AMH as a marker for resumption of ovarian function after chemotherapy: an IPD meta-analysis and systematic review.

Background Abnormal uterine bleeding (AUB) in premenopausal women is frequent, yet distinguishing benign from malignant causes remains clinically challenging. Endometrial thickness (ET) measured by transvaginal ultrasound (TVUS) is well established in postmenopausal bleeding but less validated in premenopausal women due to cyclical variations. This study aimed to assess the diagnostic accuracy and prognostic value of ET, supplemented by Kaplan–Meier survival analysis, in predicting endometrial malignancy among premenopausal women with AUB. Methods We conducted a retrospective analytical study including premenopausal women presenting with AUB at Charles Nicolle Hospital, Tunis, Tunisia (2016–2024). All underwent TVUS followed by endometrial sampling (hysteroscopy or curettage) and definitive histological confirmation on hysterectomy specimens. Sonographic features were described using International Endometrial Tumor Analysis (IETA) criteria. Diagnostic performance of ET was evaluated using receiver operating characteristic (ROC) curve analysis. Kaplan-Meir survival analysis was applied to time-to-consultation and time-to-diagnosis, not survival outcomes. Results ROC analysis identified ET as the strongest predictor of endometrial malignancy (AUC = 0.842, p < 0.001). An optimal cutoff of >9 mm achieved 69.2% sensitivity, 87.1% specificity, and a negative predictive value of 97.7%, effectively ruling out malignancy in patients with ET ≤9 mm. Although the positive predictive value was modest (26.5%), ET reliably stratified risk for further invasive evaluation. Kaplan–Meier analysis demonstrated that ET >9 mm was associated with earlier consultation (mean 27.7 vs. 70.3 months, p < 0.0001) and shorter time-to-diagnosis (median 12 months vs. not reached, p < 0.0001), reflecting a more aggressive clinical course. Conclusions ET >9 mm is a robust, non-invasive potential prognostic marker in premenopausal AUB, identifying high-risk women requiring urgent evaluation while safely excluding malignancy in low-risk patients.

