Minerva obstetrics and gynecology最新文献

Background: Pelvic floor dysfunctions are highly prevalent among women, yet many remain unaware of their condition. While conservative treatment is the first-line approach for urinary incontinence, surgical intervention is often necessary in severe cases. However, its effectiveness becomes less predictable when incontinence is associated with pelvic organ prolapse (POP). This cohort study aimed to evaluate pelvic floor muscle function in women undergoing surgical correction of POP, either alone or in combination with urinary incontinence repair.

Methods: Women aged 18 to 65 years with no prior history of POP or urinary incontinence surgery were enrolled and divided into two groups: an isolated POP group (POPg, N.=47) and a group with urinary incontinence associated with POP (UI+POPg, N.=53). A blinded researcher evaluated participants at three time points: before surgery, three months postoperatively, and twelve months postoperatively. Assessments included manometry, the Urogenital Distress Inventory, the Pelvic Organ Prolapse Distress Inventory, and the Colorectal-Anal Distress Inventor.

Results: The results demonstrated improvements in pelvic floor muscle function across both groups, emphasizing the positive impact of surgical intervention on pelvic floor performance in women with POP, regardless of the presence of urinary incontinence.

Conclusions: Pelvic floor muscle performance and symptoms in women treated surgically for pelvic organ prolapse whether isolated or accompanied by urinary incontinence correction showed comparable improvement throughout the 12-month follow-up.

Introduction: Endometriosis is an inflammatory disorder characterized by ectopic endometrial-like tissue, affecting approximately 10% of women. It significantly impairs quality of life through symptoms such as dysmenorrhea, pelvic pain, and infertility. Conventional treatments often inadequately manage the complex pain associated with the disease. Complementary, alternative, and integrative medicine (CAIM) approaches are proposed as supplementary strategies addressing broader symptomatology.

Evidence acquisition: This scoping review employed a comprehensive search of PubMed and PsycINFO databases from inception through April 25^th, 2025. Studies assessing CAIM treatments on endometriosis-associated pain or quality of life were included. Screening and data extraction were performed independently by multiple reviewers, following PRISMA-ScR guidelines.

Evidence synthesis: A total of 107 studies across diverse CAIM domains were analyzed, including acupuncture, Chinese and natural medicine, nutritional supplements, physical therapy, dietary interventions, relaxation techniques, psychotherapy, and combined therapies. Acupuncture, Chinese and natural medicine, and nutritional supplements had the most substantial evidence base, featuring randomized controlled trials and meta-analyses indicating significant pain relief and quality of life improvements. However, significant heterogeneity in study designs, diagnosis confirmation methods, intervention specifics, and outcome measures limited direct comparability and generalizability.

Conclusions: CAIM therapies demonstrate potential as adjunctive treatments for endometriosis-associated pain and quality of life enhancement. Future research should examine additive benefits of CAIM therapies combined with conventional treatments, supporting integrative care addressing endometriosis-related pain, sensitization, mental health, inflammation, and myofascial dysfunction.

Background: This study aimed to confirm the association between hypertension and the onset of menopause in Koreans.

Methods: For this retrospective cross-sectional study, data for women aged 40 to 80 years with natural menopause were extracted using the Korea National Health and Nutrition Examination Survey (IV~VIII) (2007~2019). Women with hypertension before menopause were included in the case group, and women without hypertension before menopause were included in the control group. The relationship between hypertension and onset of menopause was evaluated through multivariate linear regression analysis.

Results: Of the 105,732 participants, we selected 23,441 women aged 40 to 80 years who had no history of cancer and had undergone natural menopause. This cohort comprised 16,839 women without a history of hypertension and 6,602 women with hypertension. The median age at menopause was 52 [50; 54] and 50 [47; 52] years in the hypertension and control groups, respectively. Hypertension (Beta coefficient [BC]±standard error [SE], 1.93±0.13) increased menopausal age. In the subgroup analysis, there was no significant difference in menopausal age according to the gap between menopausal age and age at hypertension diagnosis.

Conclusions: This study found an association between hypertension and the onset of menopause, such that women diagnosed with hypertension before menopause had a higher menopausal age. However, the timing of the diagnosis of hypertension was not related to the onset age of menopause.

Introduction: Embryo implantation is a crucial step in pregnancy that requires interaction between the embryo and the endometrial lining, facilitated by cytokines, growth factors, and adhesion molecules. Failures in this process are a leading cause of implantation failure and miscarriage in in-vitro fertilization (IVF) treatments. Heparin has shown potential to improve outcomes by enhancing endometrial receptivity, promoting angiogenesis, and modulating inflammatory responses. This study aims to provide an overview of the main characteristics of existing research on the role of heparin adjuvant therapy in IVF cycles.

Evidence acquisition: A comprehensive bibliographic search was systematically conducted from inception to 2024, focusing on studies that evaluated the impact of heparin adjuvant therapy in IVF cycles and compared clinical outcomes between case and control groups.

Evidence synthesis: A total of 31 studies were included. Most of the studies have focused on patients with recurrent implantation failure, defined using highly heterogeneous criteria across studies, as well as patients with both congenital and acquired thrombophilic disorders. Additionally, most of the studies involved small sample sizes.

Conclusions: Current evidence does not adequately support the routine use of heparin in IVF cycles. To date, the research is plagued by methodological inconsistencies, which undermine both the reliability and the applicability of the findings.

