Polycystic ovary syndrome(PCOS)is among the most prevalent endocrine disorders affecting 12.1％of reproductive-aged women,yet it remains one of the least precisely defined.1 Despite its high global preva-lence,PCOS continues to be diagnosed and managed through broad syndromic criteria that fail to capture its underlying biological diversity.
Growing recognition of gender-specific dispar-ities in mental health has led to increased attention and investment in behavioural health services for women,including care for substance use disorders(SUD).As these efforts expand,obstetrician-gynaecologists(OB/GYNs)—who provide care to two-thirds of women in the USA annually—are uniquely positioned to integrate behavioural health services into routine visits.1 For one in five women,their OB/GYN serves as their main point of contact within the healthcare system.2 These longitudinal relationships and regularity of visits across the life course create a critical and often underutilised opportu-nity:embedding substance use screening and interventions into OB/GYN care.
Introduction Contraceptive provision at the time of abortion lowers rates of subsequent unplanned pregnancy but cost, method availability and other considerations impact decision-making. We examined factors associated with contraceptive preferences at the time of abortion in a US safety net hospital. Methods This is a retrospective cohort study. We abstracted medical records for patients seen in the gynaecology clinic between April 2019 and June 2021 who received a medication or procedural abortion for an undesired pregnancy. We collected demographic and clinical data from the electronic medical record. We generated descriptive statistics using Stata V.18 and used R to perform a latent class analysis to identify patterns of association with selected demographic variables and chosen contraceptive methods. Results 638 met inclusion criteria. Latent group 1, which was largely Hispanic, on Medicaid, and/or undergoing medication abortion, most often chose the subdermal implant or pills. Latent group 2, which was largely non-Hispanic and undergoing procedural abortion, most often chose a levonorgestrel intrauterine device (LNG IUD) or declined birth control. Nearly 80% initiated any contraceptive method, with over 20% choosing an LNG-IUD and over 40% choosing any IUD or the subdermal implant. Contraceptive uptake was highest among Spanish-speaking individuals (115/131, 87.8%). Non-initiation occurred most frequently among individuals who did not have insurance/self-paid (24/72, 33.3%), spoke a language other than English or Spanish (8/27, 29.6%), or had a procedural abortion <14 weeks (38/171, 22.2%). Conclusions Contraceptive uptake was high among abortion-seeking individuals. Further research can clarify how other factors impact decision-making and uptake among vulnerable populations.
Background The organisation of oocyte retrival presents significant challenges for both clinicians and patients. Methods such as the use of oral contraceptives prior to stimulation adversely affect outcomes. Our objective was to determine if a longer pretreatment with oestradiol for flexible oocyte retrieval scheduling affects the results of ovarian stimulation in patients requiring in vitro fertilisation (IVF). Methods This retrospective, descriptive, cohort study included 194 women recruited from an academic affiliated private infertility clinic in Mexico. Patients requiring IVF treatment were pretreated with oestradiol before undergoing ovarian stimulation as standard care in our centre. The short group (group A, n=98) included patients in whom oral oestradiol was withdrawn 2 or 3 days after initiating menstruation, while the extended group (group B, n=96) included patients who used oestradiol until 4–8 days after starting menstruation. Results The clinical pregnancy rate was comparable between groups B and A, at 65.6% and 57.1%, respectively, with relative risk (RR) 1.15 (95% CI 0.92 to 1.44, p=0.2412). The implantation rate was not significantly higher in group B than in group A (40.1% vs 34.2%), with an RR of 1.17 (95% CI 0.81 to 1.70, p=0.4566). The numbers of oocytes retrieved, metaphase II oocytes, fertilised oocytes and embryos transferred, and the miscarriage and live birth rates did not significantly differ between the two groups. Conclusions Administration of oestradiol in a long regimen during luteal phase does not have a deleterious effect on ovarian stimulation. Moreover, it provides a scheduling alternative that is convenient for both patients and the medical team.
Endometrial cancer(EC),the second most common gynaecologic malignancy,faces challenges in precision treatment due to limited predictive models for therapy selection.Patient-derived organoids,which recapitulate tumour heterogeneity and microenvironment,offer a transformative platform for drug sensitivity testing and personalised therapy.However,standardised protocols for establishing EC organoids,biobanking and clinical translation remain lacking consensus.This expert consensus proposes guidelines for EC organoid culture optimisation,characterisation and clinical validation.By harmonising technological advances with clinical needs,this consensus aims to accelerate the integration of organoid models into EC precision medicine,ultimately improving therapeutic outcomes.