Does transdermal testosterone treatment improve fertility-related quality of life (QOL) in women with diminished ovarian reserve (DOR)? Transdermal testosterone for 9 weeks at a dose of 5.5 mg per day did not result in improved fertility-related QOL compared with placebo in women with DOR. Reduced QOL is prevalent in women with infertility, many of whom have DOR. Several studies have shown a correlation between DOR and lower testosterone levels, and testosterone is frequently prescribed to women with DOR undergoing fertility treatment. Some studies have reported that testosterone therapy may improve wellbeing in pre- and post-menopausal women, though others have found no benefit. There are no studies evaluating the effect of testosterone on QOL in women undergoing fertility treatment. Pre-planned secondary analysis of a double-blind placebo-controlled randomized controlled trial that included 288 participants recruited between April 2015 and August 2022. Of these, 213 completed QOL surveys both before and after treatment and were eligible for inclusion in this analysis. Participants were women aged 18-43 years with DOR according to the Bologna criteria and planning to undergo IVF treatment at one of eight fertility clinics in Spain, Belgium, and Denmark. Participants were randomized to 5.5 mg of transdermal testosterone per day as 1% gel (n = 106) or an identical placebo (n = 107), applied for a median of 60 days prior to commencing ovarian stimulation. QOL was assessed using the FertiQoL instrument prior to commencing the intervention, and at the completion of the intervention but prior to commencing ovarian stimulation. QOL scores were compared using a one-way ANCOVA adjusted for age, BMI, parity, history of IVF treatment, and baseline FertiQoL scores. There were no significant differences in baseline characteristics between the testosterone (n = 106) and placebo (n = 107) groups. After adjustment, testosterone showed no benefit over placebo for the Total FertiQoL score (F(1,204)=0.07, P = 0.79), the Core and Treatment scores, nor for any of the included FertiQoL subscales. Total testosterone levels were higher in the testosterone group than the placebo group at the end of the treatment (3.2 ± 2.7 nmol/l vs 0.6 ± 0.4 nmol/l, P < 0.001). QOL was a secondary outcome in this trial, and participants were not recruited based on a low QOL. Considering the available evidence, including the current study, premenopausal women are unlikely to benefit from testosterone treatment with regard to wellbeing and QOL. This study provides further evidence that testosterone should not be seen as a treatment for low wellbeing or QOL. The study was supported by unrestricted grants and support from Besins Healthcare, Roche Diagnostics, and Ferring Pharmaceuticals. The study medication and placebo were provided by Besins Healthcare. Funders had no access to patient data and had no role in the interpretation of the data, nor in the writing or approval of the final manuscript. The researchers were independent of the funders and had full access to all the data in the study. S.J.L. has received honoraria from Merck, Organon, and Hologic, consulting fees from Merck, and travel support from Merck, Organon, Besins Healthcare, and Ferring Pharmaceuticals. S.R.D. has received grants from NHMRC Australia, MS Australia, MRFF Australia, the Australian Heart Foundation, and Lawley Pharmaceuticals, consulting fees from Besins Healthcare, Astellas, and Abbott, honoraria from Theramex, Astellas, and Bayer, travel support from Astellas, and drugs/placebo from Lawley Pharmaceuticals for clinical trials; she is an Executive Board Member of the Australian Academy of Health and Medical Sciences. C.B. has received honoraria from Ferring Pharmaceuticals, IBSA, Organon, Merck A/S, and Abbott. A.G. has received honoraria from Lab Seid and travel support from Merck Serono. P.H. has received honoraria from Merck, IBSA, Gedeon Richter, and Besins Healthcare. L.D.L.F. has received consulting fees from Gedeon Richter, Ferring Pharmaceuticals, and Organon, travel support (personal and to institution) from Gedeon Richter, Ferring Pharmaceuticals, IBSA, Merck, Organon, and Theramex, and educational support (to institution) from Gedeon Richter and Merck. A.P. has received grants from Gedeon Richter, Ferring Pharmaceuticals, and Merck A/S, consulting fees from Gedeon Richter and Ferring Pharmaceuticals, honoraria from Ferring Pharmaceuticals, Gedeon Richter, Merck A/S, Abbott, and Organon, and travel support from Gedeon Richter. D.S. has received grants from Organon, Ferring Pharmaceuticals, Besins Healthcare, Gedeon Richter, and Vitrolife, honoraria from Organon, Ferring Pharmaceuticals, Besins Healthcare, Gedeon Richter, and Merck, travel support from Organon, Ferring Pharmaceuticals, Besins Healthcare, Gedeon Richter, and Merck, and is President of the Belgian Society for Reproductive Medicine. N.P.P. has received grants from Merck Serono, Ferring Pharmaceuticals, Theramex, Organon, Besins Healthcare, and Gedeon Richter, consulting fees from Merck Serono, Besins Healthcare, Organon, IBSA, FertilAI, and Alife, and honoraria from Merck Serono, Theramex, IBSA, Ferring Pharmaceuticals, Organon, Roche Diagnostics, and Besins Healthcare. S.G.M., F.M., and F.F. have no interests to declare. NCT02418572 (ClinicalTrials.gov).

Breast cancer (BC) remains a major global health issue, influenced by modifiable factors like lifestyle and diet, and non-modifiable factors such as genetics. This study assesses their impact on BC among pre- and post-menopausal women in South India using a large, age-matched, population-based case-control design. We analyzed epidemiological risk factors for BC overall and stratified by menopausal status. A total of 3,043 newly diagnosed BC cases from the Regional Cancer Centre, Thiruvananthapuram, and age-matched controls from the general population of Kerala, recruited through face-to-face interviews (2017-2023). Odds-ratios (OR) and 95% Confidence-Interval (CI) were estimated using conditional-logistic regression model. Independent modifiable risk-factors for BC (OR;CI) among all women were frequent fried-food consumption (3.9;3.2-4.7), low vigorous-activity (2.7;2.2-3.4), low moderate-activity (2.4;1.8-3.3), more light-activity (2.2;1.8-2.6), high body-mass-index (1.5;1.1-1.8) and non-modifiable risk-factors were benign-breast-disease (4.9;3.4-7.2), prior-chest radiation (3.4;1.9-5.8), prior-pesticide exposure (2.5;1.4-4.2), family-history of BC (2.0;1.5-2.6) and family-history of other cancers (1.4;1.1-1.6), post-menopause women (1.4;1.02-1.9) and early menarche (1.3;1.03-1.7). In the stratified analyses, the independent factors among pre-menopausal women were fried-food consumption, physical inactivity, high body-mass-index, benign-breast-disease, prior-pesticide exposure, prior-chest radiation, and late first delivery were significant. Among post-menopausal women, the significant factors included fried food consumption, physical inactivity, higher waist-to-hip ratio, history of abortion, thyroid disease, benign-breast-disease, family-history of BC, family-history of other cancers, prior-pesticide exposure and prior-chest radiation. Non-modifiable factors consistently influenced BC risk across groups, modifiable-factors were more critical among post-menopausal women. Targeted prevention strategies that promote physical activity, and weight management could significantly reduce the risk of breast cancer.

