Ny forskning om jente- og kvinnehelse

Endometriosis (EMs) is a chronic gynaecological condition characterised by the ectopic growth of endometrial tissue; however, its molecular mechanisms remain insufficiently understood. Ferroptosis, an iron-dependent form of regulated cell death, has been suggested as a potential contributor to its pathogenesis. This study aimed to identify differentially expressed ferroptosis-related genes (DE-FRGs) in EMs through bioinformatics analysis and to explore their underlying molecular mechanisms. The gene expression datasets GSE7305 and GSE25628 were obtained from the GEO database. Ferroptosis-related genes (FRGs) were extracted from the FerrDb database. DE-FRGs were identified by intersecting differentially expressed genes (DEGs) with FRGs across the two datasets. Protein-protein interaction (PPI) networks were constructed using STRING and Cytoscape software, while core genes were identified through the cytoHubba plugin. Functional enrichment analysis was performed via the KEGG pathway. A total of 11 DE-FRGs were identified, all of which demonstrated consistently upregulated expression in EMs tissues across both datasets. Four core genes - GATA6, KLF2, BGN and AEBP1 - were selected for further analysis owing to their significant enrichment. KEGG analysis indicated that these genes were particularly enriched in the 'taurine and hypo-taurine metabolism' and 'muscle cell cytoskeleton' pathways. This study identified GATA6, KLF2, BGN, and AEBP1 as potential core genes associated with ferroptosis in EMs, highlighting their roles in metabolic and cytoskeletal pathways. These findings provide a novel perspective on the pathogenesis of EMs and suggest new therapeutic targets that warrant further experimental validation. Endometriosis is a prevalent condition characterised by the growth of tissue resembling the endometrium outside the uterus, resulting in pain and infertility. This study employed computational techniques to analyse genetic data and identified four pivotal genes that may affect a cell death process referred to as ‘ferroptosis’ in endometriosis. These genes are associated with metabolic and cellular structural alterations. Elucidating the functions of these genes will facilitate the development of novel therapeutic approaches for treating endometriosis in the future.

Dysmenorrhea is highly prevalent and undertreated, substantially impairing quality of life in reproductive-age individuals. Excessive uterine contractility is widely considered a key mechanistic contributor to menstrual pain. We conducted a systematic search of PubMed and Embase from inception to 24 July 2024 using MeSH and Emtree terms related to dysmenorrhea, uterine contractions and pharmacologic therapy. We included English-language human clinical trials in non-pregnant, reproductive-age participants with primary dysmenorrhea evaluating drugs intended to reduce uterine contractions and menstrual pain, compared with placebo or pre-treatment baseline. Two reviewers independently extracted data using a piloted Cochrane-based form; risk of bias was assessed using RoB 2 and ROBINS-I with disagreements resolved by consensus. Across 25 eligible trials (447 participants), nonsteroidal anti-inflammatory drugs (NSAIDs) most consistently reduced both menstrual pain and uterine contractions. Smaller trials suggested potential benefits for additional pharmacologic classes, including prostaglandin synthesis inhibitors, vasopressin antagonists, beta-adrenergic agonists, combined oral contraceptives, calcium channel blockers, and selective estrogen receptor modulators, whereas oxytocin antagonists showed mixed results. Risk of bias was low in nine studies, moderate in 12, and high in four. These findings support that established therapies for dysmenorrhea (NSAIDs and hormonal contraception) reduce pain and uterine activity, and suggest that other contractility-targeting agents warrant further rigorous evaluation, particularly given meaningful non-response to NSAIDs. PROSPERO registration: CRD42023442828 (registered 24 July 2023).

Endometriosis is a chronic, systemic condition affecting 5-10% of individuals assigned female at birth. Due to its non-specific symptoms, diagnosis is often delayed. This study aims to explore diagnostic challenges and decision-making processes that general practitioners (GPs) encounter when managing patients with symptoms suggestive of endometriosis in Denmark. A qualitative research approach was employed, incorporating the co-production of three fictional clinical vignettes representing diverse endometriosis presentations. Semi-structured interviews were conducted with 27 practicing GPs (7 males and 20 females) from urban and rural areas. Participants had a mean age of 50 years (range 41-66) and clinical experience ranging from newly qualified to 27 years. Interviews involved engagement with the vignettes, and data were analysed using thematic analysis. Findings reveal the challenge of the non-specific nature of symptoms, the role of cyclical symptom patterns in diagnosis, the influence of diagnostic hierarchies, patient-centred care approaches, the bio-psycho-social perspective in management, the persistent stigma surrounding gynaecological symptoms, and GPs limited trust in general gynaecologists. GPs were more likely to suspect endometriosis when symptoms followed a cyclical pattern, whereas gastrointestinal presentations were less commonly linked to the condition. While many GPs adopted a patient-centred, shared decision-making approach, some still adhered to mind-body dualism in their clinical reasoning. Diagnosing endometriosis in primary care is challenging due to non-specific symptoms, diagnostic hierarchies, and stigma. Encouraging GPs to routinely inquire about the cyclical nature of symptoms may serve as a valuable diagnostic tool, particularly in cases involving gastrointestinal complaints.

