Purpose of review Reproductive health care generally, and abortion care in particular, is a medically and ethically complex field where healthcare providers must navigate their personal values, professional responsibilities, and the significant stigma associated with the work, along with systemic challenges. Values exploration exercises and workshops are effective interventions to help trainees and providers explore and manage these challenges. This review synthesizes findings from recent literature and established toolkits to summarize the use and effectiveness of values exploration in the context of abortion care. Recent findings Structured values exploration workshops are an important tool usable across multiple domains, from trainee education to established clinical practice. Adaptations of exercises have been used in many training and programmatic settings. Summary Values exploration is regarded as an important and effective tool when discussing complex topics such as abortion care. Evidence from trainee education, clinical practice, and global health initiatives is that exercises in values exploration, from reflection to structured workshops, are essential components to improve attitudes, support staff, and ultimately increase access to care.
Purpose of review Retained products of conception (RPOC) are a complication following abortion. This review is timely as diagnostic standards are inconsistent and treatment paradigms are shifting from traditional vacuum aspiration and medication toward presumptively precision-based hysteroscopy. Recent findings Recent literature emphasizes that while ultrasound is the primary diagnostic tool, it suffers from high false-positive rates, particularly in asymptomatic patients. The integration of Doppler to identify enhanced myometrial vascularity is now recognized for risk stratification. While vacuum aspiration remains a cost-effective mainstay treatment for acute cases, emerging evidence suggests that targeted hysteroscopic removal without the use of vacuum aspiration of RPOC in select patients may offer benefits. Hysteroscopy can be more difficult to access logistically and financially. For patients desiring future pregnancy, both offer comparable long-term reproductive and live birth outcomes. Summary Management should be individualized. Expectant management is effective for stable patients with small, avascular remnants. Medication management offers a cost-effective alternative, with lower efficacy in those who have initially used medication to manage their pregnancy. In symptomatic or complex cases, ultrasound-guided or hysteroscopic interventions are preferred. Clinicians must balance the benefits of intervention against the risks of overtreating asymptomatic sonographic findings, taking into account patient preference and feasibility.
PURPOSE OF REVIEW:To examine the evolving role of clinician advocacy in abortion care and to highlight key domains through which obstetrician-gynecologists can influence policy, clinical practice, and patient outcomes. RECENT FINDINGS:Increasing state-level abortion restrictions have significantly altered the landscape of reproductive healthcare in the USA. Emerging evidence demonstrates worsening barriers to care, delays in treatment, and increased morbidity, particularly for marginalized populations. Clinicians are responding through a range of advocacy strategies, including interpersonal communication, institutional policy development, engagement with professional societies, and the use of research to inform policy. Community-engaged research and near real-time data initiatives have been especially valuable in documenting the impacts of legal changes and amplifying patient-centered perspectives. SUMMARY:In the post- Dobbs era, advocacy continues to be an integral component of obstetric and gynecologic practice. Multilevel engagement - from clinical interactions to institutional and policy reform - is essential to mitigating harm and promoting equitable access to evidence-based care. Strengthening clinician advocacy, particularly in partnership with affected communities, will be critical to addressing disparities and shaping a more equitable reproductive healthcare system.
Purpose of review Despite the high prevalence of urinary incontinence, many women do not receive care. Urinary incontinence requires multiple personalized decisions across the care continuum. This review examines how shared decision-making and decision science may inform efforts to improve the delivery of patient-centered urinary incontinence care. Recent findings Recent literature describes the complexity of patients’ decision-making across multiple stages of the urinary incontinence care continuum, including deciding whether to mention urinary symptoms, to seek an appropriate clinician or care setting, to select a treatment, and to initiate or complete treatment. Barriers include limited knowledge, stigma, symptom normalization, treatment concerns, competing priorities, clinician communication, and health system barriers. Existing urinary incontinence decision support research has focused primarily on patient decision aids for treatment selection. These tools appear promising for reducing decisional conflict and uncertainty, but current studies are limited by nonrandomized designs, a narrow focus on treatment selection, inconsistent evaluation of decision-quality outcomes, and limited attention to urinary incontinence outcomes and implementation. Summary Patient-centered urinary incontinence decision-making should address decision needs across the full continuum of care. Future research would benefit from increased scientific rigor, support for understudied phases of the care continuum, ascertainment of clinical outcomes, and evaluation of implementation strategies that support high-quality decisions in routine clinical practice.