Accurate preoperative differentiation between benign and malignant adnexal masses is essential for guiding optimal surgical management. This study aimed to assess the diagnostic performance, calibration, and clinical utility of serum biomarkers (CA-125, CEA), the O-RADS MRI risk score, and Risk of Malignancy Indices (RMI-I-V) in both premenopausal and postmenopausal women. This retrospective study included data from consecutive patients who underwent surgical management for ovarian masses at a rural tertiary care center in Southern India over 2years. Preoperative ultrasonography, serum CA-125, CEA levels, and O-RADS MRI risk scores were recorded. RMI-I-V were calculated for each case. Statistical analyses included Receiver Operating Characteristic (ROC) curves, calibration plots, and decision curve analysis to assess discrimination and clinical utility across decision thresholds (5-50%). A total of 129 women were evaluated-98 (75.9%) had benign, 5 (3.9%) borderline, and 26 (20.2%) malignant ovarian masses. At recommended cut-offs, all RMI models and serum biomarkers significantly differentiated between benign, borderline, and malignant cases. RMI-IV and RMI-V demonstrated the best sensitivity (92.31%), specificity (90.82% and 92.86%), and negative predictive values (97.80% and 97.85%), whereas CEA showed the poorest sensitivity (23.08%). Calibration was most accurate for RMI-V, with RMI-II and RMI-IV also performing well. Decision curve analysis confirmed the highest net clinical benefit for RMI-II and RMI-IV across thresholds of 5-50%. RMI-based models, especially RMI-IV, demonstrated excellent diagnostic accuracy and clinical utility, supporting their use as a reliable, cost-effective tool for adnexal mass evaluation.

Importance Since 2018, the TAILORx and RxPONDER trials have demonstrated that the 21-gene recurrence score (RS) can be indicative of the benefit of adjuvant chemotherapy in hormone receptor (HR)–positive, ERBB2 (formerly HER2 )–negative breast cancer with 3 or fewer positive lymph nodes. However, its applicability to key subgroups with high risk for recurrence, including premenopausal women with positive lymph nodes and racial and ethnic minority individuals, remains unclear. Objective To assess the temporal patterns of and disparities in adjuvant chemotherapy use in early-stage HR-positive, ERBB2 -negative breast cancer by age, genomic risk, and nodal involvement. Design, Setting, and Participants This retrospective cohort study analyzed clinical data from the 2010 to 2022 National Cancer Database. The cohort included women with stage I to III, HR-positive, ERBB2 -negative breast cancer who had undergone a lumpectomy or mastectomy and were eligible for endocrine therapy. Patients were categorized into premenopausal (aged ≤50 years) or postmenopausal (aged &amp;amp;gt;50 years) status. Nodal status (negative or positive) was pathologically confirmed. RS was classified per the TAILORx trial, with RS of 0 to 10 as low genomic risk, RS of 11 to 25 as intermediate genomic risk, and RS of 26 or higher as high genomic risk. Data were analyzed from January 20 to August 11, 2025. Main Outcomes and Measures Adjuvant systemic therapy, defined as receipt of either endocrine therapy alone or chemoendocrine therapy (chemotherapy plus endocrine therapy), after surgery (lumpectomy or mastectomy). Results A total of 504 937 women (mean [SD] age, 60.0 [10.7] years; 5.4% Hispanic, 4.3% non-Hispanic Asian or Pacific Islander, 8.1% non-Hispanic Black, 81.3% non-Hispanic White, and 0.9% other race or ethnicity) were included. Among premenopausal patients with node-negative tumors, adjuvant chemotherapy use decreased from 6.5% in 2010 to 0.9% in 2022 for those with low genomic risk and from 29.6% in 2010 to 11.1% in 2022 for those with intermediate genomic risk. However, among premenopausal patients with node-positive disease, chemotherapy use declined from 33.3% in 2010 to 12.7% in 2019 but increased to 25.7% in 2022 for the low genomic risk group. For the intermediate genomic risk group, chemotherapy use declined from 55.8% in 2010 to 38.1% in 2019 but increased to 48.9% in 2022. Among postmenopausal women, chemotherapy use for those with low to intermediate genomic risk continued to decrease from 2010 to 2022 in both node-negative and node-positive disease status. Black women with high genomic risk had lower odds of chemotherapy receipt than White women, regardless of menopausal or nodal status (adjusted odds ratio [AOR], 0.84; 95% CI, 0.78-0.90). Premenopausal Black women with low to intermediate genomic risk also had lower odds of chemotherapy receipt than White women (AOR, 0.85; 95% CI, 0.77-0.94), regardless of nodal status. Conclusions and Relevance This retrospective cohort study found that adjuvant chemotherapy use almost doubled in premenopausal patients with node-positive tumors and with a low to intermediate genomic risk from 2019 to 2022 but decreased for patients with node-negative disease, coinciding with the publication of the TAILORx and RxPONDER trials. The findings highlight the variability in genomic assay use to facilitate adjuvant therapy recommendations for HR-positive, ERBB2 -negative breast cancer.