Introduction: Clinical characteristics of polycystic ovary syndrome (PCOS) (menstrual irregularities, obesity, anovulation, etc.), occur together with a series of conditions at skin level like seborrhea, acne, hirsutism, and androgenetic alopecia. Estroprogestins (EPs) are recognized as the most powerful therapy to treat hyperandrogenism and/or hyperandrogenemia and regularize menstrual cycle.

Evidence acquisition: This review includes the most relevant publications about the effects of EPs in PCOS women published between 1995 and 2025.

Evidence synthesis: According to the available data, EPs composed by an anti-androgenic progestin appear the most suitable to reduce the hyperandrogenic manifestations of PCOS. More specifically, cyproterone acetate (CPA), drospirenone (DRSP) and dienogest (DNG) associated with 20-30 μg of ethinylestradiol (EE) seem to be the most effective compounds for the management of androgen excess. As the benefit risk/ratio of the association EE/CPA is less favorable, the use of EPs with other antiandrogenic progestins could be more appropriate to treat PCOS patients, also from a metabolic point of view.

Conclusions: In conclusion, an aware choice of the most adequate and tolerable EP formulation according to the pharmacological profile and individual characteristics of PCOS patient is essential to opportunely customize the treatment of androgen excess.

Background: Polycystic ovary syndrome (PCOS) is an endocrine/metabolic condition. Hyperandrogenism and insulin-resistance with compensatory hyperinsulinemia are important features of PCOS. The aim of this paper is to review the rationale of antiandrogens and insulin-sensitizers use in PCOS management.

Evidence acquisition: We include in our research the most relevant scientific literature about the impact of antiandrogens and insulin sensitizers in PCOS between 1976 and 2025.

Evidence synthesis: According to the most recent recommendations, antiandrogens can be a possible therapeutic option to reduce the impact of hyperandrogenism and treat hirsutism in PCOS patients after a period of 6 months of estroprogestins and/or cosmetic therapy without adequate results. Insulin-sensitizers can decrease the levels of insulin in subjects affected by hyperinsulinemia, improving metabolic and hormonal alterations observed in PCOS patients.

Conclusions: Antiandrogens and insulin sensitizers represent fundamental pharmacological therapies for PCOS management.

Polycystic ovary syndrome (PCOS) is a prevalent endocrine-metabolic disorder characterized by hyperandrogenism, chronic anovulation, and polycystic ovarian morphology, affecting 6-10% of women during their reproductive years. It is a leading cause of female infertility, impacting up to 40% of cases. First described in 1935, PCOS manifests with various clinical features, including hirsutism, amenorrhea, and metabolic disturbances. Additionally, PCOS patients exhibit hormonal imbalances and ovarian dysfunction, contributing to the overall clinical picture. Notably, PCOS is linked to metabolic comorbidities like hepatic steatosis, glucose intolerance, dyslipidemia, type 2 diabetes mellitus (T2DM), and hypertension. This review explores the key aspects of PCOS, providing an overview of ovulation induction strategies, including lifestyle modifications, pharmacological interventions, and emerging approaches. The review synthesizes findings from relevant studies. Effective management of PCOS necessitates early detection and intervention to prevent progression to severe health conditions. Evidence underscores the importance of addressing oxidative stress and low-grade inflammation in treatment plans. A holistic approach, including individualized medication, diet, and lifestyle modifications, is crucial for improving insulin resistance, promoting weight loss, enhancing ovulation rates, and addressing broader metabolic concerns. Key therapeutic strategies include insulin sensitizers like metformin, ovulation induction agents like clomiphene citrate (CC) and aromatase inhibitors (AIs) such as letrozole, and the use of gonadotropins for resistant cases. Combining these treatments with dietary and lifestyle interventions, such as an anti-inflammatory diet, nutritional education, and personalized exercise programs, can enhance treatment outcomes. Through an integrated approach, significant improvements in metabolic health and reproductive function for women with PCOS are possible.

The management of assisted reproductive technology (ART) in predicted hyper-responders to ovarian stimulation represents a complex and challenging clinical scenario, whereby the benefits of higher oocyte yield must be balanced against the drawbacks and risks of ovarian hyperstimulation syndrome. This review explores advances in ART for hyper-responders, focusing on adapted stimulation protocols, ovulation triggering, cryopreservation, and personalized strategies to optimize outcomes. In-vitro maturation of oocytes, an emerging alternative, is gaining traction for increasing live birth rates in selected cases and expert centers. A comprehensive review of the literature was conducted. Articles were selected based on relevance, rigor, and contributions to advancing the management of hyper-responders in assisted reproductive technology. Key findings were synthesized to provide an overview of evidence and emerging trends. Findings suggest a paradigm shift from indiscriminate oocyte retrieval towards achieving a target range, with 15-19 oocytes per cycle correlating with an optimal balance between live birth rates and complication risks. However, challenges remain in predicting ovarian response accurately, particularly in patients with elevated Anti-Müllerian Hormone levels or specific clinical profiles. The variability of ovarian response in these categories underscores the need for individualized protocols, incorporating patient-specific factors of age, Body Mass Index, and ovarian reserve markers. Strategies like tailored gonadotropin dosing and advances in cryopreservation techniques, such as embryo and oocyte vitrification, have shown promise but still require refinement. Future research should aim to refine dosing algorithms, explore genetic contributions, and enhance personalized, patient-centered approaches that prioritize safety, comfort, and improved outcomes in managing hyper-responders.