Patients with endometriosis have greater risk of infertility, which is associated with compromised ovarian function. Dysfunction in follicular granulosa cells and hyperactivation of oestrogen receptor beta (ERβ) are evident in endometriosis. It is also known that anti-Müllerian hormone (AMH)/Smad signalling pathway regulates ovarian activity. In this study, we aimed to explore effects of oestradiol (E2)/ERβ on follicular granulosa cells and on AMH/Smad signalling in endometriosis. The human ovarian granulosa cells were obtained from patients with tubal factor infertility and ovarian endometriosis, respectively, who underwent IVF/ICSI-ET using GnRH antagonist protocol in our hospital. A human ovarian granulosa tumour cell line (KGN) was cultured and subject to treatments with oestradiol and/or PHTPP (a selective ERβ antagonist). Cell viability, apoptosis, migration, and invasion were assessed. The mRNA and protein expressions were also investigated. It was found that AMH/Smad signalling pathway was suppressed in human ovarian granulosa cells in patients with ovarian endometriosis. Then, in KGN cells, E2 treatment (10 -10 mol/L for 72 h) did not alter cell viability or apoptosis, but E2 decreased migration and invasion via ERβ. Further, E2 inhibited AMH/Smad signalling pathway via ERβ in KGN cells. Conversely, selective inhibition of ERβ could reverse these effects. In conclusion, activation of E2/ERβ compromised the function of follicular granulosa cells in endometriosis, which may be mediated by AMH/Smad signalling pathway.

Female infertility is a multifactorial condition with complex biological and clinical underpinnings. Biologically, female-related infertility may stem from disruptions in the hypothalamic-pituitary-ovarian (HPO) axis, impaired folliculogenesis, oocyte maturation defects, uterine abnormalities, endometrial dysfunction, and fallopian tube abnormalities. This review highlights key genetic mechanisms contributing to reproductive dysfunction and their relevance to diagnosis and treatment. Chromosomal abnormalities, including Turner syndrome and X-autosome translocations, also contribute to infertility and recurrent pregnancy loss (RPL). Age-related declines in oocyte quality and quantity-due to increased aneuploidy significantly impact fertility after the mid-30s. Clinical causes such as polycystic ovary syndrome (PCOS), luteal phase defects, and endometriosis contribute to infertility through hormonal imbalance, inflammation, and impaired implantation. Environmental and lifestyle factors-like endocrine-disrupting chemicals, obesity, smoking, and stress-further influence reproductive function. Evaluation requires a multidisciplinary approach combining hormonal profiling, imaging, and genetic diagnostics. Ovarian reserve assessment using anti-Müllerian hormone (AMH) and antral follicle count (AFC), hormonal evaluation along with ultrasound and hysterosalpingography, are central to clinical workups. Next-generation sequencing is enhancing the role of genetic screening in unexplained infertility and specific conditions like POI and endometriosis. Treatment options-ranging from ovulation induction to surgery and assisted reproductive technologies (ART)-are increasingly personalized based on underlying causes and patient profiles. Despite advances, many cases remain idiopathic, highlighting the need for deeper molecular research and refined phenotyping. This review emphasizes the importance of precision medicine and an evidence-based, patient-centered approach to improve fertility outcomes across a broad spectrum of infertility etiologies.

The gamma-glutamyl transferase (GGT) to high-density lipoprotein (HDL) ratio (GGT/HDL) has recently emerged as a potential biomarker for metabolic and liver diseases. This study aimed to investigate the association between GGT/HDL ratio and endometriosis using a population-based dataset from the National Health and Nutrition Examination Survey (NHANES). Data from NHANES 1999 to 2006 were used to assess the relationship between the GGT/HDL ratio and endometriosis. The diagnosis of endometriosis was based on self-reported data from the Reproductive Health Questionnaire. The GGT/HDL ratio was calculated and Ln-transformed for analysis. Multivariable logistic regression and sensitivity analysis were used to estimate the odds ratio (OR) for endometriosis in relation to the GGT/HDL ratio. A total of 3815 individuals were included, with 307 diagnosed with endometriosis. The Ln-transformed GGT/HDL ratio was positively associated with the endometriosis. Each unit increase in the Ln-GGT/HDL ratio was associated with a 22% higher likelihood of endometriosis (OR = 1.220, 95% CI: 1.003-1.483, p = 0.046). Sensitivity analyses including the use of original GGT/HDL value, the further adjustments of covariates, the exclusion of those with CVD and liver diseases confirmed the robustness of this association. This study found a significant positive association between the GGT/HDL ratio and endometriosis. Higher GGT/HDL levels may serve as a potential biomarker for identifying women at risk of endometriosis. This study investigated the relationship between the gamma-glutamyl transferase (GGT) to high-density lipoprotein (HDL) ratio (GGT/HDL) and endometriosis, using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006. GGT/HDL were from laboratory tests and endometriosis diagnosis was based on self-reported information from the Reproductive Health Questionnaire.The study included 3815 individuals, of whom 307 were diagnosed with endometriosis. The results showed that a higher GGT/HDL ratio was associated with a higher risk of endometriosis. Specifically, for each unit increase in the Ln-GGT/HDL ratio, the likelihood of having endometriosis increased by 22%. This association remained robust even after conducting sensitivity analyses.The findings suggested that the GGT/HDL ratio could be a useful biomarker for identifying women at risk of developing endometriosis.

