Reed syndrome, also known as Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC), is an autosomal dominant genetic disorder caused by a mutation in the fumarate hydratase (FH) gene. It is characterized by multiple cutaneous and uterine leiomyomas, with an associated risk of developing aggressive type 2 papillary renal cell carcinoma [3,4]. This case report describes a 35-year-old nulligravid woman with symptomatic uterine leiomyomatosis. After failed embolization therapy, she underwent open myomectomy. Histopathology and immunohistochemistry confirmed FH deficiency, establishing the diagnosis of HLRCC. The patient was referred to oncology for surveillance due to the associated risk of renal cancer. Follow-up abdominal and pelvic MRI showed no recurrence. Subsequently, the patient presented with infertility, highlighting the reproductive implications of the disease. Early recognition of HLRCC is critical for cancer surveillance and genetic counseling. This case emphasizes both the oncological and reproductive consequences of the syndrome, underlining the importance of timely diagnosis and multidisciplinary management.

Objective:

To evaluate the safety, acceptability, and effectiveness of non-ablative vaginal and vulvar erbium-doped yttrium-aluminum-garnet (Er:YAG) laser in smooth mode and neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser in piano mode for the treatment of genitourinary syndrome of menopause (GSM), and to investigate their direct effects on the vaginal microbiome.

Methods:

Twenty women with GSM symptoms participated in this pilot prospective study. Ten received combined vulvar and vaginal Nd:YAG laser in piano mode with Er:YAG laser in smooth mode (Nd/Er:YAG group), and ten were treated with Er:YAG laser in smooth mode alone (Er:YAG group). Symptom relief and patient satisfaction were assessed at 1 and 7 days post-procedure. Vaginal samples were collected immediately before and after treatment and analyzed by microscopy, culture, and PCR.

Results:

Both groups experienced improvement in all bothersome symptoms, with 50% reporting no complaints (VAS=0) one day after the procedure. Combined Nd/Er:YAG treatment showed a greater effect on symptom resolution, particularly pain relief. Pain (dyspareunia and/or vulvodynia) resolved completely immediately or within one day in 87.5% of patients in the Nd/Er:YAG group versus 57.1% in the Er:YAG group. All patients reported being very satisfied or satisfied with treatment. Microbiome analysis revealed no significant changes in diversity, including Lactobacillus species, between pre- and post-treatment samples. All bacteria identified in culture studies remained viable after laser exposure, and no epithelial cell damage was observed.

Conclusion:

Combined Nd/Er:YAG laser treatment is a safe, effective, and well-tolerated non-invasive therapy for GSM. Both Nd/Er:YAG and Er:YAG in smooth mode preserve vaginal mucosal integrity and do not disrupt the healthy vaginal microbial community.

Aggressive angiomyxoma is a rare, histologically benign mesenchymal tumour with infiltrative growth and a high risk of local recurrence, particularly when involving deep pelvic structures. It predominantly affects women of reproductive age and typically arises in the pelviperineal region. Tumour expression of estrogen and progesterone receptors supports a hormonally mediated pathogenesis. We report the case of a 44-year-old woman with a progressively enlarging vulvar–pelvic mass. MRI suggested aggressive angiomyxoma, later confirmed histologically. Surgical excision was performed; however, negative margins could not be achieved because of the tumour’s proximity to critical pelvic organs. Given the hormone-receptor positivity and the high likelihood of residual microscopic disease, adjuvant hormonal suppression with GnRH analogues and aromatase inhibitors was initiated. The patient remains asymptomatic and without radiologic evidence of recurrence on serial MRI during short- to medium-term follow-up. This case illustrates the diagnostic challenges of this uncommon tumour and the difficulty of achieving complete resection without compromising pelvic function. It also underscores the potential role of hormonal therapy as an adjunctive strategy, particularly in premenopausal women, although current evidence remains limited. Long-term monitoring is essential due to the tumour’s indolent course and tendency to recur.

Congenital uterine anomalies result from Müllerian duct maldevelopment, affecting about 5.5% of the population, with higher rates in infertility and recurrent miscarriage. Often asymptomatic, they may remain undetected. We describe a rare case of spontaneous second-trimester uterine rupture in a primigravida with an unrecognized anomaly. At 21 weeks’ gestation, she arrived in hypovolemic shock after two weeks of cyclic abdominal pain. Emergency surgery revealed massive hemoperitoneum, a ruptured right rudimentary horn, and a left-sided unicornuate uterus, with the non-viable fetus free in the abdominal cavity. Excision of the rudimentary horn and ipsilateral tube was performed, and recovery was uneventful. The anomaly was classified as U4aC0V0 by ESHRE/ESGE criteria as a unicornuate uterus with a functional remnant by ASRM criteria. This case highlights the importance of early recognition of Müllerian anomalies to prevent catastrophic complications such as uterine rupture and supports including rare variants in the diagnostic workup for timely management.

Perimenopause, as defined by the North American Menopause Society, begins when menstrual cycle length varies by more than seven days and ends 12 months after the final menstrual period. Despite minor differences among definitions, it is consistently understood as the transitional phase from regular ovulatory cycles to anovulation and eventual permanent amenorrhea. This stage typically begins in the early 40s, progresses alongside declining ovarian activity, and culminates in menopause, which occurs between 48 and 52 years of age in Western populations and at a mean age of 48.6 years in Latin America. During this transition, menstrual irregularity becomes common, and symptoms such as vasomotor instability, sleep disturbances, and mood changes frequently emerge as a result of fluctuating estrogen levels. Although overall fertility declines, intermittent ovulation may persist, maintaining the risk of unintended pregnancy. This review summarizes evidence-based contraceptive options appropriate for perimenopausal women, with an emphasis on safety, effectiveness, and clinical applicability during the menopausal transition.

Background:

A 2024 meta-analysis by Douxfils et al. reported a 33% lower risk of venous thromboembolism (VTE) with body-identical estrogens compared with ethinyl estradiol (EE)–based combined oral contraceptives (COCs).

Objective:

To update that meta-analysis by incorporating the most recent evidence and to further characterize the increased VTE risk associated with EE-based COCs compared with body-identical estrogen formulations.

Method:

This systematic review and meta-analysis followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was conducted in June 2025 using Medline (Ovid) and Embase to identify observational longitudinal studies reporting VTE risk for synthetic estrogens versus body-identical estrogens. Body-identical estrogens (E2-based COCs) served as the reference. Effect sizes were expressed as Peto odds ratios (95% CI) for crude analyses and hazard ratios (95% CI) for adjusted analyses. A random-effects model was used. The protocol was registered in the Open Science Framework (ID https://osf.io/n9dav/).

Results:

Five observational studies evaluating VTE risk among users of E2-based versus EE-based COCs were included. The dataset comprised 2,343,585 women-years from cohort studies and 8,514 women from case–control studies. The updated meta-analysis demonstrated a significant 51% increased VTE risk among EE-based COC users (Peto OR 1.51; 95% CI 1.17–1.95) compared with E2-based COC users. In adjusted analyses (k = 2), EE/levonorgestrel was associated with a hazard ratio of 1.95 (95% CI 1.11–3.41) versus E2-based COCs.

Conclusion:

This updated meta-analysis corroborates previous findings supporting the safer thrombotic profile of body-identical estrogen–based COCs. Given the accumulating evidence, a reassessment of current recommendations is warranted, with consideration of body-identical estrogens as first-line COCs.