Objective To examine the potential cardiometabolic continuity gap after reproductive care among women with polyendocrine metabolic ovarian syndrome (PMOS), particularly in low- and middle-income countries.Methods This mini-review synthesizes evidence on persistent glycaemic, adiposity-related, blood-pressure, lipid, and cardiovascular risk and examines where responsibility for follow-up may become fragmented in low- and middle-income countries.Results PMOS, formerly polycystic ovary syndrome, is a lifelong multisystem condition whose cardiometabolic implications persist beyond fertility treatment, pregnancy, and childbirth. Yet care often remains organized around reproductive goals, creating a potential continuity gap when women transition from fertility, maternity, or postpartum services to primary or noncommunicable disease care. This review proposes a minimum continuity pathway: Identify, Document, Transfer, Reassess, and Retain.Conclusions The pathway defines essential functions rather than a fixed service model and requires local adaptation and prospective evaluation. Reproductive care may end, but cardiometabolic responsibility should not; every woman leaving reproductive care should have a documented risk profile, a clearly identified next service, and an accessible route to continuing follow-up.
Adolescence is a critical period of physical, psychological, and social development that shapes health trajectories across the life course. Despite its importance, adolescent health remains insufficiently prioritized within healthcare systems, while young people face increasingly complex challenges, including mental health disorders, sexually transmitted infections, social inequalities, climate change, and the deep influence of digital technologies. Although technology offers unprecedented opportunities to improve access to health information and care, it also introduces new risks that require coordinated, evidence-based responses. This position statement and its accompanying recommendations draw on the proceedings of an international workshop held in Athens in November 2025, organized by the International Academy of Human Reproduction and endorsed by leading international scientific societies. The statement addresses the biological, psychological, social, and gynecological challenges affecting adolescents in an evolving technological landscape. Its recommendations emphasize adolescent-responsive health systems, meaningful youth engagement, equitable access to care, and multidisciplinary collaboration. Investing in adolescent health represents a strategic priority, generating immediate benefits during adolescence while improving adult health and promoting better outcomes for future generations.
Introduction The transition to menopause presents unique clinical challenges, requiring a balance between pregnancy prevention and the management of perimenopausal symptoms and age-related comorbidities. Although fertility declines with advancing age, unintended pregnancy after age 40 remains possible and is associated with increased maternal and neonatal risks. Women who wish to avoid pregnancy need effective contraception until menopause is established.Objective To provide practical guidance on contraceptive counselling during the transition to menopause, considering the safety, effectiveness, noncontraceptive benefits, and limitations of available contraceptive methods.Results Age alone is not a contraindication to any contraceptive method; however, the higher prevalence of cardiovascular, metabolic, and malignant conditions in this population requires individualised contraceptive counselling based on each woman's medical history, preferences, reproductive goals, and shared decision-making. Contraceptive care in midlife is more complex than pregnancy prevention alone. Contraceptive counselling should consider both the likelihood of user adherence and the noncontraceptive benefits of each method.Conclusion This commentary provides practical guidance on contraceptive counselling during the transition to menopause, reviewing the safety, effectiveness, noncontraceptive benefits, and limitations of both short-acting reversible contraceptives (SARCs) and long-acting reversible contraceptives (LARCs) to support informed, individualised contraceptive care.
Objectives 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.Methods 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.Results 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.Conclusions 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.
