Zsuzsanna Ilona Katalin de Jármy Di Bella

Introduction: Genitourinary syndrome of menopause (GSM) is a chronic, oestrogen-deficient condition that is frequently underdiagnosed and undertreated. Although low-dose vaginal estriol improves epithelial trophism and microbial balance, a substantial proportion of women report persistent symptoms. High-quality randomised evidence evaluating combined therapeutic strategies remains scarce. Energy-based modalities, including the erbium:YAG (Er:YAG) laser (λ=2940 nm), have been proposed as adjunctive treatments. This trial aims to assess the efficacy of Er:YAG laser therapy combined with vaginal estriol compared with estriol alone in postmenopausal women with GSM. Methods and analysis: This is a single-centre, randomised, double-blind, controlled clinical trial. Postmenopausal women aged 45–70 years with vaginal pH ≥5.0 and at least one moderate GSM symptom (Visual Analogue Scale ≥4) will be eligible. Exclusion criteria include current systemic or local hormone therapy, previous vaginal energy-based treatment, abnormal cervical cytology and body mass index ≥35 kg/m ² . All participants will receive vaginal estriol cream (0.5 mg per dose) daily for 14 days, followed by twice-weekly administration for 16 weeks. Participants will be randomised (1:1) to receive either estriol plus sham Er:YAG laser or estriol plus active Er:YAG laser. Three laser sessions will be delivered at approximately 4-week intervals. Assessments will occur at baseline, monthly during treatment and 4 months after the final session. The primary outcome is the Vulvovaginal Health Index, with the primary endpoint defined as the change from baseline to 4 months post-treatment, reflecting sustained effect. Secondary outcomes include GSM symptom severity, vaginal microbiome composition (16S rRNA sequencing), quality of life (Menopause Rating Scale) and sexual function (Female Sexual Function Index). Data will be analysed using repeated-measures analysis of variance or appropriate non-parametric tests, with significance set at p<0.05. Ethics and dissemination: Ethical approval has been obtained from the Human Research Ethics Committee of UNINOVE. Written informed consent will be obtained. Findings will be disseminated via peer-reviewed journals and scientific meetings. Trial registration number: NCT06873971 .

Background: The vaginal microbiome is an important factor influencing clinical outcomes in women undergoing assisted reproductive techniques. Objective: Our review aimed to confirm that women with a favorable vaginal microbiome have better reproductive outcomes than women who have an unfavorable vaginal microbiome. Methods: This systematic review and meta-analysis included articles published in the last 10 years, identified through keyword searches in PubMed and MEDLINE using the MeSH terms “vaginal microbiome,” “reproduction,” and “human reproduction.” The search yielded 1735 records. Participants were categorized into women with a favorable microbiome and those with an unfavorable microbiome. To refine the taxonomic resolution at the species level, we additionally performed a bioinformatic analysis of a cohort of 56 women using multivariable association with linear models (MaAsLin2). Results: Women with a favorable microbiome had higher pregnancy rates compared to those with a less favorable microbiome (p = 0.0001, I2 = 0%, RR: 1.59). Live birth rates were also significantly higher in the favorable microbiome group than in the unfavorable microbiome group (p = 0.004, I2 = 0%, RR:1.41), with no evidence of heterogeneity. Women with an unfavorable microbiome had more miscarriages than women with a favorable microbiome (p = 0.04, I2 = 0%, RR: 0.65). Bioinformatic analysis showed that a high relative abundance of Lactobacillus crispatus increased the likelihood of pregnancy approximately sixfold. Conclusions: The favorable microbiome group, particularly participants with a high relative abundance of Lactobacillus crispatus, demonstrated better reproductive outcomes, with a higher clinical pregnancy rate, a higher live birth rate, and a lower rate of pregnancy loss, although there was a low-quality bias.

Key points •Differences between laser, radiofrequency (RF) and microfocused ultrasound (MFU) energy-based devices (EBD). •Indication of energy-based devices in genitourinary syndrome of menopause (GSM). •Indication of energy-based devices in urinary incontinence (UI). •What is known about the use of energy-based devices in sexual dysfunction (SD)? •Indication of energy-based devices in vulvar lichen sclerosus (VLS). Key points •Differences between laser, radiofrequency (RF) and microfocused ultrasound (MFU) energy-based devices (EBD). •Indication of energy-based devices in genitourinary syndrome of menopause (GSM). •Indication of energy-based devices in urinary incontinence (UI). •What is known about the use of energy-based devices in sexual dysfunction (SD)? •Indication of energy-based devices in vulvar lichen sclerosus (VLS).