PURPOSE OF REVIEW:To review the effectiveness of pain control methods for outpatient intrauterine device (IUD) insertions and endometrial biopsy (EMB) procedures. RECENT FINDINGS:Several approaches to decreasing pain with ambulatory IUD placement and EMB have been evaluated in the literature. Paracervical blocks, cervical lidocaine spray, nonsteroidal anti-inflammatory drugs (NSAIDs), and anxiety reduction techniques have been shown to decrease pain reported by patients. For both IUD insertion and EMB, evidence regarding NSAIDs for intraprocedural pain is mixed, and they should be advised to decrease postprocedural cramping. A paracervical block with local anesthesia successfully targets pain but can cause discomfort with injection. Misoprostol may improve ease of IUD insertion and thus may be useful in select patients with difficult placements; however, routine use is not recommended because of increased side effects and risk of expulsion. Ultrasound-guided IUD insertion and nitrous oxide administration have also shown efficacy but are limited by cost and logistical barriers. SUMMARY:Pain during IUD placement and EMB is multifactorial and best addressed with use of an individualized, multimodal approach. Shared decision-making should guide clinician and patient discussion for offering strategies such as preprocedural NSAIDs, lidocaine spray, paracervical blocks, and anxiety management to all patients to optimize comfort and procedural experience.
PURPOSE OF REVIEW:The purpose of this review is to provide practical guidance on managing menopausal hormone therapy (MHT) and to provide updated guidance on the risks and benefits of MHT. RECENT FINDINGS:Reanalysis of the Women's Health Initiative and recent studies have demonstrated the protective role of estrogen in cardiovascular disease (CVD) and bone health, particularly when initiated before the age of 60. There is an increased risk of venous thromboembolism (VTE) with oral formulations, but formulations using transdermal estradiol and micronized progesterone do not appear to increase VTE risk. MHT may be helpful in perimenopausal and menopausal mood disorders. The timing hypothesis may be applicable to both CVD and cognition. SUMMARY:Management of symptomatic menopause requires personalized risk assessment and shared decision-making with a knowledgeable provider. For otherwise healthy women less than 60 years old or within 10 years of menopause, hormone therapy is a safe and effective treatment for vasomotor symptoms. Although the role of MHT is being studied for various preventive strategies, major medical societies do not yet recommend MHT for primary prevention.
PURPOSE OF THE REVIEW:Improving survival rates for extremely preterm infants have shifted the threshold for postnatal intervention earlier, although outcomes remain uncertain. Counseling for families facing periviable birth is complex, requiring integration of evolving data, ethical considerations, and patient values. Obstetricians play a key role in this counseling. This review synthesizes recent evidence on obstetric interventions at periviability, alongside best practices for counseling. RECENT FINDINGS:Emerging data demonstrate improving survival at 22-23 weeks, although outcomes vary, highlighting the importance of using up-to-date, institution-specific outcomes in counseling. Obstetric management, including antenatal corticosteroids and mode of delivery, plays a critical role in influencing neonatal outcomes and should be integrated into counseling. Shared decision-making remains central but is challenged by prognostic uncertainty and differing values. In addition, counseling is further shaped by tone, language, and framing of the data presented. Structured counseling tools and multidisciplinary approaches may improve consistency and comprehension but remain underutilized. SUMMARY:Periviability care requires integration of evidence-based obstetric management with patient-centered counseling. A multidisciplinary, emotionally attuned approach is essential to support shared, value-concordant decisions. Future efforts should focus on optimizing counseling frameworks and expanding the use of decision support tools while preserving individualized care.
