Ny forskning om jente- og kvinnehelse

This study aimed to evaluate whether COVID-19 vaccination increases the risk of postmenopausal bleeding requiring hospital care. We conducted a nationwide population-based study using the integrated database of the Korea Disease Control and Prevention Agency COVID-19 registry and the National Health Insurance Service claims data. Women aged 56 years or older who received their first COVID-19 vaccine dose before December 2021 and were newly diagnosed with postmenopausal bleeding during the observation period were included. A self-controlled case series design was applied to compare the incidence of postmenopausal bleeding during predefined risk periods (1-30 days after each vaccine dose) with that during baseline periods within the same individuals. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using conditional Poisson regression models. Among 8075792 women aged 56 years or older who received COVID-19 vaccination, 5716 were diagnosed with postmenopausal bleeding. There was no significant increase in the risk of postmenopausal bleeding within 30 days following vaccination (IRR 0.98, 95% CI 0.92-1.04). Results remained consistent in subgroup and sensitivity analyses across vaccine types, doses, and age groups. COVID-19 vaccination was not associated with an increased risk of postmenopausal bleeding requiring hospital care. These findings provide reassuring evidence supporting the safety of COVID-19 vaccines in postmenopausal women with respect to bleeding risk.

Maternal sleep health during pregnancy has been linked to children's physical growth. Understanding its effects on early childhood growth trajectories could help mitigate the impacts on children's metabolic health. This study aims to evaluate whether late-pregnancy sleep quality is associated with children's weight trajectories from age 0 to 2 years. This study used 2015-2026 data from 645 mother-child pairs in a prospective pregnancy cohort conducted in Los Angeles; analyses were performed in 2025-2026. Late-pregnancy sleep quality was assessed using the Jenkins Sleep Scale (range: 0-20). Early childhood weight and length were abstracted from medical records or measured during follow-up visits from ages 0 to 2 years. Weight trajectories as a function of age, with and without adjustment for Jenkins Sleep Scale, were estimated using generalized additive mixed models. This study included 645 mother-child pairs with a mean (SD) maternal age of 28.8 (5.9) years at study entry, and 51.5% of the children were female. Most mothers reported mild to moderate sleep disturbance (mean [SD] Jenkins Sleep Scale=8.0 [5.5]). Children whose mothers had poor sleep quality (≥75th percentile Jenkins Sleep Scale) had lower weight at the age of 0-6 months and greater growth thereafter, leading to significantly higher weights from ages 1 to 2 years than in children whose mothers had good sleep quality (25th percentile Jenkins Sleep Scale). Comparing children whose mothers had 90th percentile with those mothers had 25th percentile Jenkins Sleep Scale, at age 1 year, the difference in weight was 346.7 g (95% CI=102.3, 591.1 g), and the highest differences were observed at the age of 17 months (751.5 g, 95% CI=432.0, 1,070.9). Associations differed substantially by sex and preterm status but were not affected by childhood feeding practices. Poor late-pregnancy sleep quality was associated with different growth trajectories between ages 0 and 2, characterized by lower early weight status followed by accelerated growth and higher weight by ages 1-2.

Anxiety symptoms can undermine women's wellbeing and family functioning. This study examines the associated factors with moderate-to-severe anxiety symptoms and wealth-related inequalities among currently married women of reproductive age in Bangladesh. This cross-sectional study analyzed 13,438 currently married women aged 15-49 years from the Bangladesh Demographic and Health Survey, 2022. Survey-weighted multivariable logistic regression was used as the primary analytical model, supplemented by exploratory path analysis for assessing direct and indirect associations. Wealth-related inequality in anxiety symptoms was evaluated using concentration indices and decomposition analysis. The weighted prevalence of moderate to severe anxiety symptoms among currently reproductive married women in Bangladesh was 4.1% (95% CI: 0.04-0.05). Survey-weighted regression indicated that high endorsement of attitudes justifying intimate partner violence, older age, sexual inactivity, pregnancy termination, and having no children were associated with higher odds of anxiety symptoms. The concentration index indicated a pro-poor concentration of anxiety symptoms (CCI = -0.03068590), with education, body mass index, and number of children contributing to observed inequality. Exploratory path analysis showed small model-consistent indirect associations involving socioeconomic status, lifestyle, BMI, and number of children, but these estimates were interpreted cautiously as non-causal indirect associations. Anxiety symptoms were unequally distributed among married women of reproductive age in Bangladesh and were more concentrated among poorer women. The findings support the need for mental health, reproductive health, and gender-sensitive interventions targeting socioeconomically disadvantaged women. The exploratory path findings should be interpreted cautiously because the cross-sectional design does not establish temporal ordering or causal mediation.

AA is a crucial fatty acid in pregnancy, especially for the growth and development of the fetus and its central nervous system (CNS). As already discussed in the previous chapters, AA regulates inflammation, immune response, and cell signaling. AA has a modulatory action on gene expression, serves as a mechanotransducer, and regulates cell membrane fluidity. By regulating cell membrane fluidity, AA modulates the expression and binding of several receptors located on the cell membrane. Eicosanoids derived from AA have both beneficial and harmful effects on pregnancy. For instance, (i) AA metabolites such as 14,15-EET and 15-HETE are associated with gestational hypertension and preeclampsia, (ii) AA in association with DHA is crucial for the fetal nervous system and neurocognitive development of the newborn, and (iii) for the growth and development of the fetus, especially during the third trimester. LA and AA are involved in human fertility and in the pathobiology of gestational diabetes.