Background. Gynecological disorders (GD) represent a major noncommunicable disease burden among women of reproductive age worldwide, yet remain under-researched among young women in Central Asia, particularly in Kazakhstan. This systematic review aims to identify the most common gynecological disorders among young women in Kazakhstan, assess associated risk factors, and explore barriers to healthcare access. Research design and methods. A systematic review was conducted according to PRISMA 2020 guidelines and registered with PROSPERO (CRD420251085283). Electronic databases were searched for English- language studies reporting on GD in Kazakhstani adolescents, with no restriction on publication start date. Eligible studies included original epidemiological research on reproductive health in Kazakhstani youth. Results. Of 60 identified records, eight met the inclusion criteria. The most commonly reported non- infectious gynecological disorders included polycystic ovary syndrome (PCOS), uterine fibroids, endometriosis, menstrual disorders (especially dysmenorrhea), infertility, and reproductive cancers such as ovarian and cervical cancer. Risk factors included obesity, limited health literacy, and sociocultural stigma. Conclusions. Gynecological disorders are highly prevalent among young women in Kazakhstan, yet remain underdiagnosed and underreported due to cultural, educational, and systemic barriers. There is a critical need for robust epidemiological research, and targeted public health interventions to address these gaps.

Both gut microbiota dysbiosis and altered pelvic immune microenvironment have been linked to endometriosis (EM), but the metabolites connecting the two remain undefined. Combining 16S rDNA sequencing with non-targeted metabolomics in a murine EM model, we found altered gut microbiota composition alongside a marked rise in peritoneal lysophosphatidylcholine (LysoPC(16:0)), linked to the microbiota shift by correlation analysis and fecal transplantation. LysoPC(16:0) promoted M2 macrophage polarization through peroxisome proliferator-activated receptor gamma (PPARγ), an effect observed in two mouse strains. Clodronate-mediated macrophage depletion blocked LysoPC(16:0)-driven lesion growth. LysoPC(16:0) further induced PPARγ-dependent IL-10 transcription, and IL-10 neutralization in vivo reduced lesion weight. Conditioned medium from LysoPC(16:0)-stimulated THP-1 macrophages promoted migration of primary endometrial stromal cells from patients with EM, an effect reversed by GW9662 or IL-10 neutralization. Together, these results outline a gut microbiota-LysoPC(16:0)-PPARγ-M2-IL-10 axis in EM pathogenesis, a mechanistic and therapeutic target for future clinical study.

Endometriosis is a common gynecological disease in which lipid metabolic dysregulation has been increasingly implicated. However, the specific metabolic changes in ectopic lesions and stromal cells remain poorly understood. It is also unclear whether these changes contribute to lipid droplet accumulation or how this process is controlled at the transcriptional level. Here, we report that ectopic stromal cells exhibit broad lipid remodeling, showing changes in phosphatidylcholines, lysophosphatidylcholines, sphingomyelins (SMs), and acylcarnitines. Both ectopic lesions and ectopic stromal cells showed increased triacylglycerol and total cholesterol levels, lipid droplet accumulation, and reduced E2F transcription factor 1 (E2F1) expression. Integrated epigenomic and transcriptomic analyses of patient-derived ectopic stromal cells, together with mechanistic validation, revealed that E2F1 transcriptionally activates monoacylglycerol lipase gene (MGLL), which encodes monoacylglycerol lipase, a lipolytic enzyme involved in lipid mobilization. Both in vitro and in vivo experiments showed that down-regulation of E2F1 increased lipid droplet accumulation, whereas restoring MGLL expression partially reversed this effect. Consistently, targeted lipidomic analysis of ectopic stromal cells following MGLL knockdown showed increased levels of several diacylglycerol species and alterations in SM profiles. In summary, our findings suggest that E2F1 down-regulation reduces MGLL expression and impairs lipid mobilization, which may contribute to lipid droplet accumulation and endometriotic lesion growth.

Research has indicated that individuals experiencing chronic pain differ in their ability to sense and interpret signals arising from inside the body, termed interoception. It is unclear whether differences in interoception exist for those with endometriosis, a common condition where pain is a major symptom. This study aimed to investigate whether interoceptive beliefs are altered in individuals with a diagnosis of endometriosis compared to those without, and whether pain experienced by those with endometriosis predicted interoceptive beliefs. Interoceptive beliefs were assessed in 247 participants with endometriosis and 98 participants without the condition. Those with endometriosis also reported their experience of dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain. Individuals with endometriosis reported that they noticed more internal signals but had reduced trust in these signals and were more worried by them. They also reported that they try to distract themselves from internal sensations more than those without endometriosis. Increased pain intensity predicted higher scores in one facet of interoceptive beliefs, such that higher levels of pain were associated with higher awareness of internal sensations in individuals with endometriosis. These results indicate that those with endometriosis differ in their interoceptive beliefs and that these differences may be influenced by their pain experience. Given these findings largely align with changes observed in other conditions marked by pain, it is possible that interoceptive changes may represent a transdiagnostic characteristic across individuals experiencing pain. This study addresses previously conflicted findings in the literature, providing a clearer picture of the changes in interoceptive beliefs present in people with endometriosis. Developing a stronger understanding of interoceptive functioning in this unique population may lead to opportunities to develop stronger interventions targeting bodily sensations in pain management in those with the condition.