PURPOSE OF REVIEW:The purpose of this review is to summarize and highlight contemporary studies evaluating sexual function after urogynecologic surgery. As nearly one in five women will undergo surgery for pelvic organ prolapse (POP) or urinary incontinence, it is critical to understand the impact of surgery on postoperative sexual function. This review includes a discussion of reconstructive surgeries for POP, uterine-preserving techniques, mesh-based prolapse repairs, and anti-incontinence procedures for both stress urinary incontinence (SUI) and urge urinary incontinence (UUI) and the associated effects on sexual function. RECENT FINDINGS:Women who undergo reconstructive POP surgery have many options for repair, including native tissue repair or mesh-based repairs, as well as uterine-sparing procedures or hysterectomy. Studies have shown general improvements in sexual functioning among all POP repair modalities, with no significant differences between modalities. Anti-incontinence procedures for SUI and UUI are also associated with improved sexual functioning. The majority of research in reconstructive pelvic surgery includes heterosexual, cisgender women. SUMMARY:Pelvic floor disorders are common and negatively affect sexual functioning. Surgical treatments for POP and urinary incontinence generally improve sexual functioning. Further research is needed given the ever-changing landscape of gynecologic surgery.
PURPOSE OF REVIEW:To compare environmental risk factors between women with and without genetic susceptibility to urinary incontinence. RECENT FINDINGS:We conducted a case-control study on women older than 18, diagnosed with stress urinary incontinence (SUI) or mixed urinary incontinence (MUI), between May 2008 and 2023. Cases were identified as being carriers of previously identified urinary incontinence-associated genetic variants. Environmental data, including age, BMI, parity, and diabetes status, were extracted from the patients' electronic health records, and genomic data were obtained from our institution's Biobank. The cohort included 2653 women (1055 with SUI and 1598 with MUI). Younger age was significantly associated with genome-wide association study positivity in the overall cohort (P = 0.0015) and in the MUI subgroup (P = 0.0149). Among women with MUI, diabetes was independently associated with genetic susceptibility (odds ratio = 2.41, 95% confidence interval = 1.06-5.10, P = 0.027). SUMMARY:Women with MUI and genetic susceptibility to urinary incontinence become symptomatic at a younger age and are more likely to have concomitant diabetes than those without identifiable genetic susceptibility. These findings suggest that genetic predisposition may modify the clinical presentation of urinary incontinence and interact with metabolic risk factors.
PURPOSE OF REVIEW:Vaginitis is one of the most common reasons a patient will present for care in both the ambulatory and urgent care settings. The objective of this review is to summarize traditional methods of evaluation and treatment for the most commonly seen vaginitis and vaginosis, but also to present updated literature and future management directions for this common and sometimes resilient medical problem. RECENT FINDINGS:A randomized controlled trial of partners in monogamous heterosexual relationships and the recurrence rate of bacterial vaginosis when male partners were simultaneously treated. Systematic review investigating the effectiveness of intravaginal vitamin C in treating and preventing recurrent bacterial vaginosis. Randomized controlled trial evaluating oteseconazole and its benefit against recurrent vulvovaginal candidiasis. A meta-analysis to evaluate breast cancer recurrence and mortality among breast cancer survivors using vaginal estrogen for genitourinary syndrome of menopause. SUMMARY:Vaginitis is an incredibly common problem among women of all ages globally. Traditional therapies, including oral and topical antibiotics and antifungals, are effective in many patients, but recurrence is common, necessitating prolonged suppressive therapy. Newer therapies include partner treatment, but also the use of newer medications with different mechanisms of action and consideration of adjunctive therapies such as vaginal pH-modulating topicals and adjunctive live biotherapeutic products.