BackgroundHormonal changes, particularly in estrogen and follicle-stimulating hormone, during the menopausal transition affect lipid and glucose metabolism, thereby increasing the risk of dyslipidemia. Dyslipidemia is a well-recognized risk factor for cardiovascular disease, which remains the leading cause of death worldwide. Therefore, assessing dyslipidemia and its associated factors among women in the reproductive age group and those who have entered menopause may help reduce the risk of cardiovascular disease by promoting balanced lipid levels.ObjectiveThe aim of this study was to determine and compare prevalence of dyslipidemia and associated factors among premenopausal and post-menopausal women: a community-based comparative cross-sectional study in Debre Markos city, Northwest, Ethiopia, 2024.MethodA community-based comparative cross-sectional study was conducted in Debre Markos city among 320 women. Participants were recruited using a multistage simple random sampling technique. Data were collected using a structured and pretested interviewer-administered questionnaire. Lipid profiles, estrogen, follicle-stimulating hormone, progesterone, luteinizing hormone, and glucose were measured using a Beckman Coulter analyzer. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 27. Multivariable logistic regression was employed to identify predictors of dyslipidemia. In the multivariable logistic regression, a significant association was considered at p < 0.05 with odds ratios and 95% confidence intervals.ResultThe prevalence of dyslipidemia was 41.9% (95% CI: 34.2–49.6) among menopausal women and 22.5% (95% CI: 16.3–28.7) among premenopausal women. In menopausal women, physical inactivity (AOR = 3.04; 95% CI: 1.18–7.85), being obese (AOR = 3.08; 95% CI: 1.14–8.34), and low estrogen levels (≤ 30 pg/ml: AOR = 5.97; 95% CI: 1.88–18.93; 30.63–39.39 pg/ml: AOR = 3.73; 95% CI: 1.30–10.71) were significantly associated with dyslipidemia.ConclusionMenopausal women demonstrated a higher prevalence of dyslipidemia compared to their premenopausal counterparts. Independent of age, decreased estrogen levels, physical inactivity, and being obese were significant predictors of adverse lipid changes. These findings underscore the need for targeted preventive strategies during the menopausal transition to reduce the burden of dyslipidemia and improve women’s long-term cardiovascular health and quality of life.

To examine our current understanding of insulin-like growth factor-1 receptor's (IGF-1R) role in female reproductive physiology and identify the mechanisms that underlie commonly reported new-onset menstrual abnormalities in premenopausal women following initiation of teprotumumab, an IGF-1R antagonist, for treatment of thyroid eye disease. This is a narrative review. First, studies were identified that reported menstrual changes with the use of teprotumumab. Then, literature regarding IGF-1R signaling and female reproductive physiology was explored to generate a hypothesis on how IGF-1R antagonism may be causative of the menstrual abnormalities attributable to teprotumumab. Reported rates of menstrual abnormalities, predominantly amenorrhea, attributable to IGF-1R antagonism range from 5% to 50%. Cellular expression of IGF-1R is documented across the spectrum of tissues that are critical to the successful functioning of the female reproductive system, including the hypothalamus, pituitary, ovary, and the endometrium. The likely mechanisms through which menstrual abnormalities occur with IGF-1R antagonism are through disruption of ovarian processes of folliculogenesis, steroidogenesis, and ovulation. Ultimately, further basic and clinical research is warranted to better understand the mechanisms whereby IGF1-R antagonism disrupts female reproductive functioning, as well as to examine if there is any lasting detriment beyond cessation of exposure to IGF1-R antagonists such as teprotumumab.