To evaluate the efficacy and safety of a combined oral contraceptive containing estetrol (E4) 15 mg and drospirenone (DRSP) 3 mg in the treatment of dysmenorrhea associated with recurrent endometriosis and/or adenomyosis. This retrospective observational study reviewed the medical records of 23 women undergoing E4/DRSP treatment. Among them, 14 patients with recurrent endometriosis and/or adenomyosis who completed at least 16 weeks of treatment were analyzed. The primary outcome was the change in endometriosis-associated pain severity, assessed using a visual analogue scale (VAS). Secondary outcomes included changes in serum estradiol and cancer antigen 125 (CA-125) levels, as well as patient-reported quality of life. Biochemical data were available for 11 patients. Statistical analysis was performed using paired t-tests, with significance defined as p < 0.05. The mean baseline VAS score was 7.7 with 95% confidence interval (CI) 6.9 to 8.6, which decreased significantly to 3.3 (95% CI, 2.3 to 4.3) after treatment (p < 0.005). The average VAS responder rate was 55.8%, with 85.7% of patients achieving a ≥30% reduction and defined as responder. Serum estradiol levels significantly declined (p = 0.024), from 214 pg/ml (95%CI, 34.7-394.1 pg/ml) to 42.7 pg/ml (95% CI, 2.23-83.2 pg/ml), whereas CA-125 showed a nonsignificant downward trend. No serious adverse events occurred. A total of 86% of patients reported improved quality of life. The E4/DRSP combination regimen appears to be an effective and well-tolerated treatment for dysmenorrhea in women with recurrent endometriosis and/or adenomyosis. It may serve as a viable long-term hormonal option, for those intolerant or have contraindications to conventional therapies.

More than 12% of reproductive-age women in the United States seek infertility services each year. Infertility is commonly defined as failure to conceive after 12 months of regular, unprotected sexual intercourse. Common gynecologic causes of female infertility include endometriosis; diminished ovarian reserve; ovulatory dysfunction and anovulation; and other cervical, uterine, or tubal factors. Advances in medicine and assisted reproductive technology have expanded treatment options for women and couples experiencing infertility. This article provides an updated review of female infertility to support PAs in delivering informed patient counseling on treatment options, recognizing potential complications, and facilitating timely and appropriate referrals.

To compare the financial burden of special diets and dietary supplement use in women with and without endometriosis. This cross-sectional, mobile health app-based survey in Hungary (December 2023-August 2024; 90% response rate) evaluated 1645 women aged 14-45 years (524 with endometriosis, 1121 without). Primary outcomes were monthly household food and individual supplement expenditures. Secondary outcomes included diet adherence and supplement use. Women with endometriosis, particularly those following special diets, reported significantly higher food and supplement spending than reference participants ( p < 0.01). Despite smaller households (mean 2.49 vs. 2.95 persons, p < 0.01), more spent over €400/month on food than in the reference group (30% vs. 24%; median €301-€400 vs. €251-€300). Women with endometriosis were more than twice as likely to report supplement costs exceeding €35/month (22% vs. 9%; median €16-€25 vs. €6-€15; p < 0.01). Diet adherence and supplement use were also significantly higher ( p < 0.01). After controlling for relevant sociodemographic characteristics, endometriosis status remained significantly associated with food expenditure (B = -0.19, β = -0.08, p = 0.02) and supplement expenditure (B = -0.52, β = -0.2, p < 0.01). Endometriosis is associated with greater financial burden from dietary self-management. These findings highlight the need for evidence-based nutritional guidance and consideration of economic impact in care.

Most endometriosis research is limited to the premenopausal period; however, case series document endometriosis among postmenopausal women. Our objective was to quantify first diagnosis of endometriosis after menopause, including variation by age at menopause, mode of menopause (surgical or natural), and postmenopausal hormone use. We analyzed data from the population-based Nurses' Health Study-II cohort 1989 baseline through 2019. Person-time of follow-up accrued from return of the first questionnaire with menopause report until confirmed death, laparoscopically-confirmed diagnosis of endometriosis after menopause, loss to follow-up or end of follow-up, whichever occurred first. We utilized multivariable Cox regression models to calculate risk of surgically-confirmed endometriosis after menopause by age at menopause, mode of menopause, and hormone use. Among 80,148 women without a report of endometriosis diagnosed before menopause, 883 reported a first diagnosis of endometriosis after menopause. Median age at diagnosis of endometriosis after menopause was 50·6 years (after surgical menopause, 48.5 years; after natural menopause, 54·7 years). Mean time to endometriosis diagnosis was longer after surgical than after natural menopause (6·6 vs 5·7 years, median = 4.0 years). The majority of postmenopausal endometriosis diagnoses were among women with surgical menopause (69·9%), and those currently using hormones (69·5%). Compared with those with natural menopause but no hormone use (N = 110 cases), the risk of endometriosis was similar among women with natural menopause and hormone use (N = 137; HR = 1·16; CI = 0.89-1·49). In contrast, women with surgical menopause had a higher risk, both without hormone use (N = 78 cases; HR = 5·79; CI = 4.29-7·81) and, to a lesser degree, with hormone use (N = 477 cases; HR = 3·86; CI = 3·08-4.82). A non-negligible 1·1% of women reported a first diagnosis of endometriosis after menopause. These diagnoses were predominantly among women with surgical menopause two or more years prior and likely represent a mixture of previously unrecognized persistent or recurrent premenopausal disease, and de novo postmenopausal lesions.

