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A comprehensive analysis shows the benefits of thromboprophylaxis often outweigh the bleeding risks during gynecologic cancer procedures, though patient-specific risk factors are crucial for decision-making.

Balancing VTE and bleeding risks in gynecologic cancer surgeries

In a recent study, patients of all age categories were less likely to conceive if they had low antimüllerian hormone levels, highlighting its potential in reproductive counseling.

Low antimüllerian hormone levels linked to reduced odds of conception

A recent review established guidelines for prenatal diagnosis and care of vasa previa, outlining its definition, screening and diagnosis, management, and timing of delivery in asymptomatic patients.

Expert consensus sheds light on diagnosis and management of vasa previa

In a recent study, an inverse relationship was discovered between anti-Müllerian hormone levels and early menopause, highlighting the need to develop interventions for fertility preservation based on genetics.

Shared genetics found between anti-Müllerian hormone and age at menopause

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A Psychedelic to Treat Postpartum Depression?

CMV: In the Know

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Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

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Anatomical & Physiological Adaptation to Normal Pregnancy

A 27-year-old woman presents with an 18-month history of vulvar irritation. She is otherwise healthy except for episodes of depression. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole. She used oral steroids but developed knee pain. Tacrolimus has not helped. A biopsy revealed lichen simplex chronicus. Immunofluorescent studies were negative.

A 27-year-old woman presents with an 18-month history of vulvar irritation. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole without relief. What's your diagnosis?

Vulvar irritation in a 27-year-old woman

Saying "obstetrician-gynecologist" is a mouthful for most people, and it's probably the most abbreviated specialty in medicine, both spoken and written. However, there doesn't seem to be a consensus on how to pronounce OB-GYN. First, is it the two-syllable "O-B" or the monosyllabic "Ob"? Second, is it "gin" or "gyne" (like "Lyme")? I wonder if you have a preference. I know I do.

Almost nobody says "obstetrician-gynecologist" when speaking about these specialist physicians. But what's the "correct" way to pronounce OB/GYN?

Is It Ob-Gin or Ob-Gyne?

Dysmenorrhea (DYS), nonmenstrual pelvic pain (NMPP), and fatigue are significantly improved by elagolix (ELA) with add-back (AB) therapy in patients with endometriosis, according to a recent study published in the 

American Journal of Obstetrics & Gynecology.

Approximately 10% of women worldwide are impacted by endometriosis, an inflammatory disease linked to pain and infertility. Patients with endometriosis often experience DYS, NMPP, dyspareunia (DYSP), and fatigue.

Moderate-to-severe endometriosis may be treated using ELA, an oral antagonist designed to be taken at either 150 mg once daily or 200 mg twice daily, described as low-dose therapy and high-dose therapy, respectively.

High-dose therapy has been linked to hypoestrogenic effects such as reduced bone mineral density (BMD), making the approved treatment duration limited to 6 months.

 However, these hypoestrogenic effects may be mitigated through hormonal AB therapy.

Investigators conducted a study to evaluate the safety and efficacy of ELA 200 mg twice daily plus AB (ELA+AB) in endometriosis patients. The analysis was of an ongoing phase 3, 48-month trial evaluating the regimen’s efficacy, tolerability, and impact on BMD.

Participants included women aged 18 to 49 years reporting moderate-to-severe endometriosis-associated pain within 35 days before baseline. A surgical diagnosis of endometriosis within 10 years before screening was also necessary for inclusion.

These participants were randomized 4:1:2 to receive ELA+AB therapy, 6 months of ELA 200 mg twice daily monotherapy followed by 6 months of ELA+AB therapy, or placebo, respectively. In the monotherapy group, BMD changes were compared following ELA monotherapy vs ELA+AB therapy.

Individuals with chronic pelvic pain, systemic corticosteroid use before screening, depression history or post-traumatic stress disorder diagnosis, bone disease, clinically significant medical conditions, or conditions contraindicated for AB therapy use were excluded from the analysis.

Daily DYS and NMPP assessments at month 6 were recorded as the coprimary efficacy endpoints. These symptoms were measures using the 4-point Endometriosis Daily Pain Impact Diary. Secondary efficacy endpoints included changes in DYS and NMPP at months 12, 6 and 4, fatigue, DYSP and overall endometriosis-associated pain within the past 7 days.

Treatment-emergent adverse events were reported to determine tolerability. Additionally, BMD comparisons were conducted including lumbar spine, total hip, and femoral neck assessments.

