PURPOSEBreast cancer (BC) is a significant health challenge in Nigeria, exacerbated by early onset, advanced-stage diagnosis, and high prevalence of triple-negative tumors. Access to genetic testing and counseling is scarce, with minimal capacity for hereditary cancer services. Despite these barriers, there is strong interest in expanding care to include genetic testing and improve understanding of familial risk. The purpose of this study was to develop and assess the effectiveness of a BC genetics education program for Nigerian health care providers (HCPs).METHODSA multidisciplinary international team developed a four-module hybrid education program combining asynchronous online learning and an in-person didactic session. Invitations were circulated to HCPs in tertiary hospitals across Nigeria. Knowledge improvement was assessed using standardized pre- and postmodule tests.RESULTSThirty-one physicians and nurses participated. All online modules had significant knowledge improvement, with the largest score increases in BRCA1/2 genetic counseling (mean change, 1.9 [95% CI, 1.3 to 2.5]; P < .001) and BRCA1/2 clinical management (mean change, 1.6 [95% CI, 1.2 to 2.1]; P < .001). The subsequent in-person workshop had additional, albeit smaller, module increases. Aggregated analysis showed a 23.0% increase in knowledge after the online training (P < .001), with a further 10.1% gain after the in-person workshop (P = .007). Overall knowledge improved from 45.0% at baseline to 87.0% post-training, representing a 43.0% absolute gain (P < .001).CONCLUSIONThis hybrid training program significantly improved provider knowledge of hereditary BC genetics in Nigeria and offers a scalable, culturally tailored model for expanding BC genetic services in low-resource settings. While promising, the modest sample size and limited follow-up warrant further evaluation and broader rollout to confirm long-term effectiveness.

Perimenopause is a clinically defined reproductive transition characterized by menstrual-cycle variability, fluctuating ovarian hormone secretion, and symptoms that often overlap with endocrine disease. Endocrinologists are well positioned to distinguish physiological reproductive aging from thyroid disease, hyperprolactinemia, pregnancy, premature ovarian insufficiency, and other causes of oligo-amenorrhea; to identify abnormal uterine bleeding requiring gynecologic evaluation; and to address the concurrent emergence of cardiometabolic and skeletal risk. Management should be symptom-directed and should explicitly separate the need for contraception and cycle control from the use of menopausal hormone therapy. This review presents a practical, evidence-based approach to diagnosis, risk assessment, and treatment for the endocrinology setting.

OBJECTIVE:Borderline ovarian tumors (BOTs) are heterogeneous primary epithelial lesions defined by atypical epithelial proliferation without stromal invasion, accounting for approximately 15% of primary ovarian neoplasms. Menopausal hormone therapy (MHT) treats vasomotor and genitourinary symptoms in postmenopausal women, yet its relationship with ovarian neoplasia, especially BOTs, remains uncertain. This systematic review evaluates the association between MHT and BOT outcomes. METHOD:Five databases were searched from inception to August 2025. Included studies were assessed for type of MHT, duration, and recurrences where reported. Risk of bias was assessed with the Newcastle-Ottawa Scale and certainty of evidence with GRADE. RESULTS:A search identified 469 studies; eleven met the inclusion criteria (four cohort, seven case-control). Six reported a statistically significant association between MHT and increased odds of BOTs; five did not. Combined estrogen-progestin therapy showed a stronger, more consistent positive association (odds ratio 1.426, 95% confidence interval 1.083-1.877), whereas estrogen-only therapy showed a nonsignificant association. Post-diagnosis evidence is extremely limited: no study addressed BOT recurrence, and only one observational study evaluated BOT survival, finding no adverse association. CONCLUSION:Evidence on the MHT-BOT association is heterogeneous and inconsistent. Although a statistical association was observed between combined MHT and increased odds of BOTs, postsurgical safety data are limited and overall certainty of evidence is very low; findings warrant considerable caution. Current literature is insufficient to confirm or exclude an association between MHT and BOT recurrence or survival. Indications for MHT after BOT surgery require individualized, multidisciplinary discussion involving oncology and menopause specialists, balancing quality-of-life benefits against unquantified theoretical risks.