Purpose: This study aimed to investigate the associations between serum per- and polyfluoroalkyl substances (PFAS) and reproductive hormones, including follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), estradiol, and progesterone, in U.S. women. Approach and Results: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018. The study included 612 women aged ≥18 years with available PFAS and sex hormone measurements. Serum concentrations of four major PFASs (linear perfluorooctanoic acid [n-PFOA], perfluorooctane sulfonic acid [PFOS], perfluorononanoic acid [PFNA], and perfluorohexane sulfonic acid [PFHxS]) were analyzed, along with serum levels of FSH, AMH, estradiol, and progesterone measured by isotope dilution liquid chromatography–tandem mass spectrometry. Higher serum PFAS concentrations were associated with increased FSH and decreased AMH, estradiol, and progesterone. For example, each interquartile range (IQR) increase in ln-PFNA was associated with a 42.0% increase in ln-FSH (p = 0.01) and 32.2% lower ln-AMH (p < 0.001), 33.0% lower ln-estradiol (p = 0.004), and 40.9% lower ln-progesterone (p = 0.02). A PFAS exposure index was related to higher FSH and lower AMH, estradiol, and progesterone, with stronger effects in premenopausal women. Conclusions: PFAS exposure was linked to broad endocrine disruption in women, with consistent alterations across gonadotropins and sex steroids. These findings suggest that PFAS exposure was associated with hormonal patterns consistent with diminished ovarian reserve and potential changes in reproductive function, underscoring the need for longitudinal studies and regulatory actions to mitigate exposure.

Endometriosis is a chronic inflammatory disorder affecting around 10% of reproductive-age women, and its diagnosis is often delayed due to the dependence on invasive laparoscopy. This study explored the potential of a serum-based biomarker panel for the non-invasive detection of endometriosis. Ninety premenopausal women (45 with surgically confirmed endometriosis and 45 controls) were enrolled, and serum levels of IL-6, TNF-α, hs-CRP, MCP-1, LIF, Glycodelin, Activin A, and CA-125 were measured using ELISA. Concentrations of all biomarkers were higher in the endometriosis group compared to controls (p &lt; 0.001). Among them, hs-CRP, TNF-α, Glycodelin, and Activin A showed relatively high diagnostic performance (AUC values ranging from 0.93 to 1.00). Multivariate regression suggested that CA-125, IL-6, and MCP-1 may serve as independent predictors, and clustering analysis indicated possible subgroups with distinct inflammatory profiles. These findings suggest that a combination of selected serum biomarkers could support non-invasive diagnostic approaches for endometriosis, warranting further validation in larger, multicenter studies

Cardiovascular disease in women: traditional and sex-specific risk factors.

