Obstetrics and gynecology最新文献

{"title":"Menopausal Estrogen Therapy and Risk of Breast Cancer.","authors":"Andrew M Kaunitz, Jason D Wright","doi":"10.1097/AOG.0000000000006397","DOIUrl":"10.1097/AOG.0000000000006397","url":null,"abstract":"<p><p>Recent evidence suggests that use of menopausal estrogen-only therapy in patients who have undergone hysterectomy reduces breast cancer risk among patients at population risk for breast cancer as well as in those with pathogenic high-risk BRCA variants. A meta-analysis of 10 randomized trials of estrogen therapy compared with placebo among 14,282 participants at population risk noted that 3.6% those randomized to estrogen alone were diagnosed with breast cancer, compared with 4.7% of those randomized to placebo (relative risk 0.77; 95% CI, 0.65-0.91, P =.002). A matched prospective cohort study of 676 patients with BRCA mutations and intact breasts who used menopausal hormone therapy (MHT) found that the estimated 15-year cumulative incidence of breast cancer with estrogen alone compared with no MHT was 24.3%, compared with 47.3% in the matched nonusers of MHT ( P <.0001). This evidence underscores the need for more data that specifically assess the effect of estradiol therapy among patients who have undergone hysterectomy. Until such data are available, counseling patients at risk for breast cancer who have completed childbearing and are planning surgery for benign gynecologic conditions should involve shared decision-making that addresses the future risk of breast and endometrial cancers, cardiovascular disease, as well as the morbidity associated with hysterectomy. When appropriate, such counseling should also describe the availability of uterine-sparing alternatives.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"584-590"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cardiometabolic Effects of Menopause.","authors":"Jana Karam, Emily S Lau, Chrisandra L Shufelt","doi":"10.1097/AOG.0000000000006418","DOIUrl":"10.1097/AOG.0000000000006418","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) remains the leading cause of death among women, yet CVD risk is frequently underrecognized during midlife, when the menopause transition is accompanied by significant biological changes. Emerging evidence demonstrates that menopause represents a critical window for adverse cardiometabolic and vascular changes that extend beyond the effects of chronologic aging alone. Because obstetrician-gynecologists often serve as the primary clinicians for midlife care in women, they are uniquely positioned to recognize emerging cardiovascular risk, implement preventive strategies, and coordinate care with primary care or cardiology when appropriate. This Clinical Expert Series synthesizes current evidence on menopause-related characteristics associated with CVD risk, including timing and type of menopause, as well as menopause-related symptoms, including vasomotor symptoms, sleep disturbances, and depression. We also review longitudinal data characterizing changes in lipids, blood pressure, glucose metabolism, body composition, and vascular structure and function across the menopause transition. Collectively, these data support framing menopause as a key opportunity for CVD risk identification and early intervention. Incorporating menopause-specific factors into routine CVD risk assessment may enable earlier prevention strategies and ultimately improve long-term cardiovascular outcomes for women.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"607-615"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hormonal Options for Perimenopause: A Clinician Toolkit.","authors":"Jaclyn Piasta, Amani Zewail","doi":"10.1097/AOG.0000000000006436","DOIUrl":"10.1097/AOG.0000000000006436","url":null,"abstract":"<p><p>Perimenopause is a clinically heterogeneous stage of reproductive aging with unique physiology distinct from menopause. It is variably defined, lacks specific guidelines or practice recommendations, and can be challenging for clinicians to manage. Patients may present with myriad symptoms, including mood and cognitive changes, abnormal uterine bleeding, sleep disruption, and vasomotor symptoms, as well as sexual concerns. Managing such complaints while taking into consideration contraceptive needs and evolving cardiometabolic risk can be nuanced. Hormonal contraceptives are commonly prescribed for the management of perimenopause symptoms, but they are not universally adequate or preferred. This clinical perspective provides a practical toolkit for clinicians, outlining the role of hormonal contraceptives for perimenopause care, alternative hormonal strategies, and options for individualizing treatment through shared decision making.