There were 681 patients randomized, with 44% discontinuing the study drug. TEAEs were reported as the most common reason for discontinuation, followed by withdrawal of consent, lost to follow-up, and other. Participants were aged a mean 32.5 years, and similar DYS, NMPP, DYSP, overall pain, and fatigue scores were reported between groups at baseline.

The ELA+AB therapy group reported significantly improved DYS and NMPP at 6 months compared to the placebo group. Responder rates for DYS were 62.8% for ELA+AB therapy vs 23.7% for placebo. For NMPP, these rates were 51.3% vs 36.8%, respectively.

An increased clinical response was also reported for DYS at 12 months in the ELA+AB therapy group vs the placebo group, at 63.8% vs 29.1%. Similarly, NMPP response rates at 12 months were 54.3% vs 42.3%, respectively. Additional improvements found from ELA+AB therapy vs placebo included DYS and NMPP at months 12, 6, and 3, and fatigue at 6 months.

TEAEs were reported in 73.8% of patients receiving ELA+AB vs 66.8% of those receiving placebo. There were no significant differences in rates of severe TEAEs between groups, and rates of TAEs leading to discontinuation were 12.6% vs 9.8%, respectively. Hot flushes, nausea, and headache were the most common TEAEs in the ELA+AB group.

Alongside the placebo group, patients in the ELA+AB therapy group had a change in BMD from baseline to month 6 and month 12 under 1%. At month 6, a statistically significant difference in mean lumbar spine changes of -0.83% was reported in the ELA+AB therapy groups vs the placebo group, but differences in total hip and femoral neck were not statistically significant.

These results indicated significant improvements in endometriosis-associated pain up to 12 months with attenuated BMD loss from ELA+AB therapy vs ELA monotherapy at 6 months. Investigators concluded ELA+AB therapy is tolerated after 12 months of treatment.

Miller CE, Kim JH, Kroll R, et al. Efficacy, tolerability, and bone density outcomes of elagolix with add-back therapy for endometriosis-associated pain: twelve months of an ongoing randomized phase 3 trial. 

 2024;231:630.e1-13. doi:10.1016/j.ajog.2024.06.040

Taylor HS, Giudice LC, Lessey BA, et al. Treatment of endometriosis-associated pain with elagolix, an oral GnRH antagonist. 

. 2017;377(1):28-40. doi:10.1056/NEJMoa1700089

In a recent study, endometriosis-associated pain was reduced among patients taking elagolix, with bone mineral density mitigated using add-back therapy.

Clinical

Elagolix with add-back therapy found effective and tolerable for endometriosis pain

Anti-Müllerian (AMH) hormone has a shared genetic architecture with age at menopause, according to a recent study published in the 

Menopause, linked to various health outcomes in women, occurs at a mean 51 years among European women. However, 5% of European women experience menopause before the age of 45 years and 1% before the age of 40 years.

As a family history of early menopause increases the risk of early menopause in women, this condition may be influenced by genetic factors.

 However, data about genetic factors linked to age at menopause remains lacking. AMH has been considered a contributing factor, but more data is necessary to determine its overlap with age at menopause.

Investigators conducted a study to assess shared genetic structures and core molecular pathways of AMH and age at menopause. Linkage disequilibrium score regression was used to conduct a genetic correlation analysis based on the linkage disequilibrium structure from the 1000 Genomes Project European reference panel.

Pleiotropic loci associated with complex traits were identified using genome-wide association study (GWAS) statistics. Pleiotropic variants were significant if they had a 

Gene-level multimarker analyses of GenoMic annotation (MAGMA) were conducted using pleiotropic analysis under composite null hypothesis (PLACO) results. This allowed investigators to identify candidate pleiotropic genes within the pleiotropic loci.

The Kyoto Encyclopedia of Genes and Genomes Orthology-Based Annotation System (version 3.0) was used to evaluate pathway enrichment, and biological processes linked to AHM and age at menopause were identified using Gene Ontology (GO).

Through summary data-based Mendelian randomization (SMR), investigators accessed the causal association between gene expression and the phenotype. This allowed genes responsible for the association between AMH and age at menopause to be identified.

SMR analyses were conducted for various genetically enriched tissues with single nucleotide polymorphisms (SNPs) linked to AMH and age at menopause. Investigators also performed colocalization analysis and mendelian randomization (MR) analysis.

A liability-scale SNP heritability of 14.8% was reported for AMH vs 19.2% for age at menopause. This indicated a positive genetic correlation between these 2 characteristics, with an intercept of genetic covariance of 0.002.