Endometriosis is a chronic oestrogen-dependent condition characterised by the presence of endometrial-like tissue outside the uterus. Although benign, the associated chronic inflammation and fibrosis can result in substantial symptomatic burden, including chronic pelvic pain, menorrhagia, dysmenorrhoea and dyspareunia. Adenomyosis, which commonly co-exists with endometriosis, is defined by endometrial glands within the myometrium, causing chronic inflammation and fibrosis. Symptoms overlap with endometriosis, including heavy menstrual bleeding, dysmenorrhoea and chronic pelvic pain. Historically, laparoscopy with histological confirmation was considered the diagnostic gold standard for endometriosis. However, imaging now plays an essential role in noninvasive diagnosis and preoperative planning. Transvaginal ultrasound remains the first-line imaging modality in the diagnosis of endometriosis due to its accessibility, cost-effectiveness and real-time dynamic assessment. Certain forms of deep endometriosis, particularly rectal and bladder involvement, are more readily detected with ultrasound when performed by an expert operator using a structured approach that includes assessment of sliding signs and detailed evaluation of each pelvic compartment. Similarly, the Morphological Uterus Sonographic Assessment (MUSA) consensus provides a standardised ultrasound approach for the diagnosis of adenomyosis, incorporating both direct and indirect signs. Magnetic resonance imaging (MRI) offers excellent soft tissue contrast and multiplanar capability, enabling assessment of the entire pelvis and characterisation of indeterminate lesions. MRI allows the comprehensive evaluation of the parametria, ureters, nerves and bowel muscle invasive lesions beyond the reach of ultrasound. Standardised reporting systems, including the #Enzian classification, now enable a unified language between radiologists and the multidisciplinary team. Comprehensive compartment-based disease mapping is essential for accurate surgical planning and improving patient outcomes. This review illustrates the typical US and MRI appearances of endometriosis and adenomyosis, using a compartment-based approach.

Endometriosis is a heterogeneous gynecological disorder for which experimental model development is often limited by diagnostic ambiguity and the restricted lifespan of primary epithelial cultures. Although immortalization strategies enable long-term expansion of patient-derived cells, concerns remain regarding the preservation of disease-specific biological characteristics and the risk of model misclassification in the absence of definitive pathological confirmation. In the present study, immortalized ovarian epithelial cell lines from clinically suspected ovarian cystic lesions representing endometriosis were established and it was evaluated whether disease-intrinsic biological features were preserved following immortalization, as determined by definitive histopathological stratification. Primary epithelial cells were isolated from two ovarian cystic lesions and immortalized via lentiviral co-expression of constitutively active cyclin-dependent kinase 4 (CDK4 R24C ), cyclin D1 and human telomerase reverse transcriptase. One lesion was subsequently identified as an ovarian endometrioma, and the other as a mature cystic teratoma, in postoperative histopathology. The endometriosis-derived immortalized epithelial line iEn1 exhibited sustained proliferative capacity (Cell Counting Kit-8 assay), maintained epithelial lineage characteristics (western blotting for pan-cytokeratin, β-catenin and claudin-1), and retained a stable 46,XX karyotype. These cells demonstrated epithelial-mesenchymal plasticity evidenced by co-expression of epithelial markers with vimentin and N-cadherin, and formed microscopic glandular structures resembling endometriosis-like lesions in an estrogen-supplemented xenograft model. However, immunohistochemistry revealed that estrogen receptor β and interleukin-6, both frequently implicated in endometriosis-associated inflammation, were not detected in either the original tissue or the xenografted lesions, indicating that this particular inflammatory phenotype is not intrinsic to this model. By contrast, the teratoma-derived line iEn2 displayed marked chromosomal instability and phenotypic heterogeneity, demonstrated by karyotyping, consistent with its germ cell origin. Thus, immortalization alone does not determine the biological validity of patient-derived cellular models; rather, accurate interpretation requires integration with definitive histopathological classification. The present study established a pathology-validated immortalized epithelial model of ovarian endometriosis and highlighted the importance of pathology-integrated frameworks for improving experimental rigor in disease modeling.

This study aimed to evaluate the experiences of transgender and gender-diverse (TGD) individuals assigned female at birth with endometriosis. This was a mixed-methods study conducted from August 2024 to March 2025. TGD individuals assigned female at birth with endometriosis were recruited through LGBTQ+ forums, mailing lists, and clinical sites. Surveys and semi-structured interviews were conducted. The survey included demographic questions and the Endometriosis Health Profile-30 (EHP-30), scored 0-100 (100 = worst health status). Interview transcripts were coded with ATLAS.ti, and codes were grouped into themes. Among 29 participants, the mean participant age was 29.5 ± 6.8 years. The mean age of symptom onset was 15.5 years (standard deviation 6.2). Most identified as nonbinary ( n = 18, 62.1%). The highest EHP-30 dimension was "control and powerlessness" (65.2). Interview themes included the following: (1) impact of pain on well-being and identity, (2) barriers to trust in health care providers, and (3) desire for collaborative care. Participants highlighted a desire for gender identity representation, along with racial representation, in endometriosis support groups. Although most reported that the EHP-30 captured their experiences, some stated that the intersection of their TGD identity and symptoms was missed. TGD individuals assigned female at birth with endometriosis face unique barriers that impact health care experiences and diminish the quality of life. Health care systems must focus on gender inclusive provider education, care models, and support groups that acknowledge the distinct challenges TGD individuals face in accessing endometriosis care.