Sexual dysfunction is a common yet under-recognized and distressing side effect of cancer treatment among female survivors. Despite its significant impact on quality of life, sexual health is often poorly integrated into survivorship care due to barriers at the provider, patient, and system levels. These barriers include limited provider training, time constraints, discomfort, and a lack of clear clinical guidelines. Marginalized populations such as LGBTQ2SIA+ individuals, older women, and racial and ethnic minorities face additional disparities in care. Patients may avoid raising concerns due to stigma, misinformation, or cultural taboos. At the system level, fragmented care models, lack of interdisciplinary collaboration, and insufficient resources further limit effective support. Although evidence-based interventions and updated guidelines are available, they remain underused. Addressing sexual health in oncology requires a comprehensive equity-driven approach that includes provider education, standardized screening, interdisciplinary referrals, and inclusive communication. Integrating sexual health into survivorship care is essential for improving patient outcomes and delivering holistic cancer care.

Menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms (VMS) and other manifestations of menopause; however, its use is limited in women with contraindications to oestrogen. Progestogen monotherapy, though historically underutilized, represents a viable alternative in this population. This narrative review summarizes the indications, efficacy, and limitations of progestogen monotherapy as MHT. A structured literature search identified systematic reviews, guidelines, randomized controlled trials, and cohort studies evaluating progestogen monotherapy for menopausal symptom management, bone health, and oncologic safety. Evidence supports its use in patients with contraindications specific to oestrogen, including those with certain gynecologic malignancies (e.g., low-grade endometrial stromal sarcoma, select ovarian cancers), prior venous thromboembolism, coronary artery disease, compensated liver disease, and endometriosis. Contraindications to progestogen monotherapy are limited to unexplained abnormal vaginal bleeding and personal history of breast cancer, with caution utilised in patients with meningioma. Clinical data demonstrate that progestogens provide significant VMS relief, with efficacy observed across oral, intramuscular, and transdermal preparations. Micronized progesterone shows additional benefits for sleep quality, while synthetic progestins such as medroxyprogesterone acetate, megestrol acetate, and norethindrone acetate variably confer bone protection. Effects on mood appear neutral overall. Breast cancer risk associated with progestogen monotherapy remains uncertain due to limited and underpowered studies. Despite promising evidence, research is constrained by heterogeneous methodologies, small sample sizes, and lack of contemporary trials directly comparing progestogen monotherapy with standard MHT or nonhormonal alternatives. In conclusion, progestogen monotherapy is an effective, well-tolerated, and under-recognized therapeutic option for women with contraindications to oestrogen-containing MHT. Its optimal use may be tailored to clinical context: micronized progesterone for sleep disturbance, norethindrone acetate for bone health, or progestins with known antineoplastic properties in hormone-sensitive tumours. Larger, high-quality studies are needed to better define long-term safety and efficacy.

OBJECTIVE:This systematic review investigated the impact of conjugated estrogens/bazedoxifene (CE/BZA) for treating perimenopausal and menopausal symptoms in patients with a history of endometriosis. METHOD:The review followed PRISMA guidelines and was prospectively registered with PROSPERO (CRD42024617174). Without randomized controlled trials (RCTs), the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports and Case Series assessed methodology and risk of bias. An information specialist completed the search in June 2025 using Ovid MEDLINE, PubMed, Ovid EMBASE, and Web of Science, combining controlled vocabularies and keywords for dysmenorrhea, dyspareunia, endometriosis, perimenopausal, postmenopausal, menopause hormone therapy, Duavive, and CE/BZA. Eligible studies included RCTs, cohort studies, case reports, and case-control studies evaluating CE/BZA for vasomotor symptoms in premenopausal and menopausal endometriosis patients. RESULTS:Of 1540 retrieved studies, two coauthors (J.C.M.-G., E.S.) independently screened titles and abstracts, selecting 20 for full-text review. Only two publications met inclusion criteria, one case report and one case series, representing nine patients (four detailed, five additional). No RCTs, cohort, or case-control studies directly addressed CE/BZA in endometriosis. Preliminary narrative evidence suggests pain and vasomotor symptom relief, though findings carry high risk of bias. CONCLUSION:Because bazedoxifene antagonizes estrogen receptors and endometriosis is estrogen-dependent, CE/BZA may alter systemic inflammation or endothelial function. Although preclinical models show reduced lesion size, human evidence remains extremely limited and biased, insufficient to assess lesion recurrence or vascular safety. CE/BZA is currently indicated only for postmenopausal vasomotor symptoms; preliminary anecdotal evidence suggests symptom improvement, but large-scale comparative trials are urgently needed to establish safety and efficacy in endometriosis.