Objective This study aimed to retrospectively characterise the clinical features of unexpected malignant endometrial lesions identified incidentally in patients undergoing hysterectomy for pelvic organ prolapse (POP) repair, and to identify potential high-risk factors to guide preoperative screening decisions in this population. Methods This study retrospectively reviewed patients who underwent hysterectomy for POP repair at Peking University People’s Hospital, a tertiary medical centre, between January 2008 and February 2024. A consecutive case series of women with unexpected postoperative malignant endometrial pathology was recruited. Demographic characteristics and auxiliary examination results were analysed to summarise the clinical features of these cases. Results Among 3588 asymptomatic women with negative preoperative auxiliary examinations who underwent concurrent hysterectomy for POP repair, 11 cases (0.3%) of unexpected malignant postoperative endometrial pathology were identified. Of these, 10 were endometrioid carcinoma, and one was uterine serous carcinoma; secondary staging surgery was performed in seven patients. Key clinical features among these 11 cases included advanced age (72.7%), overweight or obesity (60%) and hypertension (63.6%). Other comorbidities included hyperlipidaemia (27.3%), cardiovascular disease (18.2%), cerebrovascular disease (18.2%), diabetes (18.2%) and fatty liver (18.2%). Late-onset menopause or abnormal menstrual cycle history were seen in 9.1%. Tumour markers (CA125, CEA), though not routinely tested, were elevated in some patients. Notably, among cases with only overweight or obesity, 60% of occult cancers were identified. This detection rate increased to 90.9% with the addition of one metabolic syndrome complication and reached 100% in those with overweight and two or more metabolic syndrome components. Conclusion Unexpected endometrial malignancy was identified in 0.31% of asymptomatic women undergoing hysterectomy for POP repair despite negative preoperative screening. Overweight or obesity combined with metabolic syndrome components may represent a clinically relevant high-risk profile warranting consideration of targeted preoperative endometrial evaluation in women planning uterine-preserving pelvic floor repair, though prospective validation is needed before formal recommendations can be established.
Ovarian cancer (OC) remains a lethal gynaecologic malignancy characterised by late diagnosis, heterogeneity and limited stratification. While artificial intelligence (AI) has shown promise in pathology, single-modal approaches often fail to capture the interplay between morphological, molecular and clinical data. Multimodal AI (MMAI) integrates histopathological images, genomics, proteomics, radiology and clinical variables to generate holistic tumour profiles. This review synthesises recent MMAI advances in OC through three themes: methodological foundations, fusion strategies and clinical applications. Methodologically, MMAI leverages deep learning-based feature extraction and fusion architectures to align heterogeneous data. Clinically, MMAI enhances diagnostic accuracy, predicts therapy response (eg, platinum agents, poly (ADP-ribose) polymerase inhibitors), improves prognostic stratification and infers molecular features from histology. Challenges in data heterogeneity, interpretability and clinical integration persist. Future directions include self-supervised learning, federated training and spatial multi-omics to improve generalisability and biological insight. By providing a more comprehensive view of tumour biology, MMAI optimises therapeutic strategies and advances managing OC as a chronic disease.
Objective Three major guidelines (Rotterdam, National Institutes of Health (NIH) and Androgen Excess Society (AES)) have been proposed to diagnose polycystic ovary syndrome (PCOS). The concordance of these guidelines, along with covariates of individual phenotypic features, has been explored among young Bangalee women.Methods This observational study included 158 PCOS (diagnosed by Modified Rotterdam Criteria 2003) and 127 non-PCOS women (PCOS, 55%; age 18–35 years). Phenotypic characteristics were collected following standard procedures/investigations. Ovarian folliculometry was done with ultrasonography and a 75 g oral glucose tolerance test was performed. Serum total testosterone, SHBG and C-peptide were measured by chemiluminescence immunoassay and Free Androgen Index (FAI) was computed. Subjects were recategorised following NIH and AES criteria, and concordance between the guidelines was assessed by kappa test. Associations between phenotypic features of PCOS and their covariates were explored.Results As compared with 55% of the Rotterdam criteria-based PCOS among overall subjects, the proportion was 43% with NIH and 51% with AES criteria (k=0.76 and k=0.90 as compared with Rotterdam, respectively). FAI correlated positively with fasting blood glucose (FBG) in all the criteria-based groups (p<0.45 to <0.001). Body mass index, waist-hip ratio, FBG and 2-hour-after blood glucose were the significant covariates independently associated with phenotypic features of clinical (anovulation/oligomenorrhoea) and biochemical (FAI) hyperandrogenism; however, there were overlapping and variations among different criteria regarding these associations.Conclusions NIH criteria may underdiagnose PCOS among Bangalee young women, and overweight/obesity as well as hyperglycaemia are major covariates underlying the phenotypic feature of hyperandrogenism in this group.