Adenomyosis is a benign uterine condition characterised by ectopic growth of endometrial tissue within the myometrium. It is associated with dysmenorrhea, heavy menstrual bleeding and subfertility. Diagnosing adenomyosis remains challenging, due to its typically diffuse distribution. A potential distinguishing feature is abnormal uterine microcirculation, which can be visualised using contrast-enhanced ultrasound (CEUS). In our recent pilot study on the feasibility of uterine CEUS in ten participants, CEUS showed promise for diagnosing adenomyosis. The current clinical trial aims to explore if qualitative CEUS characteristics and quantitative CEUS perfusion parameters describing the uterine microcirculation can be used to differentiate between healthy controls and participants with (moderate to severe) adenomyosis. In this explorative prospective cross-sectional study, healthy controls and participants with adenomyosis are recruited. They undergo conventional ultrasound and two-dimensional and three-dimensional CEUS. The primary outcomes are quantitative CEUS perfusion parameters. Secondary outcomes are qualitative CEUS characteristics and the relationship between CEUS findings and findings on conventional ultrasound, magnetic resonance imaging, and histopathology. This is the first large study to apply extensive CEUS analysis in participants with adenomyosis and compare the results with those of a healthy control group. This study will provide insights into the microcirculation of adenomyosis, which may lay the groundwork for improving diagnostics of adenomyosis.

The human endometrium, a dynamic tissue responsive to sex hormones, plays a pivotal role in female reproduction and menstrual cycling, comprising diverse cell populations including epithelial and stromal cells. The development of in vitro endometrial models holds substantial potential for tissue repair, drug discovery, and disease modeling. However, the construction of biomimetic structural in vitro models capable of supporting long-term culture and preserving relevant biological functions has been hindered by limitations in both material properties and fabrication strategies. Here, an enzymatically cross-linked collagen-based bioink was developed, enabling extrusion bioprinting with favorable printability, biocompatibility, and bioactivity. The enzyme-catalyzed cross-linking process was optimized through room-temperature pre-crosslinking, and its evolution was described using a storage modulus ( G' )-time kinetic model, enabling prediction of the printable window and reliable fabrication of three-dimensional (3D) constructs. Then, monoculture and co-culture systems of endometrial epithelial organoids (EEOs) and endometrial stromal cells (ESCs) embedded in collagen-based hydrogels were established. Utilizing the bioink and printing strategy, an in vitro endometrial model was 3D bioprinted, exhibiting sustained viability (≥11 days) and hormone-responsive functions comparable to or showing enhanced functional characteristics relative to commonly used Matrigel-based or collagen-based systems. This biomimetic platform provides a physiologically relevant in vitro model for investigating endometrial biology, elucidating pathological mechanisms, and facilitating drug screening applications.

Previous studies have tied stress exposure and psychological response, including posttraumatic stress symptoms (PTSS), to changes in gynecological symptoms (pain, urogenital symptoms and menstruation), however the multipartite relationship between these variables has been underexplored. An online, cross sectional, survey was completed by 527 Israeli women during Israel-Gaza war. The questionnaires included demographics, gynecological symptoms before and after war onset, and validated scales for exposure to war-related stressors, exposure impact and PTSS. Serial mediation models were tested, with cumulative exposure to war related stressors as the predictor and the subjective impact of exposures and PTSS as serial mediators. Reported change in gynecological symptoms (pain, menstrual symptoms and urogenital symptoms) were outcomes. Indirect effects of cumulative exposure on changes in all gynecological symptoms were significantly mediated through PTSS alone and sequentially through the subjective impact of exposure and PTSS for all outcomes. Independent and direct effects varied between outcomes. PTSS correlated significantly with all the variables in the model. The results support serial mediation of exposure effects for all three symptom change categories, emphasizing the importance of psychological factors in gynecological symptoms changes among women during times of crisis. Potential underlying mechanisms for future exploration and implications for clinicians are discussed.

Climate change is a significant threat to global health. While its psychological impacts are documented, research exploring the link between climate change anxiety and premenstrual disorders is scarce. This study investigated the relationship between climate change anxiety and premenstrual syndrome (PMS) severity among young women. A cross-sectional study was conducted with 1035 young women (mean age: 20.83 ± 1.76) in Türkiye. Data were collected using the Climate Change Anxiety Scale (CCAS) and the Premenstrual Syndrome Scale (PMSS). Data were analyzed using Pearson's correlation and linear regression. PMS prevalence was 60.8%. A significant positive correlation was found between total CCAS and PMSS scores ( r = 0.188, p < 0.001). Higher levels of overall climate change anxiety were significantly correlated with increased PMS severity ( r = 0.188, p < 0.001). Regression analysis revealed that climate change anxiety is significantly associated with PMS symptoms, explaining 3.5% of the variance (R 2 = 0.035, p < 0.001). Age and menstruation-related daily life interference were also associated with higher climate anxiety. Climate change anxiety acts as a modern psychosomatic stressor contributing to premenstrual symptoms. Healthcare professionals should adopt holistic approaches, considering environmental distress a potential factor in menstrual health management for young populations.