PURPOSE OF REVIEW:Hypertensive disorders of pregnancy (HDP) are rising in incidence and are associated with significant adverse maternal and fetal outcomes. The purpose of the review is to synthesize the currently available evidence surrounding the diagnosis, management, and prevention of HDP to best inform clinical practice. RECENT FINDINGS:The timing and threshold for antihypertensive initiation remain controversial, but recent evidence supports the treatment of chronic hypertension targeted to a blood pressure (BP) of less than 140/90 mmHg. Whether to extend this recommendation to other HDP remains a point of controversy and future research. Diagnostic criteria for HDP, particularly for pre-eclampsia, are expanding to include placental products like circulating soluble fms-like tyrosine kinase-1 for risk-based stratification. The postpartum period is increasingly recognized as a critical window for enhanced focus and BP management with the long-term goal of reducing cardiovascular risk. Proposed strategies include lower BP treatment thresholds and postpartum hypertension referral clinics, but many gaps in evidence remain. SUMMARY:While perinatal risks and available treatment strategies for HDP are well-established, significant gaps in evidence remain, particularly regarding the optimal thresholds for antihypertensive intervention and the postpartum management strategies needed to mitigate long-term maternal adverse health outcomes.
PURPOSE OF REVIEW:Insulin resistance and related metabolic disorders are becoming increasingly common among women of reproductive age. However, the mechanisms by which insulin signaling influences female fertility remain only partially understood. Currently, there is rapid growth in the use of new insulin-sensitizing medications, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, prescribed to women who may want to conceive, raising concerns about reproductive safety and benefits. RECENT FINDINGS:Insulin acts at multiple points along the hypothalamic-pituitary-gonadal axis, including ovulatory function, oocyte maturation, and endometrial receptivity. Conditions such as polycystic ovary syndrome, diabetes, or obesity may impair oocyte development, modify IVF success rates, and compromise embryo implantation. Emerging evidence suggests that both SGLT2 inhibitors and GLP-1 receptor agonists improve factors such as ovulatory function and androgen balance, though both carry safety concerns during the periconception period. SUMMARY:Clinicians managing women of reproductive age with insulin-related metabolic disorders should incorporate reproductive counseling into treatment planning. Ultimately, fertility-focused trials of newer insulin modifiers may be beneficial.
PURPOSE OF REVIEW:Group prenatal care (GPC) has emerged as an alternative to traditional prenatal care designed to improve clinical outcomes, patient engagement, and education. Given the rapid increase in recent literature, an updated synthesis is necessary to evaluate its effectiveness across maternal and neonatal outcomes. RECENT FINDINGS:Recent studies demonstrate that GPC consistently improves patient engagement, health knowledge, empowerment, and selected health behaviors. Mental health outcomes generally improve over time, with no consistent between-group differences. Evidence for perinatal outcomes remains heterogeneous, with some studies reporting improvements in clinical outcomes, particularly among high-risk populations. Breastfeeding outcomes are mixed, with improvements in motivation but inconsistent effects on initiation. Attendance appears to be a key driver of effectiveness, with greater attendance linked to improved outcomes. Recent studies highlight the importance of fidelity, suggesting that variability in program delivery may contribute to inconsistent findings and should be considered a key determinant of GPC effectiveness. SUMMARY:GPC represents a promising model of prenatal care that enhances engagement and psychosocial outcomes, though its impact on clinical outcomes remains variable. Optimizing fidelity, improving attendance, and targeting high-risk populations will be critical to maximizing its effectiveness and informing broader integration into prenatal care systems.
PURPOSE OF REVIEW:Perimenopause is a clinically distinct stage in which abnormal uterine bleeding, fibroids, adenomyosis, endometriosis, and adnexal pathology may require surgical evaluation. Management is complex because symptom burden and structural disease must be balanced against proximity to menopause, potential spontaneous improvement and the risks of undertreatment or overtreatment. This review summarizes evidence on complex benign gynecology in perimenopausal women, focusing on surgical timing, uterus-sparing and definitive procedures, and adnexal management. RECENT FINDINGS:Recent data emphasize careful preoperative assessment of abnormal uterine bleeding because hormonal disturbance, structural pathology, and premalignant or malignant endometrial lesions may coexist. Evidence also supports individualized timing of definitive surgery, as earlier loss of ovarian function, particularly before age 45-50 years, may be associated with less favorable long-term cardiovascular outcomes. Opportunistic salpingectomy during indicated benign surgery is supported as an ovarian cancer prevention strategy that preserves ovarian hormonal function, whereas oophorectomy remains individualized. SUMMARY:Management should be tailored to symptoms, pathology, malignancy risk, proximity to menopause and patient preference. Perimenopause-specific prospective studies are needed.