Maternal emotional well-being and lifestyle behaviors co-occur during the perinatal period, yet most studies examine them separately. Using data collected since 2019 from the Longitudinal Examination Across Prenatal and Postpartum Health in Taiwan, a prospective cohort of 539 mother-child dyads, we assessed maternal depressive symptoms, eudaimonic well-being, fruit and vegetable intake, physical activity, and sleep duration from early pregnancy to 2 years postpartum. Group-based multi-trajectory modeling identified co-occurring maternal profiles. Birth weight was analyzed with multiple linear regression, and repeated measures of child attention, aggression, internalizing symptoms, and suspected language delay (ages 2-5 years) with generalized estimating equations, adjusting for covariates. Four perinatal profiles emerged: holistic flourishing (perinatal-HF), lower behavioral engagement, higher well-being (perinatal-LBE-HWB), higher behavioral engagement, lower well-being (perinatal-HBE-LWB), and high-risk (perinatal-HR). Relative to perinatal-HF, the perinatal-HR profile was associated with higher attention problems (aβ = 0.75; 95% CI, 0.35-1.16), aggression (aβ = 5.34; 95% CI, 3.85-6.83), internalizing problems (aβ = 5.65; 95% CI, 4.12-7.19), and suspected language delay (AOR = 2.38; 95% CI, 1.23-4.61). Notably, mothers with preserved emotional well-being but lower behavioral engagement showed comparatively favorable child outcomes. In contrast, mothers with lower emotional well-being showed elevated child behavioral risk despite healthier behaviors. Distinct co-occurring maternal profiles were differentially associated with offspring development, supporting multidomain perinatal screening and interventions that prioritize maternal emotional well-being.

Pseudopregnancy presents a significant diagnostic challenge in dromedary camel reproduction. Reliable, minimally invasive biomarkers capable of distinguishing true pregnancy from pseudopregnancy are scarce. This study assessed the diagnostic potential of two acute-phase proteins, haptoglobin (Hp) and serum amyloid A (SAA), as biomarkers for accurately distinguishing between pregnant and pseudopregnant dromedary camels. Serum samples were taken from 18 pseudopregnant and 18 pregnant dromedary camels. Hp and SAA concentrations were measured and analyzed using receiver operating characteristic (ROC) curves. The pregnant camels had significantly higher Hp concentrations (9.02 ± 0.33 μg/mL) than the pseudopregnant camels (2.78 ± 0.30 μg/mL), with no overlap between the groups (P = 0.0001). In the ROC curve analysis, the area under the ROC curve (AUC) for Hp was 1.000 with a cut-off of ≥ 6.0 μg/mL, indicating 100% sensitivity and specificity. The SAA concentrations were significantly higher (P = 0.0003) in the pregnant camels (416.48 ± 34.88 μg/mL) compared to the pseudopregnant camels (191.37 ± 28.53 μg/mL), with some overlap. In the ROC analysis, SAA had an AUC of 0.877, with an optimal cut-off of ≥ 388.3 μg/L, demonstrating 66.7% sensitivity and 100% specificity. These findings indicate that Hp is a promising biomarker for differentiating pregnancy from pseudopregnancy in dromedary camels, while SAA may provide complementary diagnostic information.

Pregnancy outcomes after vitrified-warmed bovine embryo transfer (ET) remain variable, reflecting the influence of multiple field-derived factors. This exploratory study applied machine learning (ML) to predict pregnancy outcomes following vitrified-warmed bovine ET and identify field-derived variables contributing to the model-predicted probability of pregnancy. A total of 236 ET records were analyzed using recipient physiological, ovarian, reproductive management, and environmental and procedural variables. Although conventional statistical analysis identified significant differences only in lactation status and corpus luteum (CL) cavity, all field-derived predictors were retained for ML modeling. Six ML models were trained and internally evaluated using six-fold stratified cross-validation. Random forest showed the most balanced predictive performance, with modest discrimination (ROC-AUC = 0.703). SHapley Additive exPlanations (SHAP) analysis of the random forest model identified the temperature-humidity index (THI), CL volume, CL cavity, and lactation status as the main contributors to the model-predicted probability of pregnancy. SHAP dependence plots identified ranges associated with positive predictions, including THI of 58-77, CL volume ≥ 4.85 cm 3 , dominant follicle volume ≥ 0.79 cm 3 , body condition score of 3.0-3.5, and packaging-to-ET interval of 1.5-2.5 h. An exploratory artificial intelligence-based clinical decision support system prototype was also implemented to demonstrate individualized prediction output. These findings suggest that interpretable ML complements conventional statistical analysis by integrating multiple field-derived variables, including those with relatively low individual contributions, to support individualized pregnancy prediction after vitrified-warmed bovine ET. However, further validation using larger and independent datasets is needed to support future clinical or field application.

Pregnancy modulates the maternal thyroid to maintain endocrine and immune homeostasis. However, it remains unclear whether early pregnancy modulates thyroid hormone synthesis-related factors and autoimmune thyroid disease (AITD)-related inflammatory factors in the ovine thyroid. In this study, thyroid tissues were collected from ewes at day 16 of the estrous cycle (N16) and on days 13, 16, and 25 of pregnancy (G13, G16, and G25), and the mRNA and protein expression levels of these factors were examined by RT-qPCR, Western blot, and immunohistochemistry. The results showed that the expression of thyroid-stimulating hormone receptor increased gradually from N16 to G25, and thyroglobulin and thyroid peroxidase were significantly upregulated during pregnancy. In addition, sodium/iodide cotransporter mRNA and protein peaked at G16, and pendrin was elevated mainly at G13 and G16. However, dual oxidase 1 (DUOX1) was highest at G25, and DUOX2 peaked at G13. Furthermore, the expression of tyrosine-protein phosphatase non-receptor type 22 and tumor necrosis factor alpha peaked at G16, whereas B cell activating factor, retinoic acid receptor-related orphan receptor-γt, and interleukin (IL)-1α were reduced during pregnancy. Moreover, IL-17A mRNA and protein increased only at G25, and FOXP3 increased progressively from N16 to G25. In summary, early pregnancy modulates the expression of thyroid hormone synthesis-related factors and AITD-related inflammatory factors in a pregnancy stage-specific manner, which may be related to thyroid endocrine adaptation, immune homeostasis, and pregnancy establishment in ewes.