To evaluate the clinical efficacy and safety of a once-daily oral fixed-dose combination of relugolix 40 mg, estradiol 1 mg, and norethisterone acetate 0.5 mg in women with symptomatic adenomyosis coexisting with uterine fibroids. This case series included six women with uterine fibroids and concomitant adenomyosis, diagnosed by transvaginal ultrasound according to MUSA criteria. All patients received continuous treatment for 12 months. Clinical outcomes included changes in dysmenorrhea and pelvic pain assessed by the Visual Analogue Scale (VAS), menstrual blood loss evaluated through the Pictorial Blood Assessment Chart (PBAC), and hemoglobin levels. Ultrasonographic assessment measured uterine volume and adenomyosis-related features before and after treatment. All patients achieved complete resolution of dysmenorrhea and chronic pelvic pain, with VAS scores reduced to zero. Menstrual bleeding ceased in all cases (PBAC = 0), and hemoglobin levels improved after 12 months. Ultrasound examination demonstrated a reduction in uterine volume ranging from 8.6% to 58.3%, along with partial regression of direct adenomyotic features. No adverse events or treatment discontinuations were reported during follow-up. Relugolix/estradiol/norethisterone acetate combination therapy was effective, well-tolerated, and associated with consistent clinical and sonographic improvement in women with adenomyosis and coexisting fibroids. Future larger-scale, controlled studies with extended follow-up are warranted to validate these findings.

Hyperandrogenism in women encompasses a spectrum of clinical manifestations including hirsutism, acne, androgenetic alopecia, menstrual dysfunction, and virilization. Although polyendocrine metabolic ovarian syndrome accounts for the majority of cases, a systematic endocrine evaluation is essential to identify less common but clinically significant etiologies including androgen-secreting tumors, ovarian hyperthecosis, congenital adrenal hyperplasia, and cortisol excess. Total testosterone liquid chromatography-tandem mass spectrometry measurement in women has refined thresholds for further evaluation across the reproductive lifespan leading to appropriate diagnosis. This article synthesizes current evidence and expert guidance on clinical assessment, biochemical testing, and diagnostic strategies for hyperandrogenism.

Women's reproductive life encompasses dynamic phases, including menarche, menstrual cycles, pregnancy, lactation, and menopause, as well as transitional periods of variable duration. These stages drive physiological changes that influence both physical and mental well-being and may modulate susceptibility to autoimmunity. The interplay between autoimmunity and reproductive milestones is bidirectional: reproductive stages can affect disease onset and progression, while autoimmune disorders influence fertility, pregnancy outcomes, and the timing of menopause. Persistent challenges in detecting autoimmune diseases, particularly within rheumatology and gastroenterology, underscore the need for targeted screening, multidisciplinary collaboration, and patient-centered strategies. Fertility preservation, preconception counseling, and individualized pregnancy management are essential to safeguard reproductive rights and optimize maternal and neonatal outcomes. Post-reproductive life, especially the menopause transition, represents a vulnerable period in which immune, hormonal, and metabolic changes converge. This manuscript highlights the importance of a comprehensive, lifespan-oriented approach to reproductive well-being in women with autoimmune diseases, integrating preventive, diagnostic, and therapeutic strategies across all stages of reproduction.

To evaluate the effect of intrauterine infusion of platelet-rich plasma (PRP) on luteal support and pregnancy outcomes in patients with thin endometrium undergoing frozen-thawed embryo transfer (FET). A total of 160 patients with thin endometrium undergoing FET from March 2023 to March 2024 were assigned to the observation group (PRP infusion, n = 80) or the control group (conventional treatment, n = 80). All patients underwent hormone replacement therapy cycles,with PRP infused on days 9, 11, and 13 in the observation group. Outcomes included endometrial thickness, uterine hemodynamic parameters (PI, RI), PBAC-assessed menstrual volume, pregnancy outcomes, and embryology-related variables. Logistic regression identified independent factors associated with clinical pregnancy. Adverse events were also recorded. Post-treatment, the observation group had greater endometrial thickness and lower PI and RI values than the control group. PBAC scores, clinical pregnancy rate (36.25% vs . 21.25%), and live birth rate (25.00% vs . 12.50%) were significantly higher, while preterm birth rate did not differ. Embryo transfer-related variables were comparable between groups. Multivariate analysis identified PRP infusion and endometrial thickness at transfer as independent protective factors for clinical pregnancy, whereas advanced age was an unfavorable factor. No obvious adverse events occurred. PRP infusion enhances endometrial receptivity by improving thickness and blood perfusion, thereby increasing pregnancy and live birth rates in thin endometrium patients undergoing FET. It is safe and may be used as an effective adjunct in endometrial preparation.