Immunotherapy stands out as an innovative and effective treatment modality that has made considerable strides in clinical practice, establishing itself as the fourth cornerstone of cancer treatment following surgery, radiotherapy and chemotherapy. Nevertheless, its efficacy in treating solid tumours is relatively low, which restricts its widespread clinical application. Post-translational modifications (PTMs) are pivotal in regulating protein function, thereby impacting physiological and pathological processes, disease progression and the tumour microenvironment (TME). These modifications can also influence the efficacy of immunotherapy. Among the various PTMs, lactylation (Kla) is an emerging and noteworthy one. Lactate is integral to tumour metabolic reprogramming and is instrumental in shaping the TME. Focusing on lactate and lactylation modifications has been shown to markedly improve the efficacy of immunotherapy. This review delves into the forefront of research on lactylation in tumour immunotherapy and elucidates its mechanisms within tumour immunity. The goal is to offer novel strategies and directions for future research, with the aim of enhancing the efficacy of cancer immunotherapy in clinical settings.
For decades,tubo-ovarian cancer has been the most lethal gynaecological malignancy,with negligible improvement in the 5-year survival rates over the past decades despite advance-ments in treatment.This reality,described in the European Society of Gynaecological Oncology(ESGO)consensus report,under-scores the urgency of effective prevention strategies.1 The growing recognition that many high-grade serous ovarian cancers orig-inate from the fallopian tube has catalysed a paradigm shift:prevention lies in removing the fallopian tube,not the ovary.
Endometrial receptivity is a decisive factor for successful embryo implantation and remains a major bottleneck limiting pregnancy outcomes in assisted reproductive technology (ART). Accumulating evidence suggests that traditional Chinese medicine (TCM) formulas may improve endometrial receptivity through multitarget and multipathway regulation. Experimental and clinical studies indicate that representative formulas enhance angiogenesis by activating vascular endothelial growth factor-related signalling pathways, modulate immune homeostasis by promoting a Th2-dominant microenvironment while preserving implantation-related inflammatory responses and improve endometrial morphology by increasing thickness, glandular development and vascular perfusion. Clinically, these effects are associated with improved implantation and pregnancy rates, particularly in patients with refractory conditions such as polycystic ovarian syndrome, thin endometrium, ageing-related infertility, controlled ovarian hyperstimulation-induced endometrial impairment and chronic endometritis. Nevertheless, current evidence is heterogeneous, with variations in study design, sample size and mechanistic depth across different formulas. This review systematically summarises the clinical evidence and molecular mechanisms underlying TCM formula-mediated improvement of endometrial receptivity, highlights existing limitations and discusses future research priorities to facilitate the integration of TCM-based interventions into modern reproductive medicine.
East Asia has long been committed to strengthening international academic ties and joint innovation in the field of medicine.On 7 June 2025,the academic community of East Asia marked a significant milestone with the successful convocation of the Tokyo-Beijing-Seoul(TBS)Joint Meeting in Tokyo.
Background Somalia has one of the highest maternal mortality rates globally, driven by decades of conflict, fragile health systems and limited access to skilled birth attendance. Institutional delivery services are critical in preventing maternal and neonatal deaths, yet their utilisation remains low. This study aimed to assess the level and predictors of institutional delivery among women in the Benadir Region of Somalia.Methods A community-based cross-sectional study was conducted from February to April 2025 in four purposively selected peripheral districts of northern Benadir: Heliwa, Karaan, Warta Nabadda and Yaqshid. A total of 710 women who gave birth in the past 12 months were selected using multistage sampling. Data were collected through structured questionnaires and analysed using Poisson regression with robust variance to estimate adjusted prevalence ratios (aPRs) and 95% CIs. Statistical significance was set at p<0.05.Results Institutional delivery accounted for 292/710 (41.1%) of births. Women who attended antenatal care (ANC) were more than three times as likely to deliver in a health facility (aPR=3.20; 95% CI 2.30 to 4.40), those aware of obstetric danger signs had two times the likelihood (aPR=2.00; 95% CI 1.50 to 2.70), and living within walking distance significantly increased facility delivery (aPR=3.01; 95% CI 2.10 to 5.02). Conversely, women lacking formal education were far less likely to deliver in a facility (aPR=0.19; 95% CI 0.09 to 0.58). Home delivery in Benadir is mainly driven by cost and access barriers (distance/transport/sudden labour), with comfort and cultural preferences also important, while gender-related concerns are less common.Conclusion Institutional delivery in Benadir remains low. Strengthening ANC coverage, improving community awareness of danger signs and addressing geographic and financial barriers are essential to increase facility-based births.