Recipients' gut microbiota and serum metabolites are linked to pregnancy outcomes in frozen embryo transfer (FET), but the underlying integrative mechanisms remain unclear. Here we compared the gut microbiome, serum metabolome, and reproductive hormones between pregnant (P group) and non-pregnant (N group) Small-Tailed Han ewes at three time points: prior to oestrus detection (1st), prior to embryo transfer (2nd), and prior to pregnancy diagnosis (3rd). Of 55 recipients, 24 became pregnant (43.6%). Beta-diversity of the gut microbiota partially separated P from N at 1st (R 2 = 0.0597, P = 0.159), 2nd (R 2 = 0.0330, P = 0.293), and 3rd (R 2 = 0.0062, P = 0.405). On the day of oestrus detection, Prevotellaceae UCG-001 was more abundant in the P group than in the N group (P < 0.05). On the day of embryo transfer, the opportunistic pathogen Escherichia-Shigella was enriched in the N group (P < 0.05). On the day of pregnancy diagnosis, the probiotic Lactobacillus was higher in the P group. Untargeted metabolomics identified 24, 24, and 33 stage-specific differential metabolites. Glycerophospholipid metabolism was consistently enriched across all stages. Notably, oleoyltaurine was a differential metabolite at both 2nd and 3rd (FC = 2.11 and 3.60, respectively; both P < 0.05). At oestrus, serum luteinizing hormone (LH) and prostaglandin E2 (PGE2) were significantly higher in the P group than in the N group (P < 0.05 for both). On the day of embryo transfer, cortisol and prostaglandin F2α (PGF2α) were markedly elevated in the N group (P < 0.01 for both). Microbiota-metabolite integration revealed that oleoyltaurine correlated negatively with Escherichia-Shigella (r = -0.51, P < 0.05) and positively with Lactobacillus (r = 0.64, P < 0.05). Adequate LH/PGE2 priming at oestrus was associated with a receptive peri-transfer period in ovine FET. This endocrine profile aligns with a distinct gut microbial succession and a systemic metabolomic signature, with oleoyltaurine emerging as a candidate metabolite putatively linking gut microbial shifts with systemic metabolic changes. These findings offer a basis for developing multi-target candidate biomarkers to improve recipient selection in sheep FET.

Recent evidence suggests that prenatal environmental factors, particularly maternal infection or maternal immune activation (MIA), may influence the progression of brain aging and lifetime risk for neurodegenerative disorders. The hypothesis is that even a short-lived inflammatory event during pregnancy may leave a lasting imprint on the developing brain and immune system of the fetus, such that aging or subsequent insults may later unmask neurodegenerative disorders. Support for this hypothesis comes largely from animal studies, where gestational inflammation has been shown to potentiate the onset of Alzheimer's and Parkinson's diseases (AD/PD), by increasing amyloid/tau pathology, reducing synaptic connections, and damaging nigrostriatal dopaminergic neurons. We review convergent mechanisms, including microglial priming, chronic cytokine excess, oxidative stress, epigenetic marks and proteostatic deficits, through which maternal immune activation may embed a latent "hit" that synergizes with aging to precipitate AD or PD. Furthermore, we appraise experimental models and available human data linking MIA to AD versus PD, noting shared and distinct pathways. Despite growing preclinical evidence, translation to human cohorts remains limited by heterogeneity in MIA exposure timing and outcome measures. An understanding of MIA's impact on neurodegeneration could suggest preventive strategies and interventions for early diagnosis and treatment.

Exercise may be an effective tool to improve symptoms and quality of life in those with endometriosis. However, the optimal dose to elicit such changes is unknown. This study will explore the critical threshold of exercise dose required to elicit symptomatic and biomarker changes in women with endometriosis, particularly for those who may be disadvantaged through spatial and aspatial factors. Fifty women with clinically confirmed endometriosis will be randomly allocated into one of four groups: a passive control, active control (yoga), short duration walking and yoga, long duration walking and yoga. Participants in the three active groups will complete 12 weeks of exercise. Symptom severity (chronic) and biomarkers will be assessed pre-post intervention; adherence, and symptom impact (acute) will be assessed each week.

The management of menstrual irregularities and/or endometrial thickening in reproductive-age breast cancer survivors (BCS) is debated, particularly during tamoxifen therapy, due to the impossibility of performing any hormonal screening. In this retrospective study, we evaluated the potential role of phyto-progestins, such as Dioscorea villosa (DV), Vitex agnus-castus (VAC), and Turnera diffusa (D) in this setting. We reviewed the clinical records of BCS of reproductive age with BRCA mutations who presented with oligo-amenorrhea and/or transvaginal ultrasound (TV-US)-detected endometrial thickening and were treated with phyto-progestins over the past five years. Patients were monitored every 6 months according to our surveillance program. The risk of BC recurrence was specifically assessed. We included a final group of 28 women (mean age: 44.0 ± 5.5 years). Of these, 57.1% presented with a baseline endometrial thickness > 10 mm. The treatment induced menstrual flow in all women except one (27/28, 96.4%) at a mean interval of 17.8 ± 2.4 days. At the subsequent TV-US check performed within 45 days of treatment, the endometrial thickness was < 5 mm in 100% of cases. The cyclical treatment was then used long-term, for a mean of 19.2 ± 15.5 months (mean satisfaction score: 7.8/10). After a mean follow-up of 42.2 ± 12.6 months, we recorded 3/28 (10.7%) loco-regional BC recurrences. A combination of DV, VAC, and D may represent a promising option for managing menstrual irregularities in BCS, with the potential for long-term use. The oncological safety of this treatment deserves further evaluation.

