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.

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.

Purpose:

To present the case of an 18-year-old woman with prolonged pelvic pain and elevated inflammatory markers who was successfully managed with combined antibiotic therapy and laparoscopic intervention. This report aims to highlight the importance of timely, expert management and the key role of laparoscopy in both diagnosis and treatment.

Method:

Patient presented with a one-month history of intermittent pelvic pain and febrile episodes (up to 38 °C), without a definitive diagnosis or treatment during this period. Laboratory evaluation revealed a markedly elevated serum CA-125 level (850 U/mL). Imaging with ultrasonography and magnetic resonance imaging identified bilateral hydropyosalpinges. Initial management consisted of intravenous cefoxitin and metronidazole combined with oral doxycycline for four days. Diagnostic and therapeutic laparoscopy was subsequently performed, beginning with thorough pelvic visualization. Dense adhesions involving the fallopian tubes and uterus were identified, along with bilateral distended tubes consistent with hydropyosalpinges. Extensive adhesiolysis was performed, followed by drainage of bilateral tubo-ovarian abscesses.

Results:

Serum CA-125 levels decreased from 850 to 450 U/mL following antibiotic therapy. Postoperatively, levels declined further to 350 U/mL and normalized to 50 U/mL within one week. The procedure was completed without complications. The patient recovered rapidly, with complete resolution of symptoms and normalization of inflammatory markers.

Conclusion:

This case underscores the importance of early, expert intervention in pelvic inflammatory disease, particularly in young patients for whom fertility preservation is paramount. Despite a one-month delay in diagnosis and management, the coordinated use of targeted antibiotic therapy followed by timely laparoscopic surgery by an experienced team resulted in an excellent clinical outcome. Laparoscopy proved invaluable for accurate assessment, effective adhesiolysis, and definitive abscess drainage, highlighting its essential role in modern gynecologic care.

Preterm birth (PTB), defined as delivery before 37 weeks of gestation, is the leading cause of neonatal death worldwide. Latvia, with a PTB rate of 5.45%, offers a useful model for understanding outcomes. This paper discusses a phenotype-based approach to PTB prevention, focusing on underlying mechanisms such as cervical insufficiency, infection, inflammation, and hormonal or genetic factors. The use of second-trimester transvaginal ultrasound enables early detection of a short cervix and the implementation of interventions such as vaginal progesterone and cerclage. Genomic studies indicate that up to 67% of women with cervical insufficiency carry rare variants in genes involved in collagen structure or progesterone pathways, supporting a multifactorial etiology. Vaginal microbiota alterations and intra-amniotic inflammation also contribute to PTB risk, highlighting the need for integrated molecular and microbial screening. Management includes targeted antibiotic therapy, which can resolve inflammation in up to 75% of cases and prolong pregnancy. When PTB is imminent, corticosteroids, magnesium sulfate, early referral, and adherence to golden hour protocols are essential. Delivery at experienced centers can reduce neonatal mortality by 50% in births before 32 weeks. Cesarean delivery may lower perinatal risk, particularly in cases of breech presentation. Europe should adopt unified standards for prevention and care, strengthen referral systems, and develop monitoring networks. Every preterm birth is an opportunity for personalized care; every baby counts.

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.

Ectopic pregnancy is defined as implantation of a pregnancy outside the uterine cavity. Its twin form is exceptionally rare and potentially life-threatening, making early diagnosis essential. We report the case of a 30-year-old primigravida diagnosed with a spontaneous unilateral tubal twin ectopic pregnancy, successfully treated with right laparoscopic salpingectomy without complications. Although uncommon, twin ectopic pregnancy should be considered in patients presenting with abnormally elevated β-hCG levels and compatible ultrasound findings, as prompt recognition is critical to reduce maternal morbidity.

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.

Background:

Women with endometriosis have a lower quality of life (QoL) than those without the disease. Treatment should therefore aim not only to improve symptoms but also to enhance overall QoL.

Objective:

To evaluate QoL in patients with dysmenorrhea and ultrasound suspicion of endometriosis after starting nomegestrol acetate 2.5 mg plus 17β-estradiol 1.5 mg (NOMAC/E₂) in an extended regimen.

Methods:

Prospective cohort pilot study evaluating changes in QoL in women with ultrasound-suspected endometriosis treated with NOMAC/E₂ for dysmenorrhea. QoL was assessed using the EuroQol-5D questionnaire, including the EQ-5D index and the visual numeric scale (EQ-VAS). Changes after initiating treatment were analyzed using a repeated-measures general linear model and confirmed with the Wilcoxon test.

Results:

Fourteen patients were included (mean ± SD age 36.6 ± 7.4 years). Significant improvements were observed in QoL after starting treatment. The EQ-5D increased from 0.65 ± 0.22 at baseline to 0.86 ± 0.11 at 6 months and 0.93 ± 0.07 at 12 months (p<0.001). The EQ-VAS index increased from 78.4 ± 12.7 points at baseline to 89.2 ± 9.7 points at 6 months and 94.4 ± 4.0 points at 12 months (p<0.001).

Conclusions:

Continuous treatment with NOMAC/E₂ in women with dysmenorrhea and ultrasound suspicion of endometriosis may significantly improve QoL as measured with the EQ-5D questionnaire.

Primary angiosarcoma of the breast (PAB) is an exceptionally rare and aggressive malignancy, representing only 0.05% of all breast tumors. Its low incidence and nonspecific presentation frequently lead to diagnostic delays, as current clinical guidelines remain limited. We report the case of a 27-year-old woman who presented with a rapidly enlarging inflammatory mass in the right breast, initially interpreted as a possible abscess. Lack of response to empirical treatment and continued growth prompted further evaluation. Imaging and subsequent biopsy established the diagnosis of a primary low-grade angiosarcoma. Staging studies showed no evidence of metastasis, and the patient underwent a simple right mastectomy with curative intent. This case underscores the diagnostic challenges associated with PAB, particularly its ability to mimic benign or infectious conditions and its variable imaging features, which differ according to histologic grade. Accurate diagnosis requires correlating the clinical course with imaging findings and pathological assessment. Breast MRI is considered the most informative imaging modality, but tissue biopsy remains essential for confirmation. At present, complete surgical excision with clear margins is the standard approach, although the benefit of adjuvant therapy is still debated. Given the absence of well-defined management protocols, each case requires individualized, multidisciplinary evaluation.