Around 8% of sexually active, fertile women wishing to delay or prevent pregnancy have an unmet need for modern family planning. While progestin-only contraceptive methods are highly effective, fear of infertility following use is a barrier to adoption. We conducted this narrative review with a systematic approach to summarise evidence on ‘return to fertility’, with the outcomes of return to ovulation, median or mean time to pregnancy, and pregnancy rates (ability to become pregnant within a year of method discontinuation) following progestin-only contraceptive discontinuation. We searched four databases (PubMed, CINAHL, Web of Science and The Cochrane Library) for any conference abstracts, original research articles or systematic reviews or meta-analyses published in English through 31 August 2023. We located 9 systematic reviews, 47 original research articles and 4 conference abstracts for oral contraception, injectables, hormonal intrauterine devices (IUDs) and implants. Oral contraception and hormonal IUD users return to ovulation and fertility sooner than injectable and implant users. However, by 1 year after discontinuation, pregnancy rates across methods are similar. While future fertility is a concern of potential modern contraceptive method users and healthcare providers, evidence suggests that individuals using progestin-only contraceptive methods may experience only slight delays in return to fertility following discontinuation and comparable . These results point to the need for continued and new efforts to provide communities with accurate information about contraceptives to dispel myths discouraging their use, and additional research using standard measurements.
Cervical cancer is a malignant disease that poses a serious threat to women's health.For early-stage cervical cancer,surgery remains the primary treatment,with pelvic lymph node dissection(PLND)serving as a crucial component.However,this procedure has inherent limitations.Since the majority of early-stage patients do not have lymph node metastases,routine PLND may lead to over-treatment and is associated with various complications such as lymphoedema,venous thrombosis and lymphocyst formation.Furthermore,PLND may disrupt the anatom-ical basis for immune surveillance.In the era of precision medicine,there is a growing imperative to re-evaluate this classic surgical approach.
Development of the vesicovaginal space in a patient with a history of repetitive abdominal surgery can be difficult.Known risk factors for lower urinary tract injury are previous caesarean section and laparotomy.12 Addition-ally,a laparoscopic approach to hysterectomy has an increased risk of bladder injury.3 In these individuals,preoperative imaging may be helpful for surgical planning.This video demonstrates a safe and reproducible tech-nique for bladder dissection using a robotic-assisted laparoscopic approach in a patient with extensive surgical history.Traditionally,dissection of the bladder is performed in a medial-to-lateral fashion,but we propose a lateral-to-medial approach to minimize the risk of lower urinary tract injury.4
Australia established a National Cervical Screening Programme (NCSP) in 1991 using the Papanicolaou smear on a 2-yearly interval. This led to an initial drop in cervical cancer incidence, mainly of the squamous origin, but has plateaued since 2007. Introduction of a National HPV Vaccination Program for girls in 2007, which now includes boys, was followed by a major change in the NCSP to a 5-yearly cervical screening for people aged 25–74, using a primary human papillomavirus (HPV) test with partial HPV genotyping and reflex liquid-based cytology triage, designated as a Cervical Screening Test. The next important milestone was expanding the option of self-collection to all eligible people in 2022 to encourage more participation in cervical screening. Population-based cancer screening programmes require monitoring of their performance, quality and safety. NCSP monitoring reports are produced annually with performance indicators grouped under each of the five population screening pathway stages of ‘Recruitment’, ‘Screening’, ‘Assessment’, ‘Diagnosis’ and ‘Outcomes’. From this monitoring, changes are being made in the renewed NCSP Guidelines to improve participation and management of screened abnormalities. All this is underpinned by the provision of cervical screening data by the National Cancer Screening Register. In 2020, WHO published the Global Strategy for cervical cancer elimination with goals to achieve through HPV vaccination, screening with a high-performance test and women identified with cervical disease receiving treatment. Australia has made good progress in 2023 with 84.2% HPV vaccine coverage for girls by the age of 15 years, 82.8% of women aged 35–39 screened at least once with an HPV test and 79.8% of women aged 45–49 having been screened at least twice, and 84.5% and 88.7% of those with precancer detected in 2022 were treated within 6 and 12 months.