Endometriosis is benign, but it is associated with an increased risk of clear-cell and endometrioid ovarian carcinoma. Several multivariable prediction models have been developed to identify malignant transformation or differentiate endometriosis-associated ovarian cancer (EAOC) from benign ovarian endometrioma. It remains unclear whether these models are sufficiently validated and reported for clinical use. We searched PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, Scopus, CNKI, Wanfang, VIP, and SinoMed from inception to 24 May 2025. We included reports that developed or evaluated a multivariable model for endometriosis-associated ovarian malignancy. Two reviewers independently selected studies, extracted data with the CHARMS framework, and assessed risk of bias with PROBAST. Studies were grouped by clinical purpose and by evaluation stage. AUCs were pooled on the logit scale with restricted maximum-likelihood random-effects models only within clinically comparable groups. Adjusted ORs were pooled on the log scale when predictor definitions and reference categories were compatible. Eighteen reports describing heterogeneous model-development or model-evaluation studies were included. Logistic regression was the predominant modeling approach, whereas several studies evaluated nomograms, rule-based models, and machine-learning algorithms. In the exploratory stratified analyses, the pooled AUC was 0.907 (95% CI 0.874-0.932) for model-development or apparent-performance datasets and 0.915 (95% CI 0.880-0.941) for internal validation datasets. The two independent external or temporal evaluations were not pooled. Threshold-defined maximum tumor diameter (OR 1.85, 95% CI 1.64-2.08) and intratumoral blood flow (OR 3.90, 95% CI 1.73-8.80) showed positive pooled associations, whereas dysmenorrhea was not statistically significant. Calibration was inconsistently reported, and all included studies had an overall high risk of bias. Six reports presented calibration plots, two reported a Brier score, and seven presented decision-curve analysis; none reported a calibration intercept or slope. Current models often report high discrimination, but the supporting evidence is limited by high risk of bias, inconsistent calibration reporting, few independent validations, and geographic concentration. Routine use is premature. The most promising models should first undergo prospective external validation, calibration assessment, and evaluation of clinical net benefit in diverse populations.

Endometriosis (EMs) is a common gynecological disorder affecting reproductive‑aged women, characterized by ectopic endometrial growth and chronic pelvic pain that severely impairs quality of life. Although its pathogenesis remains incompletely understood, accumulating evidence indicates that the tumor suppressor p53 and aberrant epigenetic modifications play critical roles in EMs initiation and progression. p53 expression is significantly reduced in ectopic lesions, leading to apoptosis resistance and hyperproliferation of endometrial cells. Importantly, p53 dysfunction contributes to EMs through at least four epigenetic mechanisms: (1) p53 transcriptionally represses DNA methyltransferases (DNMTs), and its loss indirectly promotes locus‑specific hypermethylation and silencing of tumor suppressors; (2) p53, via its interaction with histone modifiers, influences their recruitment to target genes, and p53 impairment synergizes with histone deacetylase dysregulation to create a pro‑proliferative, anti‑apoptotic microenvironment; (3) p53 functionally interacts with the chromatin remodeler ARID1A, and their co‑dysruption impairs chromatin accessibility and immune homeostasis; (4) p53 coordinates non‑coding RNA networks (e.g. lncRNA MALAT1, miR‑34a) that regulate epithelial-mesenchymal transition, angiogenesis, and apoptosis. This review systematically summarizes the p53‑mediated epigenetic regulatory network in EMs and highlights potential therapeutic opportunities targeting p53-epigenetic crosstalk. Future studies should investigate synergistic mechanisms among different epigenetic layers and validate these findings in multi‑center clinical cohorts.

Premenstrual symptoms may negatively influence psychological readiness, cognitive-motor performance, and perceived exertion in female athletes. Rhodiola rosea (RR) is an adaptogenic herb that has been investigated for its potential effects on fatigue, stress tolerance, mood, and exercise-related outcomes. However, its effects on premenstrual symptoms and performance-related responses in female athletes remain unclear. This study aimed to investigate the effects of short-term RR supplementation during the estimated symptomatic premenstrual phase on premenstrual symptoms, peripheral serum serotonin and gamma-aminobutyric acid (GABA) concentrations, reaction time, perceived exertion, and aerobic performance-related indices in female taekwondo athletes with premenstrual syndrome (PMS). In this randomised, double-blind, placebo-controlled trial, 24 female taekwondo athletes with moderate-to-severe PMS symptoms were randomly assigned to receive either 500 mg/day of standardised RR extract ( n = 12) or placebo ( n = 12) for 10 days during the estimated symptomatic premenstrual phase. Premenstrual symptoms were assessed using the Premenstrual Symptoms Screening Tool (PSST). Visual reaction time, peripheral serum serotonin and GABA concentrations, time to exhaustion (TTE), estimated VO₂max, and rating of perceived exertion (RPE) were evaluated before and after the intervention. Data were analysed using analysis of covariance with baseline values as covariates. Compared with placebo, RR supplementation significantly reduced several PMS symptoms, including irritability, depression, anxiety, social withdrawal, decreased concentration, hypersomnia, food cravings, crying, skin problems, and abdominal pain ( p < 0.05). The RR group demonstrated faster reaction time compared with placebo (adjusted mean difference: -60 ms; p < 0.001). Peripheral serum serotonin and GABA concentrations were significantly higher in the RR group than in the placebo group ( p < 0.001). In addition, RR supplementation reduced post-exercise RPE (adjusted mean difference: -1.40 Borg units; p = 0.006). However, no significant differences were observed between groups in TTE or estimated VO₂max ( p > 0.05). Short-term RR supplementation during the estimated symptomatic premenstrual phase may improve selected PMS symptoms, visual reaction time, and perceived exertion in female taekwondo athletes with PMS. Larger trials with hormonal confirmation of menstrual cycle phase, longer intervention periods, direct physiological measurements, and sport-specific performance assessments are required to confirm these findings.