OBJECTIVES:To determine whether a paracervical block (lidocaine 1% with epinephrine 1:100,000 10 mL) decreases pain during intrauterine device (IUD) placement STUDY DESIGN: We conducted a randomized, double-blind trial of three arms: paracervical block, saline injection, or capped needle from June 30, 2022, to August 16, 2024. The primary outcome was the global pain score, rated on a 100 mm visual analog scale. Secondary outcomes included pain perception at procedural timepoints using a numeric score and patient satisfaction. RESULTS:We included a total of 246 patients (n = 82 per group). Overall, participants who received a paracervical block reported lower global pain scores during IUD placement (median 30 mm, interquartile range [IQR] 10-50) compared with those receiving saline injection (median 45 mm, IQR 25-60) or a capped needle (median 45 mm, IQR 20-70) (p = 0.003 and p = 0.001, respectively). Among nulliparous participants, the paracervical block also reduced pain (median 40 mm, IQR 25-53) compared with saline (median 50 mm, IQR 30-68) and capped needle (median 60 mm, IQR 33-70) (p < 0.001). Paracervical injection pain was minimal with a median of 1 out of 10 (IQR 0.00-2.00). Secondary outcomes demonstrated reduced patient pain at all timepoints of IUD insertion (eg, tenaculum placement, uterine sounding, and IUD insertion) as well as higher patient satisfaction (p < 0.01) in comparison to the capped needle group. CONCLUSIONS:The paracervical block reduced global pain score during IUD insertion, particularly for nulliparous participants, and is associated with minimal injection pain. IMPLICATIONS:Findings from this randomized, double-blind trial support incorporating the paracervical block into routine IUD insertion, especially for nulliparous patients who experience higher pain. Wider adoption may improve procedural comfort, satisfaction, and acceptability of IUD use. Future research should evaluate implementation, patient preferences, and variations in technique.

Introduction Continued medical education is vital for cancer control in low-resource settings. A recent survey of healthcare providers (HCPs) in Nigeria identified lack of training programs as a major barrier to implementing breast cancer genetic testing. In response, we developed and evaluated an online program aimed at improving breast cancer genetics education for Nigerian HCPs. Methods A multidisciplinary team of subject matter experts including genetic counsellors, surgical oncologists, a gynaecologist/obstetrician, and education experts from West Africa and North America, collaboratively designed a four-module education program. Pre- and post-module knowledge assessments were conducted using the Wilcoxon signed-rank test. Participants who completed the online course were invited to complete a structured survey assessing content quality, platform usability, and self-reported knowledge improvement. Results Thirty-one HCPs participated. Across all modules, both physician and nurse cadres showed significant improvements in knowledge. Physician scores increased by 1.00-2.22, highest in Module 3 (p<0.001). Nurses improved by 1.40-2.00, with the greatest increase in Module 4 (p=0.009). Twenty-six participants completed the evaluation survey: 96.2% indicated the program met its intended objectives; over 88% reported improved understanding of BRCA1/2 pathogenic variants; and 92.3% reported improved knowledge of genetic testing and counselling. Content was well presented, with 96.1% commending the clarity and effectiveness of the course. Over 96% found online learning effective. Module duration and contextual relevance were noted for improvement. Conclusion The program significantly enhanced participants’ understanding of hereditary breast cancer and was highly rated for quality and usability. Online training is an effective and scalable approach to strengthen cancer genetic services in low-resource settings.