PURPOSE OF REVIEW:This review synthesizes current evidence on pathophysiology, diagnosis, and management strategies for endometriosis of the urinary tract, emphasizing the urgent need for multidisciplinary care to prevent long-term complications. RECENT FINDINGS:Urinary tract endometriosis is an increasingly recognized subset of deep infiltrating endometriosis that poses a significant risk for severe morbidity. Advances in specialized transvaginal ultrasound and pelvic MRI have improved preoperative mapping of urinary tract endometriosis. Recent literature highlights a shift toward collaborative surgical planning between gynecologic and urologic surgeons. While medical management remains suppressive, surgical management via laparoscopy or robotic surgery demonstrates low recurrence rates and high patient satisfaction. However, the lack of standardized surgical criteria and postoperative surveillance protocols remains a challenge in clinical practice. SUMMARY:Urinary tract endometriosis requires a high index of clinical suspicion, particularly in patients with known deep infiltrating or parametrial nodules. Early recognition and individualized multidisciplinary management are critical to prevent renal deterioration and improve outcomes. Future research should focus on establishing evidence-based clinical pathways to standardize surgical decision-making and optimize long-term surveillance of renal function.
PURPOSE OF REVIEW:Adenomyosis is characterized by the presence of ectopic endometrial glands and tissue within the myometrium. The diagnosis and detection of adenomyosis on imaging have been hindered by a lack of consensus among clinicians and the historical view that diagnosis can only be made through histopathology posthysterectomy. The purpose of this review is to discuss updates in imaging findings for adenomyosis and summarize the current literature regarding ultrasonography. RECENT FINDINGS:The Morphological Uterus Sonographic Assessment consensus published in 2015, with updates in 2018 and 2022, has provided novel criteria for ultrasound diagnosis of adenomyosis. Studies comparing ultrasound with MRI have found that these imaging methodologies have similar sensitivity, specificity, and accuracy. However, concerns remain about the repeatability and reproducibility of these features in ultrasound imaging. There is a strong need for universal adoption to enhance ultrasound reporting and access for adenomyosis. SUMMARY:Transvaginal ultrasonography is a widely available, time- and cost-effective imaging modality with excellent detection rates of adenomyosis. Common terms, definitions, and diagnostic criteria are needed among clinicians worldwide. Early recognition and diagnosis of adenomyosis and associated endometriosis are essential for streamlined treatment, improved quality of life, and prevention of disease progression.
PURPOSE:Recurrent pregnancy loss (RPL) is a multifactorial condition with varying definitions across professional societies and is often misunderstood. This review summarizes recent insights into genetic, paternal, anatomic, metabolic, immunologic, and infectious contributors that may explain otherwise unexplained RPL. RECENT FINDINGS:In most RPL cases, a cause can be identified when standard evaluation is combined with genetic testing of products of conception (POC). When no clear etiology emerges, additional factors should be considered, including the couple's metabolic health, chronic endometritis, adenomyosis, and paternal contributors. Preimplantation genetic testing for aneuploidy appears beneficial, particularly for older patients and those with recurrent aneuploid losses despite normal evaluations. Conversely, emerging evidence suggests that many empiric treatments for unexplained RPL have limited or no benefit. SUMMARY:Comprehensive RPL evaluation should include POC genetic testing and assessment of both partners. An individualized, targeted approach improves outcomes while reducing costs, delays, and exposure to ineffective therapies. Paternal factors are increasingly recognized as important and should be included in both evaluation and management strategies when possible.