Intrauterine adhesions (IUA), particularly moderate to severe cases, is a leading cause of decreased menstrual flow and secondary infertility in women, affecting an estimated 2.8%∼46% of infertile women. Hysteroscopy remains the gold standard for diagnosis, with high sensitivity and specificity (both exceeding 90%), while three-dimensional ultrasonography offers a non-invasive alternative with a reported sensitivity of 86% and specificity of 90% for detecting intrauterine abnormalities. The success of surgical management via transcervical resection of adhesions (TCRA) is primarily gauged by the resumption of normal menstrual flow and the absence of significant adhesions on second-look hysteroscopy or ultrasonography. However, the high recurrence rate postoperatively, especially in severe cases (up to 60%), and the persistently thin endometrium significantly impair patients' reproductive outcomes. Existing adjuvant treatments such as high-dose oestrogen, uterine stents and hydrogels have failed to substantially improve patients' fertility outcomes. Platelet-rich plasma (PRP), as an autologous biological preparation rich in various growth factors, has demonstrated remarkable application prospects in recent years for the adjuvant and combined treatment of IUA due to its potent pro-angiogenic, anti-inflammatory and tissue repair/regeneration-promoting properties. This review aims to summarize the mechanisms and clinical efficacy of PRP as an adjuvant therapy for IUA, providing new perspectives for the comprehensive management of this condition. We explore the mechanisms of action and clinical outcomes of PRP monotherapy following IUA surgery and evaluate the safety and application advantages of PRP and autologous PRP. The mechanisms of the synergistic effects of PRP combined with mesenchymal stem cells(MSCs), uterine scaffolds and hydrogels, as well as the efficacy of these combination therapies, were discussed. In most studies, favourable feedback was obtained, while a few studies suggested that PRP alone or in combination failed to improve the reproductive outcomes of IUA patients. Current evidence suggests that PRP, both as a standalone and adjunctive therapy, shows promise in promoting endometrial regeneration and improving certain clinical outcomes, such as endometrial thickness and menstrual flow, in patients with IUA. However, the clinical efficacy remains inconclusive due to significant heterogeneity in study designs, patient populations and PRP preparation protocols. High-quality, large-scale randomized controlled trials with standardized methodologies and long-term follow-up are urgently needed to definitively establish its impact on critical reproductive outcomes, such as live birth rates, before its widespread clinical adoption can be recommended.

Recognizing normal and abnormal menstrual features is essential for the early detection of gynecologic conditions, facilitating timely medical care and preventing associated biopsychosocial impacts. However, there is limited information on menstrual cycle characteristics, clinical profiles, and education among menstruating adolescents in Puerto Rico, as well as how these factors relate to sociodemographic factors such as age, school type (public/private), region of residence (metropolitan/non-metropolitan and residential zone (urban/rural). This cross-sectional study was designed to assess the menstrual cycle characteristics, symptoms and dysregulations, self-reported menstrual conditions, and sources of menstrual education available to menstruating adolescents across Puerto Rico. An anonymous online survey designed by the study team was disseminated via social media, text messaging, and in collaboration with the Department of Education of Puerto Rico. Differences in the likelihood of receiving education, sources, trusted figures, and level of understanding and comfort regarding menstrual health topics and clinical outcomes (moderate-severe menstrual pain, emergency room (ER) utilization) based on sociodemographics factors were assessed by logistic regressions. Analysis of data from 1094 menstruating adolescents showed high rates of menstrual symptoms, particularly severe dysmenorrhea and cycle irregularities, with substantial impacts on daily life. Participants living in urban areas had higher odds of reporting prior menstrual health education. Older participants were more likely to receive information through school classes, social media, and physicians. Students in public schools had lower odds of reporting media and physicians as key sources or trusted contacts. Comfort discussing menstrual health topics increased with age, while perceived understanding of the menstrual cycle did not differ significantly across sociodemographic groups. Moderate to severe menstrual pain was not associated with sociodemographic factors, whereas ER visits varied by age, region, and school type that may determine access to care. This study revealed high prevalence of menstrual irregularities and pain among menstruating adolescents, emphasizing the need for improved menstrual health education and implementation of early intervention strategies. Significant disparities in education, trusted figures, comfort and ER utilization across demographics demonstrate the importance of tailoring menstrual health initiatives to address the unique needs of this population.