Accurate preoperative classification of ovarian tumors is essential for guiding treatment. There is an increasing body of data evaluating ultrasound-based models for this purpose in diverse clinical settings. The aim of this systematic review and meta-analysis was to generate up-to-date evidence on the diagnostic accuracy of the most relevant ultrasound-based models, including the Risk of Malignancy Index (RMI) versions 1, 2 and 3, Logistic Regression model 2 (LR2), Simple ultrasound-based Rules (SR), the Assessment of Different NEoplasias in the adneXa (ADNEX) model and subjective assessment (SA), for the differentiation between benign and malignant ovarian tumors. Ovid/MEDLINE, EMBASE and the Cochrane Library were searched systematically from database inception until 19 June 2025. Eligible studies investigated the diagnostic accuracy of at least one of the preselected models, collected model parameters prospectively and provided sufficient data to construct 2 × 2 tables. The risk of bias of all included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 and QUADAS-C extension tools. Pooled summary estimates of sensitivity and specificity for all included models were calculated and bivariate models were fitted into hierarchical summary receiver-operating-characteristics curves. Bivariate random-effects meta-regression analysis was conducted to determine significant differences in sensitivity and specificity between models. Subgroup analyses were conducted according to menopausal status and prevalence of ovarian malignancy. A total of 99 studies were included, describing 42 496 ovarian tumors, of which 31 371 (74%) were benign and 11 125 (26%) were malignant. SA had both high sensitivity (90.2% (95% CI, 87.8-92.2%)) and high specificity (91.4% (95% CI, 89.3-93.2%)). SR followed by SA of inconclusive cases (SR + SA) showed similar performance to SA (sensitivity, 88.6% (95% CI, 85.7-91.0%); P = 0.397 and specificity, 91.0% (95% CI, 89.0-92.7%); P = 0.811), as did the ADNEX model with a cut-off of 20% (sensitivity, 86.7% (95% CI, 80.6-91.0%); P = 0.095; specificity 87.9% (95% CI, 80.1-92.9%), P = 0.119). The ADNEX model with a cut-off of 10% had a similar sensitivity to SA (92.7% (95% CI, 90.8-94.2%); P = 0.130), but lower specificity (78.4% (95% CI, 71.7-83.8%); P < 0.001). Higher cut-offs of the ADNEX model led to a decrease in sensitivity, whereas lower cut-offs resulted in reduced specificity. The LR2 model with a 10% cut-off had a sensitivity of 89.5% (95% CI, 85.8-92.4%) and a specificity of 82.3% (95% CI, 75.0-87.8%). The RMI had the lowest diagnostic accuracy, with a sensitivity of 69.7% (95% CI, 67.0-72.2%) and a specificity of 90.5% (95% CI, 88.3-92.4%) for RMI version 1 with a cut-off of 200. Subgroup analyses showed that both menopausal status and prevalence of malignancy significantly affected sensitivity (P < 0.01) and specificity (P < 0.01). Postmenopausal status and higher disease prevalence were associated with lower specificity, while sensitivity was lower in premenopausal women. All approaches, except for the RMI, performed well and could be used to differentiate between benign and malignant ovarian tumors. Although SA with or without SR had the highest diagnostic performance, it is dependent on operator expertise. If a strategy independent of operator expertise is preferred, the ADNEX model is recommended. Because of the high sensitivity of the ADNEX model, the likelihood of missing malignancies is low. In postmenopausal women, however, the reduced specificity may warrant a higher cut-off, depending on how the impact of a false-positive test result is evaluated. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Abnormal uterine bleeding (AUB) represents a notable sign for benign and malignant uterine pathology. Differentiating adenomyosis from leiomyoma via hysteroscopy aids in selecting appropriate surgical or medical management. Accurate diagnosis is crucial for optimizing fertility outcomes and symptom control. The current study evaluated the diagnostic accuracy of hysteroscopy in differentiating between uterine adenomyosis and leiomymatosis. In addition to; compare between continuous versus intermittent administration of Norethissterone to control both uterine adenomyosis and leiomymatosis. A total of 100 premenopausal women present with AUB. History takin and clinical evaluation was done. All women were subjected to hysteroscopy. Two regimens were used by Norethindrone administration the 1st regimen as continuous manner from day 5 to day 21 46 patients (46%). The 2nd manner was the intermittent type from day 16 and for 10 days 54 patients (54%). Roc-curve of hysteroscopy usage to predict diagnosis; adenomyosis sensitivity was 73.33% and specificity 95.29% and fibroid sensitivity was 73.33% and specificity was 97.65%. Both groups of therapy revealed; highly significant decrease in follow up menorrhagia in continuous Norethindrone group (P < 0.001).By using ROC-curve analysis; Norethindrone administration predicted decreased menorrhagia pain with AUC was 0.973. Hysteroscopy has effective role in differentiating between adenomyosis and fibroids. Yet, long term follows up of abnormal uterine bleeding cases with large sample size in future research are still warranted.

EE163 Cost-Effectiveness Analysis of Ribociclib With Endocrine Therapy for Treatment With Premenopausal Women With HR Positive HER2 Negative Early Breast Cancer in the UK

Endocrine disrupting chemicals and female sexual health: An emerging research priority.

Evaluation of risk-reducing radical fimbriectomy followed by delayed oophorectomy in high-risk Women: A single-center retrospective study.