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"571-583"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building a Comprehensive Menopause Program.","authors":"Rajita Patil, Pelin Batur, Beri Ridgeway, Makeba Williams","doi":"10.1097/AOG.0000000000006401","DOIUrl":"10.1097/AOG.0000000000006401","url":null,"abstract":"<p><p>Menopause care in the United States is limited by inadequate access, insufficient clinician training, and the absence of scalable care models. Despite increasing awareness and intolerance of menopause symptoms, few health systems offer coordinated menopause services, and no published frameworks exist to guide program development. We present a practical, evidence-informed flexible nine-step blueprint for designing, implementing, and sustaining comprehensive menopause programs, including a structured needs assessment and a resource-tiered implementation framework for program development. Drawing on implementation science, multidisciplinary care models, and the authors' real-world experience from large academic health systems, we describe each of the essential steps. This approach provides practical strategies for developing standardized clinical workflows, scalable care pathways, and workforce capacity. Case examples demonstrate stepwise adoption across diverse settings, beginning with foundational activities and expanding as resources grow. This blueprint offers a scalable approach to addressing persistent gaps in women's health for midlife and beyond.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"662-670"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menopause and the Social Determinants of Health.","authors":"Heather Quaile, Sameena Rahman, Kudzai Dombo, Louise Newson, Sara Perelmuter","doi":"10.1097/AOG.0000000000006408","DOIUrl":"10.1097/AOG.0000000000006408","url":null,"abstract":"<p><p>This clinical perspective examines how social determinants of health (SDoH) such as economic stability, education and health literacy, health care access and quality, and social and community contexts shape menopause experiences and outcomes through a health equity lens. Menopause is not experienced uniformly: Black, immigrant, and LGBTQ+ (lesbian, gay, bisexual, transgender, queer+) individuals and those with low income often face earlier symptom onset, greater symptom burden, and reduced access to evidence-based care due to structural inequities, economic barriers, and cultural stigma. Menopause care must move beyond a purely biological model to incorporate the social, economic, and cultural realities that influence symptom recognition, treatment access, and long-term health. Integrating SDoH screening, expanding inclusive research, and advancing culturally responsive, trauma-informed, person-centered care are essential to improving menopause outcomes and promoting equitable healthy aging.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e281-e288"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaginal Estrogen Application Techniques for Prevention of Urinary Tract Infection: A Randomized Trial.","authors":"Stephanie W Zuo, Erin E Mowers, Shea Hem, Megan Bradley, Halina M Zyczynski, Sharon L Hillier, Mary F Ackenbom","doi":"10.1097/AOG.0000000000006376","DOIUrl":"10.1097/AOG.0000000000006376","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether periurethral estrogen application is noninferior to intravaginal estrogen application for the prevention of urinary tract infections (UTIs) in postmenopausal individuals with laboratory-proven recurrent UTI.</p><p><strong>Methods: </strong>The TAPER (Techniques of Applying Vaginal Estrogen for Prevention of Recurrent Urinary Tract Infections) trial was a single-center, nonblinded, randomized noninferiority trial that compared outcomes after a twice-weekly intravaginal estradiol applicator instillation of 1.0 g cream (intravaginal) compared with periurethral digital application of 0.5 g cream (periurethral) in postmenopausal individuals with recurrent UTIs. The primary outcome was the proportion of UTI-free participants at 6 months postintervention. Secondary outcomes included number of UTIs, the amount of time elapsed to the first UTI, vaginal pH, PGI-I (Patient Global Impression of Improvement) scores, patient experience with the study drug, study drug adverse effects, and urinary and sexual function. To achieve 80% power with a type 1 error of 5% and to account for loss to follow-up, 114 participants needed to be randomized based on a noninferiority margin of 25%.