Adenomyosis causes severe dysmenorrhoea and menorrhagia. While the Levonorgestrel-Releasing Intrauterine System (LNG-IUS) is a highly effective conservative treatment, its success is frequently compromised by high expulsion rates (15%-37.5%) caused by uterine enlargement and cavity distortion. This review evaluates the principles, clinical efficacy, and safety of emerging intrauterine fixation techniques designed to prevent LNG-IUS downward displacement and expulsion. A comprehensive literature search was conducted across PubMed, Web of Science, and Google Scholar for articles published between January 2000 and February 2026. The review synthesised data from observational studies, retrospective cohorts, and controlled trials focusing on the surgical modification and stabilisation of the LNG-IUS in patients with adenomyosis. Current intrauterine fixation strategies are broadly classified into hysteroscopic suture fixation (utilising non-absorbable sutures to anchor the device to the myometrium) and non-suture fixation (encompassing combined frameless IUD fixation, device-modified anchoring, and direct tail-embedding). Current literature indicates that these techniques significantly reduced expulsion rates, generally to below 7%, compared to conventional placement failure rates that can exceed 30%. This mechanical stabilisation maintains the device's pharmacological efficacy, yielding sustained improvements in dysmenorrhoea and reducing menstrual blood loss. Nonetheless, these procedures introduce new clinical and safety challenges. Key concerns include off-label regulatory issues regarding manual device modification, altered sonographic imaging profiles, increased removal complexity requiring secondary hysteroscopic intervention, and theoretical long-term risks associated with myometrial micro-scars. Intrauterine fixation significantly mitigates LNG-IUS expulsion in adenomyosis. While highly effective, the manual and invasive nature of these techniques necessitates careful patient selection and rigorous safety monitoring. Future research must prioritise large-scale randomised controlled trials. Ultimately, clinical practice should transition from manual surgical modifications towards the standardised industrial development of next-generation LNG-IUS devices equipped with inherent anti-expulsion features. Adenomyosis is a painful condition where the lining of the womb grows deep into its muscle wall. This causes severe cramps, heavy menstrual bleeding, and makes the womb larger. A very effective treatment is a small, hormone-releasing device placed inside the womb to reduce bleeding and pain. However, because the disease changes the size and shape of the womb, the body often pushes the device out. When the device falls out, the painful symptoms quickly return.To solve this problem, doctors have developed new techniques to securely attach the hormone device directly to the inside wall of the womb. Instead of simply placing it inside, surgeons use small stitches or special anchors to hold the device in place.Our review looked at recent studies to see how well these new methods work. We found that stitching or anchoring the device stops it from falling out in almost all cases. This allows women to get long-lasting relief from heavy bleeding and pain without needing major surgery to remove their womb.While these techniques are very helpful, they require special surgical skills and may carry some risks, such as making the device harder to remove later. In the future, medical companies should design better hormone devices with built-in features that prevent them from falling out, so doctors do not have to rely on manual stitching or custom modifications.

Bacterial vaginosis (BV) is a common dysbiotic condition associated with adverse pregnancy outcomes, including preterm delivery, and its diagnosis remains challenging due to limitations of conventional methods and the lack of standardized molecular criteria. In this cross-sectional study, we evaluated the diagnostic performance of the Allplex™ Bacterial Vaginosis Plus assay, a multiplex real-time quantification polymerase chain reaction (qPCR), compared with Gram stain using the Ison-Hay criteria in a population of pregnant female, and explored optimal quantitative cut-off values for BV-associated bacteria (BVAB). A total of 90 pregnant female with a median age of 37 (95% CI: 35-38) years were included during the BV screening process. According to the Ison-Hay criteria, 6 patients (6.7%) were classified as BV (grade III), whereas the Allplex™ BV Plus assay identified BV in 19 patients (21.1%). Using Gram staining as the reference standard and considering intermediate flora/Gram grade II as negative, qPCR demonstrated a sensitivity of 100% (95%CI: 78-100%) and a specificity of 89.3% (95%CI: 79-95%), with a positive predictive value (PPV) of 40% (95%CI: 23-59%), and a negative predictive value (NPV) of 100% (95% CI: 92-100%). Agreement between methods was moderate (κ=0.53, 95%CI:0.35-0.71), and a statistically significant difference was observed (p < 0.05). Quantitative analysis showed that Gardnerella vaginalis (AUC = 0.93), Atopobium vaginae (AUC = 0.99), and Megasphaera type 1 (AUC = 0.87) exhibited strong discriminatory capacity. Lactobacillus spp. also showed good overall performance (AUC = 0.88) with high sensitivity but lower specificity, whereas BVAB2 (AUC = 0.55) and Mobiluncus spp. (AUC = 0.61) demonstrated poor diagnostic performance. The molecular assay tended to classify more cases as both normal flora and BV compared to microscopy, reflecting differences in diagnostic frameworks. Overall, qPCR demonstrated excellent performance for ruling out BV but a tendency to overestimate BV cases. These findings highlight the complexity of interpreting multiplex molecular results and support the use of combined diagnostic approaches. In clinical practice, qPCR may be particularly useful as a rule-out tool, while BV-positive results should be interpreted cautiously and in conjunction with microscopy and clinical findings. Further studies are needed to assess the clinical relevance of molecular diagnosis in relation to pregnancy outcomes.

This study aimed to investigate whether women with unilateral and bilateral OMA differ in anxiety symptoms, and secondarily in depressive symptoms and sexual dysfunction symptoms, and to evaluate the independent contribution of chronic pelvic pain to psychological outcomes. This study, a prospective, cross-sectional study, included 149 women aged 20-35 who had OMA but were not pregnant and had a desire to become pregnant. There were 79 women with unilateral OMA and 70 women with bilateral. The Zung Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Female Sexual Function Index were administered at enrolment. Multivariable linear regression models were adjusted for age, BMI, chronic pelvic pain, dysmenorrhoea, primary infertility, and medication use. Post-hoc power analysis was performed. The average age of the patients was 27.45 ± 3.44, with an average BMI of 19.46 ± 2.28. 29.53%(44/149) of the patients had mild or moderate anxiety, while 38.92%(57/149) had mild or moderate depression. Among the 103 patients with a history of sexual activity, 67.96%(70/103) had sexual dysfunction. In multivariable analyses, cyst laterality was not significantly associated with anxiety symptoms (adjusted B = -2.58[-5.19, 0.03], p = 0.052), depressive symptoms (adjusted B = -1.86[-5.25, 1.53], p = 0.279), or sexual dysfunction symptoms (adjusted B = -0.91[-2.01, 0.19], p = 0.072). Chronic pelvic pain independently predicted anxiety symptoms ( p = 0.01) and depressive symptoms ( p = 0.025). Post-hoc power analysis indicated an achieved power of 50% for the primary SAS comparison. In this study, the prevalence of anxiety, depression and sexual dysfunction was high in OMA, but there was no significant difference between unilateral and bilateral OMA. Chronic pelvic pain, rather than cyst laterality, independently predicted psychological distress. These findings underscore the importance of comprehensive pain assessment and routine psychological screening for all women with OMA.