[Voir la version anglaise de l'article ici : www.cmaj.ca/lookup/doi/10.1503/cmaj.240337][1] Selon le Stages of Reproductive Aging Workshop (stades du vieillissement de l'appareil reproducteur féminin), la périménopause commence par des variations persistantes de 7 jours ou plus de la durée

It has been suggested that women with a pathogenic variant (mutation) in BRCA1 or BRCA2 are at a higher risk of developing high-grade endometrial cancer. Furthermore, significantly higher follicular (but lower luteal) endometrial thickness, a surrogate marker for endometroid adenocarcinoma risk, has been reported for this high-risk population. Given that medications known to affect endometrial thickness (i.e., tamoxifen, oral contraceptives) are often indicated for BRCA mutation carriers, it is important to elucidate substantial differences exist in carriers. Thus, we conducted a retrospective chart review of endometrial thickness among women with a BRCA1 or BRCA2 who had an intact uterus and were referred to a specialized ovarian cancer clinic between 2007 and 2016. Clinical data was collected from chart review, while endometrial thickness (millimeters; mm) was abstracted from transvaginal ultrasound reports with endometrial dating and compared to published levels in the general population. In total, 114 women were identified, 73 of whom were premenopausal and 41 who were postmenopausal. Among premenopausal women, the median follicular endometrial thickness found was 7.00 mm (n = 40, range 3–13) compared to 6.8 mm (range 2.4–14) in non-carriers and the median luteal endometrial thickness was 10.85 mm (n = 30, range 5–18), compared to 9.6 mm (range 3.3–18.2) in non-carriers. Among postmenopausal women, the median menopausal endometrial thickness was 4.0 mm (n = 41, range 1–18) compared to 4.0 mm (range 1–25) in non-carrier controls. Although based on small numbers, we found no significant difference in the endometrial thickness of BRCA mutation carriers versus non-carriers.

INTRODUCTION:Early life bilateral salpingo-oophorectomy (BSO) leads to immediate estradiol loss and increased risk of late-life Alzheimer's disease (AD). We investigated risk and resilience (RandR) on the average of 5 years post BSO and their possible impact on subjective cognitive decline (SCD), and brain structure. METHODS:A cohort in Canada (n = 333) included women with and without BSO of whom some reported SCD. We used multiple factor analysis, logistic regression, and magnetic resonance imaging to assess RandR, odds of SCD, and differences in gray matter volume (GMV). RESULTS:BSO was a risk for worse neuropsychological performance, a 2-fold increase in the odds of SCD, and decreases in GMV in regions sensitive to estradiol, and important for mood, memory, and language. However, estradiol therapy (ETBSO), and verbal IQ mitigated this risk. DISCUSSION:Risk of SCD exists for younger women with BSO, which affects GMV. Importantly, ETBSO and verbal IQ may shift that risk. HIGHLIGHTS:Oophorectomy in early middle age may be a risk for subjective cognitive decline. Oophorectomy is associated with less gray matter volume in the prefrontal cortex. Estradiol therapy and verbal IQ might be resilience factors mitigating such risk.