Objective: This study aims to characterize voiding urodynamics parameters suggestive of bladder outlet obstruction (BOO) diagnosis in women with and without symptomatic pelvic organ prolapse (POP). Methods: Cross-sectional research. Patients were selected and clinically evaluated with anamnesis, pelvic organ prolapse quantification system and standard Urodynamic Testing, performed according to International Continence Society and International […] Abstract Objective: This study aims to characterize voiding urodynamics parameters suggestive of bladder outlet obstruction (BOO) diagnosis in women with and without symptomatic pelvic organ prolapse (POP). Methods: Cross-sectional research. Patients were selected and clinically evaluated with anamnesis, pelvic organ prolapse quantification system and standard Urodynamic Testing, performed according to International Continence Society and International […]

Objectives: This study investigated the effects of the menstrual cycle phases on cortisol levels before and after a maximal incremental exercise test in women with and without premenstrual syndrome (PMS). Methods: Nineteen healthy, active and eumenorrheic women completed five maximal incremental exercise tests; three of those were performed at specific phases of the menstrual cycle (i.e., menses, follicular, and luteal). The participants were allocated into two groups according to the presence of PMS (n = 11) or absence of PMS (NO-PMS, n = 8). Samples of blood were collected before and after each experimental test. A three-way ANOVA was conducted to compare the differences between menstrual cycle phases (i.e., menses, follicular, and luteal), time (before and after) and groups (PMS and NO-PMS). Results: The results demonstrated an alteration of cortisol across the menstrual cycle, with cortisol levels significantly (p < 0.05) higher during the follicular phase (mean = 11.0 µg/dL, CI95% = 9.1, 12.9) compared to the luteal phase (mean = 8.6 µg/dL, CI95% = 7.2, 10.4) in the PMS and NO-PMS groups. There was no difference (p > 0.05) in cortisol levels for groups or time. Conclusions: This study observed significant cortisol fluctuations across the menstrual cycle phases in women with and without PMS. Future studies should consider alternative maximal incremental test protocols and incorporate a more comprehensive hormonal profile to provide a deeper physiological understanding of this population.

The aim of the study was to provide a golden opportunity to access sexual function in women who act as leaders in companies through the use of an instrument validated for this purpose (the Female Sexual Function Index). The number of women in leadership positions has been gradually increasing, which shows the need for women to prepare themselves to reorganize the different aspects of life, including social, family, and personal factors as well as sexuality.

Introduction: Excessive menstrual bleeding is menstrual loss that interferes with the woman's quality of life, regardless of the absolute amount. Drug treatment is preferred to avoid surgical risks and preserve fertility. Anti-inflammatory, antifibrinolytic, oral contraceptive and progestogen are prescribed. These therapies result in 40 to 50% reduction in menstrual loss. The intrauterine levonorgestrel system (SIU-LNG) is the most effective long-term clinical treatment. On the other hand, hysterectomy is the most widely performed gynecological surgical procedure in the world and, although it offers complete control of symptoms, it is the most invasive, morbidly, irreversible and costly method of treatment. Objective: To compare the results and costs of clinical treatment with SIU-LNG and hysterectomy in women with large uteri and excessive menstrual bleeding. Method: It is a retrospective cohort study with 62 patients who performed two treatments: SIU-LNG insertion or videolaparoscopic hysterectomy (HVLP) and followed for four years. Results: The groups were homogeneous regarding age, parity, body mass index, schooling and uterine volume. SIU-LNG failed in 32.3% of patients, while the efficacy of hysterectomy was 100%. Complications occurred 22.6% after UIS insertion and 19.4% in the surgical group, the most serious. The cost of clinical treatment, including its complications, was nearly five times lower than the cost of surgical treatment with its complications. Conclusion: Compared to hysterectomy, treatment with SIU-LNG had lower efficacy, but simpler complications and lower costs.

Highlights The levonorgestrel intrauterine system treatment prevents 67.7% of surgeries in patients with heavy menstrual bleeding and enlarged uteri. ABSTRACT Objective To evaluate the effectiveness of the levonorgestrel intrauterine system in the treatment of patients with heavy menstrual bleeding and an enlarged uterus and to compare satisfaction and its complications with hysterectomy. Methods This was a comparative cross-sectional observational study of women with heavy menstrual bleeding and an enlarged uterus. Sixty-two women were treated and followed up for four