Endometriosis (EMs) is a common gynecological disorder associated with infertility. EMs patients often require assisted reproductive technology (ART) but exhibit lower success rates. This study aimed to characterize the follicular fluid microbiome in EMs patients undergoing in vitro fertilization (IVF) and provide insights into mechanisms underlying lower pregnancy rates. Follicular fluid samples were collected from EMs patients and control subjectsundergoing IVF. Microbial DNA was subjected to 16S rRNA gene sequencing. Bioinformatic analyses, including alpha and beta diversity analysis, microbial composition profiling and biomarker identification, were performed. The follicular fluid microbiome in EMs patients exhibited altered alpha and beta diversity compared to controls. Distinct microbial compositions were observed at various taxonomic levels. Differentially abundant taxa were identified as potential biomarkers for EMs. Microbial profiles were associated with clinical parameters such as oocyte quality and fertilization rates. Models based on microbial profiles were constructed to elucidate the relationship between EMs and IVF outcomes. Functional predictions suggested alterations in metabolic pathways in the follicular fluid microbiome of EMs patients. This study revealed significant alterations in the follicular fluid microbiome of EMs patients, providing a basis for further research into the role of the microbiome in EMs-related infertility.

Lung injury is a frequent complication following heart failure (HF) due to systemic inflammation, hypoxia, and reduced cardiac function. This study compared the therapeutic effects of menstrual blood-derived stromal cells (MenSCs) and bone marrow-derived stromal cells (BMSCs) on HF-induced lung injury in rats. Twenty male Wistar rats underwent permanent ligation of the left anterior descending coronary artery to induce myocardial infarction (MI). They were randomly assigned to receive intravenous injections of MenSCs (2 × 10 6 cells), BMSCs (2 × 10 6 cells), or PBS 7 days post-MI. Cardiac function was assessed by echocardiography, and lung tissues were analyzed 28 days post-cell administration. Histopathology (H&E and Masson's trichrome staining) evaluated pulmonary structural changes and fibrosis, TUNEL assay assessed apoptosis, and immunohistochemistry measured NF-κB and iNOS expression. Results showed that MenSC treatment significantly improved left ventricular ejection fraction compared with MI and BMSC groups (both P < 0.0001 ). MenSCs markedly reduced pulmonary injury scores and apoptotic cell numbers compared with both untreated and BMSC-treated rats (P < 0.0001 ). Both cell types reduced pulmonary fibrosis compared to MI (P < 0.0001 ). Both MenSCs and BMSCs similarly reduced NF-κB expression, whereas only MenSCs effectively decreased iNOS expression (P < 0.0001 ). Human mitochondrial antibody staining confirmed successful homing of both cell types to injured lung tissue. systemic administration of MenSCs effectively ameliorated HF-induced lung injury through anti-inflammatory, anti-apoptotic, and anti-fibrotic mechanisms. Compared with BMSCs, MenSCs demonstrated superior therapeutic potential, highlighting their promise as a non-invasive and immunologically favorable cell source for regenerative therapy in remote organ injury following MI.

Hyperandrogenic insulin-resistant states, most commonly polycystic ovary syndrome (PCOS) and severe phenotypes such as HAIR-AN syndrome, are characterized by metabolic dysfunction, androgen excess, and reproductive disturbance. Insulin resistance is a central pathogenic driver and therapeutic target. To systematically evaluate the effects of glucagon-like peptide-1 (GLP-1) receptor agonizts on metabolic, hormonal, and reproductive outcomes in adult women with hyperandrogenic insulin-resistant states. Data Sources and Study Selection: A systematic search identified randomized controlled trials, observational studies, and case series evaluating GLP-1 receptor agonizts in PCOS and HAIR-AN syndrome, reflecting the heterogeneity of the current evidence base.Data extraction and synthesis Outcomes were synthesized across metabolic (anthropometric and glycaemic), hormonal, reproductive, dermatologic, and safety domains, accounting for heterogeneity in interventions and study designs. Metabolic responses appeared more consistent and robust than endocrine outcomes. Reproductive outcomes such as menstrual regularity were variably reported and showed inconsistent improvement across studies, limiting firm conclusions regarding fertility-related benefit. Evidence in severe phenotypes remains limited but suggestive of clinical benefit. GLP-1 receptor agonizts are a promising adjunctive therapy in hyperandrogenic insulin-resistant states, with the strongest evidence for metabolic improvement. Reproductive and endocrine outcomes remain less consistent, likely reflecting heterogeneity in study design, populations, and outcome reporting. Further high-quality, phenotype-specific trials are required.

Endometriosis is a heterogeneous inflammatory condition that may influence long-term metabolic health. Prior studies have reported largely null associations with type 2 diabetes, potentially missing subtype-specific and subgroup heterogeneity. We investigated the association between endometriosis, including clinically relevant subtypes, and incident type 2 diabetes, and assessed effect modification by menopausal status, BMI and history of gestational diabetes mellitus. We assembled a dynamic population-based cohort of 2,939,364 individuals assigned as female at birth from the Utah Population Database (1996-2021). Endometriosis and subtypes were identified using validated ICD-9/10 codes and modelled as time-varying exposures. Incident type 2 diabetes was ascertained using ICD codes. Cox proportional hazards models with calendar time as the time scale were used to estimate HRs and 95% CIs, adjusting for birth year, birth state, race/ethnicity, age and BMI at cohort entry. Stratified analyses evaluated effect modification by menopausal status, BMI and history of gestational diabetes mellitus. During a mean follow-up duration of 10.8 years, 99,978 women were diagnosed with endometriosis. Endometriosis was associated with a 46% higher risk of type 2 diabetes compared with no endometriosis (aHR 1.46; 95% CI 1.43, 1.50). Risk varied by subtype, with the strongest associations observed for 'other site' endometriosis (specified site: aHR 2.67; 95% CI 2.51, 2.84; unspecified site: aHR 2.47; 95% CI 2.35, 2.60). Associations were stronger among premenopausal women than postmenopausal women (aHR 1.55; 95% CI 1.50, 1.60) and those with BMI <30 kg/m 2 than those in higher BMI categories (aHR 2.39; 95% CI 2.34, 2.44), and were present regardless of history of gestational diabetes mellitus. Endometriosis was associated with increased type 2 diabetes risk, with substantial heterogeneity by subtype and metabolic context. Associations were strongest among individuals who are traditionally considered at lower baseline risk, although these findings should be interpreted cautiously given the potential for residual confounding and detection bias.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have rapidly expanded in use for the treatment of obesity and type 2 diabetes, including among women of reproductive age. Emerging evidence suggests that GLP-1 signaling may influence reproductive physiology through central effects on the hypothalamic-pituitary-ovarian axis and indirect metabolic pathways. In women with polyendocrine metabolic ovarian syndrome (PMOS), GLP-1 RAs improve insulin resistance and androgen profiles and may improve menstrual regularity. Most GLP-1 RAs do not significantly affect oral contraceptive pharmacokinetics, although tirzepatide may require temporary backup contraception. Evidence regarding fertility outcomes and pregnancy safety remains limited.