Premenstrual symptoms may vary across reproductive transitions, but few studies have examined changes, heterogeneity, and correlates of premenstrual symptom burden from recalled prepregnancy to postpartum after menstrual resumption. Among 821 women recruited postpartum at two hospitals in China, 329 completed follow-up after menstrual resumption. Premenstrual symptoms were assessed using the Premenstrual Symptoms Screening Tool for recalled prepregnancy and postpartum symptoms; depressive symptoms were assessed at 6 weeks postpartum. Paired tests, baseline-adjusted linear regression, exploratory factor analysis, latent profile analysis, and latent transition analysis were conducted. The median 14-item symptom score increased from 5.00 to 6.00 (P = 0.002), and the median number of endorsed symptoms increased from 4.00 to 6.00 (P = 0.007). Two prepregnancy and three postpartum profiles were retained. Based on most likely assignments, 67.8% of women had descriptively corresponding profiles, whereas 21.3% shifted toward more symptomatic profiles and 10.9% toward a lower-symptom profile. After adjustment for recalled prepregnancy burden and covariates, each one-point increase in Edinburgh Postnatal Depression Scale score was associated with a 0.52-point higher postpartum symptom score (95% CI, 0.39-0.65); dysmenorrhea affecting daily life was associated with a 2.77-point higher score than no pain (95% CI, 0.59-4.94). Depressive symptoms and severe dysmenorrhea were also associated with postpartum profile destination (P < 0.001 and P = 0.039, respectively). Premenstrual symptom burden increased modestly after menstrual resumption, with substantial heterogeneity. Early postpartum depressive symptoms and severe prepregnancy dysmenorrhea may identify women more likely to report greater symptom burden after childbirth.

The article presents results of comprehensive analysis of gynecological morbidity of girls-adolescents 15-17 years old in St. Petersburg in 2019-2024. It is established, on the basis of preventive examinations data, that average level of pathological affect made up to 105.04‰ and had pronounced trend to decreasing (β=-4.07; p=0.048). The comparative historical analysis demonstrated improvement of reproductive health indicators by 1.9 times as compared to basic data for 1996-1997. The characteristic of structure of gynecological morbidity of modern girls-adolescents in megalopolis is predominance of menstrual disorders (90.7% of newly diagnosed cases). At that, low medical activity of girls-adolescents continues that is proved by high percentage of newly diagnosed diseases detected only during preventive examinations (29.0%) and as well as significant prevalence of general morbidity over primary one. It is established that in St. Petersburg indicators of morbidity are 2.3-2.6 times higher than the National average indicators that is related to better accessibility of medical care and more efficient system of preventive examinations in the megalopolis. The analysis of the impact of the COVID-19 pandemic on gynecological morbidity of girls-adolescents revealed significant decreasing of appealability in 2020 and subsequent incomplete reestablishment of indicators that testifies structural changes in pattern of medical activity of girls-adolescents. The study confirms efficiency of the system of protection of reproductive health of girls-adolescents in St. Petersburg but at the same time indicates at necessity to further enhance medical activity of girls-adolescents and to develop target preventive programs. Проведен комплексный анализ гинекологической заболеваемости девушек-подростков 15—17 лет в Санкт-Петербурге за 2019—2024 гг. На основе данных профилактических осмотров установлено, что средний уровень патологической пораженности составил 105,04‰ и имеет выраженную тенденцию к снижению (β=−4,07; p=0,048). Сравнительный исторический анализ показал улучшение показателей репродуктивного здоровья в 1,9 раза по сравнению с исходными данными 1996—1997 гг. Особенностью структуры гинекологической заболеваемости современных подростков мегаполиса является доминирование расстройств менструаций (90,7% впервые выявленных случаев), при этом сохраняется их низкая медицинская активность, о чем свидетельствует высокий удельный вес впервые выявленных заболеваний, установленный только на профилактических осмотрах (29,0%), а также значительное преобладание общей заболеваемости над первичной. Установлено, что показатели заболеваемости в Санкт-Петербурге в 2,3—2,6 раза превышают среднероссийские значения, что связано с лучшей доступностью медицинской помощи и более эффективной системой профилактических осмотров в мегаполисе. Анализ влияния пандемии COVID-19 на гинекологическую заболеваемость девушек выявил значительное снижение обращаемости в 2020 г. и последующее неполное восстановление показателей, что свидетельствует о структурных изменениях в модели медицинской активности подростков. Проведенное исследование подтверждает эффективность созданной в Санкт-Петербурге системы охраны репродуктивного здоровья подростков, но одновременно указывает на необходимость дальнейшего повышения медицинской активности девушек и развития целевых профилактических программ.

Metabolic bone health is crucial for the overall well-being of female patients. Female athletes and young females are of particular interest, as their skeletal systems are still developing and are sensitive to the hormonal and physical stress of training and diet. Stress fractures occur with higher frequency in females with risk factors such as low bone mineral density (BMD). When low bone mineral density occurs along with menstrual irregularities and relative energy deficiency, it completes the female triad (23, 27, and 28). Any discussion of female BMD and metabolic bone health must include the female triad.

Premenstrual symptoms occur in the late luteal phase as a result of differential sensitivity to normal hormonal fluctuations. These symptoms can include mood symptoms such as mood lability, anxiety, sadness or irritability as well as physical symptoms such as lethargy, bloating and breast tenderness. Symptoms can significantly impact quality of life, particularly in patients with the more severe form of premenstrual symptoms, PMDD. Importantly, symptoms should improve or resolve in the follicular phase. Evidence-based treatment options include SSRIs or hormonal suppression of ovulation with COCs or GnRH agonists.