</p><p><strong>Results: </strong>Of 270 eligible individuals, 114 consented and were randomized (57 intravaginal, 57 periurethral). Participants were predominantly White (92.1%) with a mean age of 71.1 years (range 52-93). Participants reported a median of three UTIs in the 12 months before enrollment. Individuals randomized to periurethral estrogen application had a similar proportion of UTI-free participants at 6 months as those randomized to intravaginal estrogen application (50.9% vs 52.6%; risk difference, -1.75 percentage points; 95% CI, -20.0 to 17.0 percentage points). Both groups experienced a decrease in vaginal pH at 6 months; the decreases did not differ by application method (-1.2 intravaginal vs -0.8 periurethral, P =.30). Participants assigned to intravaginal estrogen were more likely to experience vaginal itching after 3 months of use than those assigned to periurethral application (24.0% vs 2.4%, P <.01). Other outcomes did not differ by route of estrogen application.</p><p><strong>Conclusion: </strong>For postmenopausal individuals who are experiencing recurrent UTI, periurethral application of estradiol cream is noninferior to intravaginal application for UTI prevention. Both application methods resulted in approximately half of the participants being UTI-free at 6 months.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov , NCT05472779.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"671-679"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiation and Duration of Systemic Hormone Therapy for Menopausal Symptoms.","authors":"Intira Sriprasert, Yongmei Huang, Donna Shoupe, Megan L Evans, Xiao Xu, Jason D Wright","doi":"10.1097/AOG.0000000000006386","DOIUrl":"10.1097/AOG.0000000000006386","url":null,"abstract":"<p><strong>Objective: </strong>To examine real-world patterns of systemic hormone therapy (HT) initiation and continuation among women with a diagnosis of menopause.</p><p><strong>Methods: </strong>Using the Merative™ MarketScan® Research Databases (2009-2022), we identified women aged 45-60 years with menopause-related claims and at least 12 months of continuous enrollment. Patients with bilateral oophorectomy, breast or gynecologic cancers, or HT contraindications were excluded. Multivariable regression analyzed factors associated with HT initiation, formulation, and duration.</p><p><strong>Results: </strong>Of 318,621 eligible women, 21.7% initiated systemic HT within 1 year. Predictors of HT initiation included younger age (adjusted odds ratio [aOR] 2.17; 95% CI, 2.12-2.23), prior hysterectomy (aOR 1.98; 95% CI, 1.77-2.21), and local hormone use (aOR 3.25; 95% CI, 3.05-3.47). Initiation was significantly lower among women with obesity (aOR 0.78; 95% CI, 0.75-0.81), diabetes (aOR 0.69; 95% CI, 0.66-0.72), and Black racial identification (aOR 0.78; 95% CI, 0.68-0.89). Initial formulations were estrogen plus progestogen (52.5%), estrogen-alone (32.4%), and progestogen-alone (15.1%). The median first-episode duration was 6.6 months; 38.8% of patients continued at 12 months. Black racial (adjusted hazard ratio [aHR] 1.52; 95% CI, 1.34-1.73) and Hispanic ethnic (aHR 1.43; 95% CI, 1.14-1.80) identities predicted faster discontinuation. Conversely, prior hysterectomy (aHR 0.75; 95% CI, 0.68-0.83) and concurrent local hormone use (aHR 0.84; 95% CI, 0.80-0.89) reduced discontinuation risk.</p><p><strong>Conclusion: </strong>Although one-fifth of women initiated systemic HT shortly after their diagnosis, low persistence and racial disparities among those who initiated reveal critical gaps in long-term menopause management. Furthermore, true real-world utilization is likely even lower due to underdocumentation in clinical coding. These findings underscore an urgent need for targeted, equitable interventions to improve treatment adherence and ensure consistent, comprehensive care for menopausal women.