Endometriosis is heterogeneous, and evidence for individualised postoperative management is limited. We assessed whether postoperative hormonal therapy exposure is associated with one-year changes in pain domains after first-time endometriosis surgery and explored factors related to treatment allocation. Retrospective cohort study (Erlangen, 09/2019-06/2024) of premenopausal women (18-45 years) undergoing first minimally invasive surgery for endometriosis-associated pain with one-year follow-up. Patients were classified into four hormonal therapy (HT) patterns based on baseline and follow-up status: HT none ( n = 73), HT initiation ( n = 57), HT discontinuation ( n = 21), and HT continuation ( n = 38). For each pain domain, adjusted analysis of covariance (ANCOVA) models estimated one-year follow-up Numeric Rating Scale (NRS) differences, and therapy-group effects were tested using robust Wald omnibus tests with Holm multiplicity adjustment across domains, and post-hoc contrasts were Holm-adjusted within domains and interpreted only for domains with significant omnibus tests. HT-group membership was analysed using multinomial logistic regression. After multiplicity adjustment across domains, therapy-group differences were observed only for dysmenorrhoea/pelvic pain ( p < 0.001). Within this domain, only HT initiation was associated with lower one-year follow-up scores versus HT none (adjusted difference -2.39 NRS points, 95% confidence interval (CI) -3.58 to -1.21; p < 0.001), whereas other contrasts were not significant after within-domain multiplicity correction. No domain-level evidence of between-group differences was found for dyspareunia, dysuria, or dyschezia. Younger age was associated with HT initiation (odds ratio (OR) 0.92, 95% CI 0.86-0.98; p = 0.012) and continuation (OR 0.82, 95% CI 0.74-0.91; p < 0.001). HT initiation was associated with lower one-year dysmenorrhoea/pelvic pain scores, while other domains showed no consistent differences. Younger patients were more likely to initiate or continue hormonal therapy, suggesting non-random allocation. Given the observational design and potential residual confounding, findings are hypothesis-generating and support symptom-profile-guided postoperative management; prospective studies with standardised regimens and domain-specific outcomes are needed. Endometriosis can cause different kinds of pain. This may include period-related pain in the lower abdomen (pelvic pain), pain during sex, pain when passing urine, and pain during bowel movements. Surgery can remove visible endometriosis lesions. Many women are advised to use hormone treatment, but it is not clear whether this helps all types of pain in the same way. We looked at information from women aged 18–45 years who had their first keyhole surgery for endometriosis-related pain and completed a follow-up questionnaire one year later at our specialist centre in Erlangen, Germany. We compared four groups: women who did not use hormone treatment at all, women who started hormone treatment after surgery, women who stopped hormone treatment by the one-year follow-up, and women who used hormone treatment both before surgery and at follow-up.Most women reported that their symptoms improved one year after surgery. When we compared the groups, the clearest difference was for period-related lower abdominal pain: women who started hormone treatment after surgery improved more than women who stopped hormone treatment or did not use it. For pain during sex, urination, or bowel movements, we did not see the same pattern. Younger women were more likely to start or continue hormone treatment. Because this study looked back at existing records rather than assigning treatments, we cannot prove that hormone treatment caused the improvement. Overall, hormone treatment after surgery may be most helpful for period-related pelvic pain, while other pain symptoms may need additional or different approaches.

Millions of women of reproductive age suffer from endometriosis, a chronic, estrogen-driven condition that causes pelvic pain, dysmenorrhea and infertility. Conventional therapy focuses on symptom suppression with hormone medications or the surgical excision of lesions; however, it is not curative. Recent developments in the understanding of the pathophysiology of endometriosis have revealed novel immunological and molecular mechanisms that are being used in experimental therapies. The present review outlines developing techniques, including targeted endocrine modulators, epigenetic treatments, anti-inflammatory and immunomodulatory drugs, antioxidants, anti-angiogenic medicines, and microbiome-based therapy. Prominent examples are new oral gonadotropin-releasing hormone receptor antagonists, selective progesterone receptor modulators and aromatase inhibitors that aim to overcome progesterone resistance. Alternative methods, such nutraceuticals and biologic and small-molecule inhibitors (such as metabolic drugs and anti-cytokine therapies) are being explored. Novel supplemental options are provided by device-based neuromodulation and improved surgical techniques (such as advanced laparoscopy, robotic excision, image-guided surgery, nerve-sparing techniques and adhesion barriers). While many of these innovations are promising, current evidence is limited by small studies and disease heterogeneity. Future directions emphasize rigorous trials with standardized outcomes, including fertility measures and combinations of therapies to achieve personalized, long-term relief.