Background Polycystic ovary syndrome (PCOS) affects a patient’s ovarian function and reduces a patient’s fertility. This study aimed to evaluate predictors of clinical pregnancy after in vitro fertilisation-embryo transfer (IVF-ET) in infertile PCOS patients.Methods The study included infertile patients with PCOS who received IVF-ET from January 2017 to March 2024 at the Reproductive Medicine Center of the General Hospital of Northern Theater Command. This study analysed the predictors of clinical pregnancy after IVF-ET in infertile patients with PCOS and analysed the predictive effect of these factors on clinical pregnancy.Results A total of 425 patients with PCOS who met the criteria were included in the study. Multivariate logistic regression analysis found that luteinising hormone (LH)/follicle-stimulating hormone (FSH) (OR=0.577, 95% CI 0.422 to 0.789; p=0.001), free thyroxine (FT4) level (OR=1.107, 95% CI 1.009 to 1.214; p=0.031), number of embryos transferred (OR=1.781, 95% CI 1.238 to 2.562; p=0.002), number of oocytes retrieved (OR=1.071, 95% CI 1.016 to 1.130; p=0.011), optimal embryo rate (OR=21.347, 95% CI 2.647 to 172.131; p=0.004) and level of antral follicles (OR=1.444, 95% CI 1.131 to 1.845; p=0.003) were independent predictors of clinical pregnancy after ET in PCOS infertile patients. The predictive model constructed based on these predictors had an area under the curve of 0.732 (95% CI: 0.683 to 0.782) for clinical pregnancy.Conclusions Our study found that LH/FSH, FT4 level, number of embryos transferred, number of oocytes retrieved, optimal embryo rate and level of antral follicles were significantly associated with clinical pregnancy rate in PCOS infertility patients after assisted reproductive therapy. Combining these variables can effectively predict clinical pregnancy.
INTRODUCTION Patients receive much of their medical information from the Internet,which can shape their attitudes towards medical interventions.1 Social media platforms such as TikTok,a video sharing site,have become increasingly popular for the dissemination of information related to healthcare and patient experiences,specifically within gynaecology.2 3 Many studies investigating online medical infor-mation are outdated,and new platforms such as TikTok have not been extensively studied.4 The primary aim of our study was to describe the content on TikTok related to cervical cancer screening.Secondary aims included analysis of perceived bene-fits of and barriers to pursuing screening.Our goals were to arm providers with the knowledge of the type of online content to which patients may be exposed and to inform them of potential avenues for patient outreach and education.
Pre-eclampsia, a devastating obstetrical complication of pregnancy, poses significant risks to both maternal and fetal health. This condition is estimated to affect 2%–15% of all pregnancies globally. Despite considerable attention, the exact aetiology of pre-eclampsia is still debatable; however, it is increasingly recognised as a placental disorder with lasting implications for both mother and child, potentially predisposing them to chronic diseases later in life. This review highlights the urgent need for targeted interventions and policy development to improve maternal health outcomes. It further reviews the latest advancements in prediction, prevention, management and the knowledge among healthcare workers, pregnant women and the community in general. Through the lens of Tanzania’s healthcare landscape, where challenges are compounded by scarce healthcare resources and limited awareness, the review calls for a comprehensive approach to enhance management of pre-eclampsia. Recommendations include targeted screening measures, such as first trimester assessments of uterine artery blood flow resistance due to impaired spiral artery remodelling, use of diagnostic biomarkers, lifestyle modifications including weight control, a healthy diet and regular exercise, advanced practical training for primary healthcare providers, improved antenatal care facilities and strengthened education on pre-eclampsia for pregnant women to support early diagnosis and intervention. With a call for innovation in diagnostic methods and a deeper dive into the disease’s underlying mechanisms, the review aims to advance clinical practice and reduce both maternal and fetal morbidity and mortality associated with this prevalent obstetrical complication.
