstrates histopathologically confirmed endometriosis at two anatomically distinct cesarean-associated scar sites. Concurrent endometriosis may be underrecognized because uterine cesarean scars are not routinely sampled or specifically evaluated. CSSE should be considered in patients with prior cesarean delivery and cyclic incisional pain, even when preoperative imaging suggests benign pathology.

Associations between carbohydrate and fiber intake and endometriosis (EM) have been inconsistent, and no study has evaluated the combined effect of the carbohydrate-to-fiber ratio (CFR) or its inflammatory mechanisms. TThis cross-sectional study used data from two NHANES cycles (2003-2004 and 2005-2006), including 2,400 women aged 20-54 years. Weighted multivariable logistic regression assessed associations between CFR and physician-diagnosed EM, with restricted cubic splines used to identify non-linear relationships. The neutrophil percentage-to-albumin ratio (NPAR) was examined as a potential inflammatory mediator. CFR was positively associated with EM in all models (fully adjusted OR: 1.02, 95% CI: 1.01-1.04). A non-linear relationship emerged, with a turning point at CFR 17.3 (p for nonlinearity = 0.037): below this threshold, a one-unit increase in CFR raised EM odds by 11% (OR: 1.11, 95% CI: 1.00-1.22), while no significant association was observed above it (OR: 1.02, 95% CI: 1.00-1.04). The fully adjusted OR for the highest CFR quartile (≥23.1) was 2.17 (95% CI: 1.06-4.14). NPAR partially mediated the CFR-EM association (proportion mediated: 5.16%). Subgroup analyses showed a consistent positive association, with a significant interaction only for hypertension status ( p for interaction = 0.040). This study identifies a novel association between CFR and EM prevalence, partially mediated by NPAR. It is the first to apply CFR as a specific dietary measure, offering a clinically actionable tool for dietary assessment and patient counseling. Given the cross-sectional design, causal inference cannot be drawn, and prospective studies are needed to confirm these findings. CFR may be a useful dietary metric associated with EM prevalence, with a specific threshold of 17 for risk stratification.CFR offers a simple, actionable metric for dietary counseling that emphasizes reducing refined carbohydrates and increasing fiber intake.

Inguinal endometriosis is a very rare extrapelvic form of endometriosis, estimated to occur in only 0.3-0.6% of women with endometriosis. It mostly affects the right round ligament running inside the inguinal canal. Its symptoms, an intermittent, cyclical right groin mass or pain, can very easily be confused with an inguinal hernia, which results in patients not being diagnosed on time or being operated on inappropriately. Here we present a 38-year-old female patient with repeated episodes of gradually worsening and relieving right inguinal pain, in whom ultrasound and magnetic resonance imaging (MRI) findings were highly suggestive of inguinal endometriosis. Laparoscopic excision of the lesion together with the involved round ligament segment was performed, and histopathological examination confirmed the diagnosis, rather than management as a simple hernia.

This article examines gynecological decision-making in clinical contexts where interventions carry significant implications for fertility and future reproductive possibilities. Conditions such as uterine fibroids, endometriosis, and ovarian cysts are commonly managed through treatments that differ in their potential impact on reproductive capacity, introducing an ethical dimension beyond immediate symptom management. This proposes a theological-bioethical framework of clinical discernment as a conceptual supplement to shared decision-making in reproductive healthcare. Drawing primarily on Karol Wojtyla's personalist philosophy, it advances an account of the human person as an irreducible moral subject whose embodied life carries existential and relational significance. Clinical discernment is understood as a structured ethical orientation that enhances standard biomedical reasoning by integrating attention to value-laden dimensions of fertility-related care. The framework articulates hope as an ethically relevant category referring to the openness of the patient's future possibilities, and fertility as a dimension of embodied personhood with relational meaning beyond biological function. On this basis, the article outlines a fertility-sensitive approach to gynecological care emphasizing proportionality in intervention, clarity and responsibility in risk communication, and holistic patient accompaniment. The paper concludes that integrating clinical discernment into gynecological decision-making offers a philosophically and theologically grounded enrichment of contemporary reproductive healthcare by aligning biomedical practice with a personalist account of moral agency, embodied dignity, and future-oriented care.

Girls with Cerebral Palsy (GCP) face unique difficulties during adolescence, particularly related to menstruation and reproductive health, which are compounded by caregivers' limited knowledge and preparedness. Educating caregivers may improve the management of menstrual and reproductive health concerns in GCP. Hence, this study was conducted to assess the effect of a Reproductive Health Education (RHE) intervention on knowledge and reproductive health-related caregiving intentions among caregivers of GCP in India. A single-arm pre-test-post-test pilot intervention study. The study was conducted among caregivers of GCP attending a weekly CP clinic at a tertiary care hospital in South India. Participants were recruited consecutively within a predefined time frame. The intervention consisted of a one-on-one education session, guided by a validated Information, Education and Communication (IEC) material. Knowledge and reproductive health-related caregiving intention were assessed before and 3 months after the intervention using a structured questionnaire. Paired t-tests were used to compare outcomes before and after the intervention. A total of 25 caregivers were included. A significant improvement in both knowledge and caregiving intention was observed following the intervention. Mean knowledge score increased from 41.2 ± 4.66 to 62.3 ± 1.77 (p < 0.001, 95% CI of mean difference = 19.5-22.7), and the mean caregiving intention score rose from 41.2 ± 4.02 to 57.6 ± 1.78 (p < 0.001, 95%CI of mean difference = 15.1 -17.7). The corresponding paired Cohen's d value was larger (Cohen's d = 5.43 for knowledge; 5.22 for caregiving intention). The study provides preliminary evidence on the effect of a brief tailored RHE intervention on knowledge and reproductive health-related caregiving intention among caregivers of GCP. Causal inference is limited by the single-arm design of the study.