PURPOSE OF REVIEW:Preimplantation genetic testing for aneuploidy (PGT-A) increasingly identifies embryos classified as mosaic and segmental aneuploid, yet the biological significance and clinical implications of these intermediate results remain uncertain. This review synthesizes current evidence on their biological origins, technical limitations in detection, reproductive outcomes, and implications for embryo selection and counseling. RECENT FINDINGS:Emerging molecular data show that many embryos labeled as 'mosaic' reflect meiotic errors or technical artifacts rather than true embryonic mosaicism. Trophectoderm biopsy poorly represents inner cell mass ploidy for segmental and mosaic abnormalities, with high rates of discordance and nonreproducibility on re-biopsy. Retrospective studies suggest mosaic embryos implant less efficiently than euploid embryos, particularly with high-level or complex findings. However, newer prospective nonselection studies demonstrate that low-level mosaic embryos may have reproductive potential comparable to euploid embryos. Segmental aneuploid embryos, including nonmosaic segmental aneuploid, can also result in live birth. Neonatal outcomes after mosaic transfer appear reassuring, and prenatal confirmation of the embryonic mosaic finding is rare. SUMMARY:PGT-A mosaic and segmental results reflect biological and technical heterogeneity. Rigid interpretation risks unnecessary embryo discard. Individualized counseling, cautious prioritization, and structured prenatal planning are essential while more standardized classification and long-term outcome data evolve.
PURPOSE OF REVIEW:Adenomyosis is increasingly diagnosed in reproductive-aged patients, particularly those undergoing assisted reproductive technology, due to advances in imaging and standardized diagnostic criteria. Its association with infertility and adverse obstetric outcomes has prompted growing interest in understanding disease mechanisms, prognostic features, and optimal fertility-focused management strategies. This review summarizes recent evidence on the pathophysiology, diagnosis, and treatment of adenomyosis in the context of reproductive outcomes. RECENT FINDINGS:Emerging data highlight multifactorial mechanisms linking adenomyosis to impaired implantation and placentation, including hyperestrogenism, progesterone resistance, junctional zone disruption, immune dysregulation, and chronic inflammation. Studies evaluating imaging features suggest that disease phenotype, lesion size, uterine volume, and junctional zone involvement may influence reproductive outcomes, though findings remain inconsistent. Treatment strategies are evolving, with gonadotropin-releasing hormone agonists, levonorgestrel intrauterine systems, and aromatase inhibitors widely used, and growing evidence supporting pretreatment with prolonged gonadotropin-releasing hormone agonists. Adjunct approaches targeting inflammation, uterine contractility, and hormonal pathways are under investigation. Fertility-preserving procedures, including high-intensity focused ultrasound and adenomyomectomy, show promising but heterogeneous reproductive results. SUMMARY:Adenomyosis remains a clinically heterogeneous condition requiring individualized fertility management. Standardized diagnostic frameworks and well designed prospective studies are needed to clarify prognostic factors and optimize therapeutic strategies to improve reproductive outcomes.
PURPOSE OF REVIEW:Cesarean scar ectopic pregnancy (CSEP) is an uncommon but increasingly encountered pathology associated with severe maternal morbidity. Rising cesarean delivery rates and improved early pregnancy imaging have led to greater recognition of CSEP, highlighting the need for standardized diagnostic frameworks and evidence-based management strategies. RECENT FINDINGS:Recent literature emphasizes early first-trimester transvaginal ultrasound for diagnosis and risk stratification. Classification systems incorporating gestational sac location and residual myometrial thickness have been created to predict hemorrhage risk, placenta accreta spectrum, and treatment failure. Evidence increasingly supports classification-driven, interventional management, with surgical approaches demonstrating the highest success rates for higher-risk CSEP types. Non-excisional therapies, including medical and other interventional techniques, may be appropriate in selected early cases. Long-term data suggest that fertility is often preserved following uterus-sparing treatment, although recurrence and abnormal placentation remain important considerations. SUMMARY:CSEP represents a complex clinical entity requiring early recognition and individualized management. Use of standardized sonographic criteria and classification-based treatment strategies improves maternal outcomes while preserving fertility when appropriate. Ongoing efforts to refine risk stratification and better define long-term reproductive outcomes are essential to optimize counseling and care.