OBJECTIVE:There are many menopauses; bilateral oophorectomy is associated with the worst cognitive outcomes. Compared to females with intact ovaries, females with bilateral oophorectomy experience early, abrupt ovarian hormone loss and are at increased risk for later-life Alzheimer's disease. They also have double the odds of developing later-life sleep disordered breathing (SDB) - a modifiable Alzheimer's risk factor. With respect to bilateral oophorectomy, it is unknown when respiratory disturbances occur or whether estradiol therapy (ET) ameliorates them. Also unknown is whether SDB influences cognition in this group. METHOD:Females with risk-reducing bilateral salpingo-oophorectomy (BSO) taking ET (BSO+ET, n = 19) or not (BSO, n = 16) and premenopausal age-matched controls (AMC, n = 17) were assessed for SDB markers using take-home polysomnography and for working memory performance. RESULTS:The BSO group showed signs of respiratory disturbance compared to the AMC group. Memory performance was uncorrelated with respiratory metrics. While the BSO+ET group showed an intermediate sleep phenotype, estrone glucuronide levels correlated with improved respiratory metrics. CONCLUSION:The results suggest that respiratory disturbances manifest as early as 5 years post-BSO in younger females; ET offers some amelioration. The close relationship between sleep disruption and Alzheimer's risk emphasizes the importance of SDB screening post-BSO for early intervention.

OBJECTIVE:To assess the management and outcomes of patients diagnosed with an isolated serous tubal intraepithelial carcinoma lesion across Canada. METHODS:This retrospective study included consecutive patients with an isolated serous tubal intraepithelial carcinoma lesion diagnosed between 2006 and 2020 at 15 Canadian centers. Cases underwent multicenter panel pathology review. RESULTS:Of 107 patients, 41 serous tubal intraepithelial carcinoma cases (38.3%) were identified at prophylactic surgery for germline pathogenic variants, 36 (33.6%) at surgery for suspicion of malignancy, and 30 (28.0%) at surgery for benign conditions. Treatment groups included observation (n=62, 57.9%), staging surgery (n=35, 32.7%), and adjuvant chemotherapy (n=10, 9.3%). Median follow-up was 55.5 months (interquartile range 30.26-82.07 months). Overall, nine patients developed high-grade serous carcinoma. The cumulative incidence of high-grade serous carcinoma was not significantly different between treatment groups ( P =.181); however, no patient treated with chemotherapy developed high-grade serous carcinoma. The cumulative incidence of high-grade serous carcinoma was 1.1% (95% CI, 0.1-5.3%) at 2 years and 5.7% (95% CI, 1.8-13.1%) at 5 years. No significant predictive factors were found on univariate analysis. After multicenter pathology review of 59 cases (55.1%), consensus diagnosis was reached: 45 (76.3%) with serous tubal intraepithelial carcinoma, three (5.1%) with serous tubal intraepithelial lesion, seven (11.9%) with high-grade serous carcinoma, and two (3.4%) with normal tissue. Of the cases reviewed, only 1 of 45 patients (2.2%) with confirmed serous tubal intraepithelial carcinoma developed high-grade serous carcinoma at 73 months, indicating a 5-year cumulative incidence of cancer of 2.6% (95% CI, 0.2-11.7). CONCLUSION:Management of serous tubal intraepithelial carcinoma varied across centers. The 5-year cumulative incidence of high-grade serous carcinoma after isolated serous tubal intraepithelial carcinoma was 5.7%, consistent with recent literature. However, multicenter pathology review revealed initial underdiagnosed high-grade serous carcinoma, and 5-year cumulative incidence of high-grade serous carcinoma after confirmed serous tubal intraepithelial carcinoma decreased to 2.6%, underscoring the importance of diagnostic confirmation by expert pathologists to guide accurate management.