This meta-analysis aimed to evaluate the association between endometriosis (EM) and cardiovascular disease (CVD) risk by synthesizing evidence from large-scale cohort studies, with emphasis on subtype-specific risks and geographic disparities. We systematically searched PubMed, Embase, and Cochrane Library for cohort studies published until December 2024. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses stratified CVD subtypes (e.g. ischemic heart disease, atrial fibrillation), continents, and country development levels. Heterogeneity and publication bias were assessed via I 2 statistics, sensitivity analyses, and Egger's test. Eleven cohort studies ( n = 3,100,610 participants) were included. EM was associated with a 22% increased risk of all-cause CVD (HR = 1.22; 95% CI: 1.08-1.38; I 2 = 94.6%). Subgroup analyses revealed elevated risks for myocardial infarction (HR = 1.29; 95% CI: 1.10-1.50), coronary artery disease (HR = 1.47; 95% CI: 1.29-1.67), and cerebrovascular events (HR = 1.18; 95% CI: 1.12-1.25), but not heart failure. Geographic disparities were significant, with higher CVD risks in Asian (HR = 1.36; 95% CI: 1.25-1.48) and North American cohorts (HR = 1.37; 95% CI: 1.16-1.61) compared to European populations (HR = 0.93; 95% CI: 0.64-1.34). EM is independently associated with an elevated risk of CVD, particularly for coronary artery disease and myocardial infarction. These findings underscore the need for targeted cardiovascular monitoring in EM patients, particularly in high-risk populations.

To describe clinical intrauterine insemination (IUI) outcomes among infertile patients with different infertility indications, and further compare reproductive outcomes between natural cycle (NC) and ovarian stimulation cycle (OSC) IUI. A total of 1451 infertile couples that underwent their first IUI cycle with husband sperm were included in this retrospective cohort study. The clinical pregnancy rates and live birth rates were compared between NC and OSC by diverse infertility indications. A total of 833 NC-IUI and 618 OSC-IUI cycles were available for analysis. Logistic regression showed patients with ovulatory disorder had significantly higher clinical pregnancy (21.99% vs 14.15%; AOR 1.992, 95% CI 1.207-3.288) and live birth rates (18.67% vs 11.51%; AOR 2.326, 95% CI 1.312-4.124), along with a higher preterm birth rate ( p = 0.032) when compared to the normal ovulation group. Among normal ovulatory patients, NC-IUI achieved higher clinical pregnancy rate than OSC-IUI in endometriosis (12.70% vs 8.00%), tubal infertility (16.67% vs 7.14%), and male factor group (15.92% vs 9.40%, p = 0.047), with similar live birth trends. For unexplained infertility, OSC‑IUI presented higher clinical pregnancy (20.51% vs 12.89%, p = 0.205) and live birth rates (12.82% vs 11.11%, p = 0.970), without statistical significance. Ovulatory disorder was independently associated with favorable IUI outcomes. For patients with endometriosis, tubal factor infertility and male factor infertility, NC-IUI showed a potential trend of clinical applicability, while OSC-IUI tended to be more suitable for unexplained infertility; however, these subgroup differences did not reach statistical significance and warrant further validation in larger cohorts. Ovulatory dysfunction serves as an independent favorable factor for IUI clinical outcomes.Natural cycle IUI may be considered a feasible option for patients with endometriosis, tubal, and male factor infertility.Ovarian stimulation cycle IUI could be a potential choice for those with unexplained infertility.

The concept of ferroptosis debuted as a newly defined programmed cell death in 2012. Among programmed cell death mechanisms, ferroptosis stands out as being fundamentally dependent on iron. At the heart of this mechanism lies the progressive accumulation of lipid peroxides - a chain reaction propelled by available iron, terminating when intracellular levels become fatally toxic. Inhibition of cystine transporters within cells (notably induced by compounds like Erastin) initiates a chain reaction: when intracellular levels of glutathione (GSH) become depleted, downstream suppression of glutathione peroxidase 4 (GPX4) activity impedes lipid peroxide clearance, whose accumulation drives the cell toward death upon exceeding a critical concentration. Early-stage experimental models highlight ferroptosis's contribution to propelling high-impact gynecological disease progression, namely precancerous endometrial hyperplasia, endometrial cancer (EC), endometriosis (EMS), and ovarian cancer (OC). Hence, elucidating the intricate regulatory machinery behind ferroptosis in gynecological pathologies bears both theoretical importance and translational promise. This review aimed to systematically synthesize current knowledge on ferroptosis in gynecological diseases and their associated regulatory mechanisms, offering insights relevant to both basic research and clinical application. The article may have systematically linked ferroptosis with various gynecological diseases for the first time, revealing both commonalities and differences in the regulatory networks of ferroptosis across different diseases.By integrating transcriptomics, proteomics, and other omics data, we developed a ferroptosis-related gene prognostic model for gynecological tumors, which may represent the first such effort in this fieldThe elucidation of the complex regulatory network governing ferroptosis in gynecological pathologies holds both theoretical significance and clinical translational promise, prompting this study to systematically integrate existing knowledge within this field.The article also emphasizes that in the early stages of ferroptosis research within gynecological diseases, it demonstrates substantial theoretical and clinical potential, especially in the realms of personalized therapy and precision medicine.Emphasis on ferroptosis’s role in personalized therapy and precision medicine, particularly through its modulation in high-impact gynecological diseases.