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e318-e328"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep Disruption in the Menopausal Transition and Postmenopause: A Narrative Review.","authors":"Audrey C Lyu, Howard M Kravitz","doi":"10.1097/AOG.0000000000006420","DOIUrl":"10.1097/AOG.0000000000006420","url":null,"abstract":"<p><p>The objective of this narrative review is to provide a comprehensive overview of sleep disruptions during menopause by examining primary sleep disorders and secondary disruptors, the biopsychosocial etiology of these disruptions, and approaches to clinical diagnosis. Literature published between January 2015 and March 2026 was searched using PubMed and MEDLINE, Embase, and Google Scholar databases. Findings are summarized into a narrative review that addresses primary sleep disorders that commonly occur during menopause, specifically insomnia, obstructive sleep apnea, restless legs syndrome, and periodic limb movement disorder, as well as the biopsychosocial etiology of sleep pathophysiology. Prevalence of sleep disruption varies by menopausal stage (perimenopause or postmenopause), the presence of vasomotor symptoms, and the definition and measurement of sleep disruptions (self-report questionnaires or objective measures), and can be influenced by a variety of modifiable and nonmodifiable factors. Compared with premenopausal women, prevalence is higher in women during perimenopause and postmenopause, highlighting an increased burden and effect on quality of life in this population. Individual biological, psychological, and social disruptors and their contributions to and effects on sleep are described, as well as practical clinical considerations in the assessment of sleep disruption symptoms. Finally, salient points are discussed.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"616-625"},"PeriodicalIF":5.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Milestones in Motion: Ectopic Pregnancy.","authors":"Kurt T Barnhart","doi":"10.1097/AOG.0000000000006452","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006452","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progesterone Receptor Antagonists for Labor Induction: A Systematic Review and Meta-analysis.","authors":"Isabelle R Pellot, Rachel L Darché, Paulo W Pires, Elise N Erickson","doi":"10.1097/AOG.0000000000006450","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006450","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate mifepristone, a progesterone receptor antagonist, for labor induction and cesarean delivery and related measures of maternal and neonatal safety.</p><p><strong>Data sources: </strong>A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) 2020 guidelines and registered in PROSPERO (CRD420251236886). MEDLINE, Embase, ClinicalTrials.gov, and Scopus were searched through October 2025.</p><p><strong>Methods of study selection: </strong>Eligible studies included randomized trials evaluating mifepristone for labor induction in singleton pregnancies at 37 weeks or more of gestation. Studies involving pregnancy termination, intrauterine fetal death, preterm induction, or concomitant cervical ripening interventions in which the effects of mifepristone could not be isolated were excluded. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. The primary outcome was cesarean delivery. Secondary outcomes included induction-to-delivery interval, time to labor onset, Bishop score, need for prostaglandin or oxytocin, postpartum hemorrhage, neonatal intensive care unit (NICU) admission, and 5-minute Apgar score less than 7. Data were pooled with a random-effects model.</p><p><strong>Tabulation, integration, and results: </strong>The primary analysis included all 15 eligible randomized controlled trials across mifepristone dosing regimens (n=1,063) and control conditions (n=811). Mifepristone was associated with 33% reduced odds of cesarean delivery (33.1% vs 41.9%, odds ratio 0.67, 95% CI, 0.54-0.82) compared with the control method of induction. Mifepristone was associated with higher Bishop scores at 24 hours, shorter induction-to-delivery intervals, and less prostaglandin and oxytocin use compared with control methods. Findings were similar in sensitivity analysis limited to placebo-controlled and high-quality trials (cesarean delivery odds ratio 0.58, 95% CI, 0.40-0.83). No differences were observed in postpartum hemorrhage, NICU admission, or low Apgar score, although most studies did not report these outcomes.</p><p><strong>Conclusion: </strong>Use of mifepristone for labor induction was associated with reduced odds of cesarean delivery, as well as improved cervical ripening and labor induction efficiency. No evidence of short-term maternal or neonatal risk was found, although robust data were limited. Findings support the role of progesterone antagonists for labor induction.</p><p><strong>Systematic review registration: </strong>PROSPERO, CRD420251236886.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}