Early midlife bilateral salpingo-oophorectomy (BSO) is associated with greater Alzheimer's disease risk compared to spontaneous/natural menopause. Previously, we found that participants with BSO had lower volume in the hippocampal dentate gyrus and cornu ammonis 2/3 composite subfield (DG-CA2/3). We sought to extend those hippocampal subfield findings by assessing whether BSO affected volumes along the anteroposterior hippocampal axis, anterolateral entorhinal cortex, and perirhinal cortex subregions (Brodmann area (BA) 35 and 36). We also correlated volumes with key demographic and wellbeing-related factors (age, depressive mood, education), hormone therapy characteristics, and recognition memory performance. Early midlife participants with BSO (with and without 17β-estradiol therapy (ET)) and age-matched control participants with intact ovaries (AMC) completed high-resolution T2-weighted structural magnetic resonance imaging (MRI). Medial temporal lobe volumes and Remember-Know task recognition memory performance were compared between groups-BSO (n = 23), BSO + ET (n = 28), AMC (n = 34) using univariate analyses. Multivariate Partial Least Squares (PLS) analyses were used to examine how volumes related to demographic and wellbeing-related factors, as well as hormone therapy characteristics. Relative to BSO + ET, BSO had lower posterior hippocampal and DG-CA2/3 volumes but greater perirhinal BA 36 volumes. Compared to age, depressive mood, and education, ET was the strongest positive predictor of hippocampal volumes and negative predictor of perirhinal BA 36 volumes. For BSO + ET, hippocampal volumes were negatively related to ET duration and positively related to concurrent progestogen therapy. Relative to AMC, BSO had greater anterolateral entorhinal cortex and perirhinal BA 35 and BA 36 volumes. BSO groups (with and without ET) relied more on familiarity than recollection for successful recognition memory. BSO and ET may have distinct effects on medial temporal lobe volumes, with potential implications for memory processes affected by Alzheimer's disease risk.

Bilateral salpingo-oophorectomy (BSO; removal of ovaries and fallopian tubes) prior to age 48 is associated with elevated risk for both Alzheimer's disease (AD) and sleep disorders such as insomnia and sleep apnea. In early midlife, individuals with BSO show reduced hippocampal volume, function, and hippocampal-dependent verbal episodic memory performance associated with changes in sleep. It is unknown whether BSO affects fine-grained sleep measurements (sleep microarchitecture) and how these changes might relate to hippocampal-dependent memory. We recruited thirty-six early midlife participants with BSO. Seventeen of these participants were taking 17β-estradiol therapy (BSO+ET) and 19 had never taken ET (BSO). Twenty age-matched control participants with intact ovaries (AMC) were also included. Overnight at-home polysomnography recordings were collected, along with subjective sleep quality and hot flash frequency. Multivariate Partial Least Squares (PLS) analysis was used to assess how sleep varied between groups. Compared to AMC, BSO without ET was associated with significantly decreased time spent in non-rapid eye movement (NREM) stage 2 sleep as well as increased NREM stage 2 and 3 beta power, NREM stage 2 delta power, and spindle power and maximum amplitude. Increased spindle maximum amplitude was negatively correlated with verbal episodic memory performance. Decreased sleep latency, increased sleep efficiency, and increased time spent in rapid eye movement sleep were observed for BSO+ET. Findings suggest there is an association between ovarian hormone loss and sleep microarchitecture, which may contribute to poorer cognitive outcomes and be ameliorated by ET.

INTRODUCTION:Women with early bilateral salpingo-oophorectomy (BSO) have greater Alzheimer's disease (AD) risk than women with spontaneous menopause (SM), but the pathway toward this risk is understudied. Considering associative memory deficits may reflect early signs of AD, we studied how BSO affected brain activity underlying associative memory. METHODS:Early midlife women with BSO (with and without 17β-estradiol therapy [ET]) and age-matched controls (AMCs) with intact ovaries completed a face-name associative memory task during functional magnetic resonance imaging. Hippocampal activity along the anteroposterior axis during associative encoding and retrieval was compared among three groups (BSO [n = 28], BSO+ET [n = 35], AMCs [n = 40]). RESULTS:Both BSO groups (with and without ET) showed lower posterior hippocampal activation during encoding compared to the AMC group. However, this difference in activation was not significantly correlated with associative memory task performance. DISCUSSION:Early 17β-estradiol loss may influence posterior hippocampal activity during associative encoding, possibly presaging late-life AD. HIGHLIGHTS:After ovarian removal, changes in hippocampal function may affect dementia risk. Midlife ovarian removal is associated with less activation in the posterior hippocampus. Estradiol therapy may ameliorate alterations in brain function during learning.