Benign metastasizing leiomyoma is a rare disease characterized by the spread of benign smooth muscle tumors, primarily affecting premenopausal women with a history of myomectomy or hysterectomy. The unclear pathogenesis complicates diagnosis. We report a 50-year-old Iranian woman with concurrent masses involving the lung, heart, and uterus. While initially suspected to be malignant, pathological evaluation demonstrated a uterus mass with benign nature but metastatic behavior, confirming the benign metastasizing leiomyoma diagnosis with evaluation of the patient's condition post-surgery. The condition affected critical organs, specifically the heart and lungs. Sadly, the patient's health deteriorated after surgery, leading to her death. This case shows the rare potential of benign metastasizing leiomyoma to involve vital organs such as the heart and lungs. It highlights the need for vigilance and timely evaluation of new symptoms rather than routine multi-organ screening in all patients with uterine leiomyomas. Notably, we identified a rare subtype of this tumor that exhibits aggressive characteristics.

Circulating free PSA in breast cancer patients: is it a reliable biomarker?

The effects of non-pathogenic cytosine-adenine-guanine (CAG) repeat sizes on sleep remain unclear, although disrupted sleep has been observed in patients with pathogenic CAG expansions in polyglutamine disease-associated genes (PDAGs), particularly in HTT , ATXN3, and CACNA1A . Here, we assessed the associations between CAG repeat sizes of the three genes and self-reported sleep outcomes in the Netherlands Epidemiology of Obesity study (NEO) and the Netherlands Study of Depression and Anxiety (NESDA). Sleep outcomes included excessive daytime sleepiness (EDS) and Pittsburgh Sleep Quality Index (PSQI) in NEO, insomnia score in NESDA, and sleep duration and chronotype in both. We also stratified by sex, menopausal status in women, and questionnaire-based depression score. We observed 31 associations, of which 26 were specific to women. Larger HTT CAG repeat sizes were associated with lower EDS risk and lower PSQI score in premenopausal women, but higher PSQI score in women with depression. CAG repeats in all three PDAGs were associated with sleep duration, with ATXN3 showing U-shaped effects in all population groups except men. CAG repeat size in CACNA1A was primarily associated with chronotype in women. These findings suggest that non-pathogenic CAG repeats in PDAGs affect sleep differentially by sex and depression status.

To characterize the clinical and ultrasound features of usual-type leiomyoma and variants of leiomyoma. This retrospective, single-center study included patients with a histologically confirmed diagnosis of benign mesenchymal uterine tumor, prospectively collected between January 2019 and December 2021 in the MYometrial Lesion UltrasouNd And mRi (MYLUNAR) study. Tumors were classified according to the Morphological Uterus Sonographic Assessment criteria and grouped according to the 2020 World Health Organization (WHO) classification of female genital tumors into usual-type and variant leiomyomas. The variants of leiomyoma were further classified into specific histological subtypes as defined in the WHO classification. Two ultrasound examiners independently reviewed all available ultrasound images to identify patterns associated with usual-type leiomyoma and variants of leiomyoma. A total of 1766 patients were included, of whom 1383 (78.3%) had usual-type leiomyoma and 383 (21.7%) had a variant of leiomyoma. The median age at diagnosis was 45 (range, 15-88)years, with no statistically significant difference between the two groups. Most patients were premenopausal, although the variant group had a higher proportion of postmenopausal patients compared with the usual-type group (21.5% vs 12.6%; P < 0.001). On ultrasound examination, leiomyoma variants were larger than usual-type leiomyomas (median maximum diameter, 82.5 mm vs 70.0 mm; P < 0.001) and more frequently exhibited cystic areas (33.2% vs 12.8%; P < 0.001). Acoustic shadows were present in 79.1% of variants, compared with 90.4% in usual-type leiomyomas (P < 0.001). Some variant subtypes appeared only in premenopausal women and had distinct morphological characteristics. Epithelioid leiomyomas were the largest variant, with a median diameter of 139.5 mm. Mitotically active leiomyomas showed regular margins and uniform echostructure, and lacked cystic areas in almost all cases. Lipoleiomyomas contained calcifications in some cases. After reviewing the ultrasound images, 13 patterns were identified, some of which were distinctive of specific variant subtypes. Patients with usual-type vs variant leiomyomas presented with some distinct clinical and ultrasound characteristics. Among variants of leiomyomas, some histotypes exhibited distinctive clinical and ultrasound features. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.