During PLACO analysis, investigators identified 2686 single nucleotide variants with potential polymorphic variants. In comparison, 245 significant pleiotropic genes were identified during the MAGMA analysis. Pleiotropic effects of independent genomic risk loci were found for 42 chromosomal regions, with 10 potentially shared between AMH and age at menopause.

Within GO enrichment, there were 245 genes with multiple effects concentrated in DNA replication. Analysis of GWAS data highlighted 9 potentially shared causal risk genes. Of these, 

were present in most of the enriched tissues.

MR analysis showed no effect of AMH on age at menopause, but an inverse relationship was discovered, highlighting the causality of age at menopause on AMH. This association was supported by heterogeneity and pleiotropy tests.

These results indicated a potential causal relationship between AMH levels and age at menopause. Investigators concluded this data should be used to conduct research developing therapeutic interventions to protect fertility in women.

Long P, Tan H, Chen B, et al. Dissecting the shared genetic architecture between anti-Müllerian hormone and age at menopause based on genome-wide association study. 

2024;231:634.e1-11. doi:10.1016/j.ajog.2024.06.050

Louwers YV, Visser JA. Shared genetics between age at menopause, early nenopause, POI and other traits. 

. 2021;12:676546. doi:10.3389/fgene.2021.676546

Challenges for college students in contraception deserts

Contraceptive access

, Jason Bell, MD, a board-certified OB-GYN and Director of Medical Affairs at 

, a global company dedicated to women’s health, discussed the challenges female college students face when living in contraceptive deserts, defined as areas with limited access to reproductive health services.

Bell began by highlighting the widespread issue of contraceptive deserts in the United States, where over 19 million women of reproductive age lack reasonable access to health care centers offering contraceptive services. This lack of access can be particularly impactful for college students, who may relocate from states with better reproductive health services to attend universities in restrictive states, often in the South where many historically Black colleges and universities are located. As a father of daughters who have gone to college, Bell emphasized the importance of preparing young women for the potential challenges they may face in accessing contraception once they leave home.

The implications of unplanned pregnancies among college-aged women were also discussed. Bell stressed that unplanned pregnancies are not only disruptive to a woman's life but also to her partner, often leading to educational setbacks and emotional strain. He noted that unplanned pregnancies are a leading cause of attrition from college, particularly among women aged 20 to 24 years. Additionally, Bell advocated for the importance of education about reproductive health and contraception, emphasizing that accurate, science-based information is crucial. Bell also noted the growing role of social media in shaping young women’s understanding of sexual health, though it can be a double-edged sword because of the spread of both helpful and misleading information.

Regarding contraceptive access, Bell explained that services vary significantly across universities depending on factors such as state funding and local regulations. While some university health centers offer a full range of contraceptive options, others may be more limited because of financial or regulatory constraints. He emphasized that regardless of what services are available on campus, it is critical for students to know where and how they can access contraception outside of the university setting. As part of Organon’s Her Plan is Her Power initiative Bell mentioned that Organon has partnered with 

 and supported their "Beyond the Sheets" campaign, which trains peer educators at historically Black colleges and universities to provide students with accurate information about contraception and sexual health.

In conclusion, Bell stressed the importance of open, fact-based conversations about contraception before students leave for college. As a father and ob-gyn, he believes that students should be informed about their contraceptive options, whether they are short-acting methods such as pills, patches, rings, injections, long-acting methods such as implants and intrauterine devices, or permanent options such as sterilization. According to Bell, the key is to listen to what the student needs and provide the method that aligns with her goals and lifestyle.

Jason Bell, MD, discusses the impact of living in contraceptive deserts on college-aged women, highlighting the importance of education, access, and support for reproductive health.

Contraceptive access challenges for college students in contraception deserts

Addressing Challenges in Accessing Traditional STI Screening Options

Video content above is prompted by the following:

In what ways can asymptomatic STIs impact overall health, and why is screening important?

How can health care providers effectively raise awareness about less commonly known STIs like trichomoniasis and 

What challenges do patients face when accessing traditional STI screenings testing, and how can these be addressed?

How does the use of newer screening methods like NAAT impact patient access to necessary screenings?

The panelist discusses how asymptomatic sexually transmitted infections (STIs) can silently impact overall health, emphasizing the importance of comprehensive screening and education, particularly for less known STIs like trichomoniasis and Mycoplasma genitalium, while exploring how newer testing methods like nucleic acid amplification testing (NAAT) can address challenges in traditional screening access and improve patient care.

Heba M. Ismail

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