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A new study finds that digital behavior change programs do not significantly increase moderate to vigorous physical activity among women with a history of hypertensive pregnancy disorders.

App interventions not found to boost physical activity in HPD patients

A phase 3 analysis shows that estetrol with drospirenone significantly reduces menstrual pain, mood swings, and other menstrual symptoms, offering clear benefits for both new and switching contraceptive users.

Mitchell Creinin, MD, reports estetrol pill eases menstrual symptoms

New research reveals elevated C-reactive protein levels during the follicular phase of menstruation may explain pain crisis patterns in female sickle cell patients.

Menstrual cycle phase linked to inflammation in women with sickle cell disease

A new study reveals a sharp rise in preventable pregnancy-related deaths across the United States, with significant racial, age, and state-level disparities.

US maternal mortality rates surge 28% from 2018 to 2022

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Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

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Third Revised Editionby Kathleen Huggins,R.N., M.S.

The Nursing Mother's Companion

Multimodal physical therapy is effective in women with chronic pelvic pain (CPP), according to a recent study published in the 

American Journal of Obstetrics & Gynecology.

CPP has been linked to adverse sexual, behavioral, cognitive, and emotional outcomes. It has been estimated in 25% of female individuals, making it a significant health burden.

While CPP may be treated with conservative, pharmacological, or surgical therapies, data about the efficacy of conservative options remains lacking.

 Additionally, current reviews are outdated, failing to provide a comprehensive overview.

Investigators conducted a systematic review to evaluate the efficacy of conservative therapies in women with CPP. The Amed, PsycINFO, CINAHL, SportDiscuss, Embase, Medline, PubMed, and Cochrane databases were assessed for articles published from inception to January 16, 2023.

Studies evaluating women with pelvic pain lasting at least 3 months without an underlying pathology were included in the analysis. Additional eligibility criteria included evaluating an intervention in a trial arm and comparing the intervention with inert or nonconservative treatment.

Conservative therapies assessed included multimodal physical therapy, predominantly psychological approaches, and other tissue-based monotherapies. Relevant outcomes included sexual measures, pain outcomes, health-related quality of life, physical and psychological function, symptom severity, and perceived improvement.

Two independent reviewers performed title and abstract screening, with disagreements resolved through discussion or by a third reviewer. A single reviewer performed data extraction, with a second reviewer verifying the accuracy of data.

Extracted data included study design, participant characteristics, intervention and control treatment details, type of conservative therapy, primary diagnosis, outcome measures used, and results. Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale.

There were 41 (RCTs) studies included in the final analysis, 38 of which were randomized controlled trials, 2 were follow-up studies, and 1 was a pilot study. The trials included 2168 female patients aged a mean 35.1±8.6 years. Most studies were published from 2018 onwards.

CPP was assessed in 13 RCTs, vulvodynia in 16, bladder pain syndrome in 5, dyspareunia in 2, and genito-pelvic pain and urogynecological pain each in 1. Multimodal physical therapy was assessed in 7 RCTs, predominantly psychological approaches in 10, acupuncture in 5, and tissue-based monotherapies in 18.

Pain intensity was reduced in patients undergoing multimodal physical therapy vs controls, with a standardized mean difference (SMD) of -1.69. Additionally, a mean difference of -2.87 was reported when retransforming SMD to a normal 0 to 10 pain scale. This data indicated a significant effect and had high certainty of evidence.

During follow-up, the SMD was -1.82, highlighting efficacy at 12 to 36 weeks posttreatment. This indicated a mean difference of -3.09 on a 0 to 10 pain scale.

In comparison, no significant impact on pain intensity was reported from predominantly psychological approaches, with an SMD of -0.18. For acupuncture, the SMD was 1.08, highlighting a nonsignificant effect. Similar results were reported for tissue-based monotherapies.

Sexual measures were also improved by multimodal physical therapy when compared to controls. Intercourse was attempted less often in the conservative therapy group, indicating a more flexible approach toward sexual activity.

Predominantly psychological approaches also showed a statistically significant, small effect. However, no effect was reported from tissue-based monotherapies.

For psychological function, 6 of 8 RCTs found superiority from multimodal physical therapy vs controls. In comparison, only 1 trial showed significant between-group differences from tissue-based monotherapies, and only for pain catastrophizing and pain anxiety.

These results indicated efficacy from multimodal physical therapy in managing CPP without an underlying pathology. Other conservative therapies did not show efficacy, highlighting multimodal physical therapy as the only conservative method with proven efficacy.

Starzec-Proserpio M, Frawley H, Bø K, Morin M. Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: a systematic review and meta-analysis. 

American Journal of Obstetrics & Gynecology. 

2025;232(1):42-71. doi:10.1016/j.ajog.2024.08.006

Ghai V, Subramanian V, Jan H, Loganathan J, Doumouchtsis SK; CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women’s Health (i-chorus.org). Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument. I

. 2021;32(11):2899-2912. doi:10.1007/s00192-021-04848-1

A recent study highlights multimodal physical therapy as the only conservative treatment with proven efficacy in managing chronic pelvic pain, improving pain intensity, sexual health, and psychological function.

Clinical

Multimodal physical therapy proves effective for women with chronic pelvic pain

 targeting human papillomavirus type 16 (HPV16) has shown promise in reducing advanced precancerous 

, according to results from a phase II clinical trial published in 

“Nearly all premalignant cervical lesions and cervical cancers are caused by 

 infection, with HPV16 implicated in the majority of cases,” said Refika Yigit, MD, lead researcher and gynecologist at University Medical Centre Groningen in the Netherlands.

The trial focused on grade 3 cervical intraepithelial neoplasia (CIN3), a condition where cells show significant precancerous changes. If untreated, about one-third of these cases progress to cervical cancer within 10 years, and nearly half within 30 years, Yigit explained.

“The main goal of our trial was to see if our vaccine—Vvax001—could provide an alternative to the standard surgical treatment, which often has complications,” Yigit added.

The Vvax001 vaccine is a modified version of a virus that cannot replicate. It produces proteins specific to HPV16-infected cells. Previous research showed that the vaccine triggers strong immune responses against HPV16 proteins.

In the trial, 18 newly diagnosed HPV16-related CIN3 patients received 3 vaccine doses over 3 weeks. Each dose contained 5x10⁷ infectious particles. They were monitored for up to 19 weeks, with a final examination and biopsy conducted after treatment. Surgery was performed only if CIN2/3 lesions remained.

The results showed that nine of the 18 patients had improvements—6 had less severe changes in their cervical cells, and 3 had no signs of disease. Most patients saw a reduction in lesion size within a month of finishing treatment, with reductions evident as early as 3 weeks after the last immunization. Among the 9 patients whose disease did not improve, surgery was performed, but no remaining disease was found in four cases, suggesting the vaccine may have worked over time.

Histopathological analysis revealed a complete response (regression to CIN1 or no dysplasia) in 50% of the patients. Additionally, HPV16 clearance was observed in 10 of the 16 patients tested (63%). However, the vaccine did not clear other HPV types.

“To our knowledge, this makes Vvax001 one of the most effective vaccines for treating HPV16-related CIN3 reported so far,” Yigit said. “If confirmed in larger studies, our findings suggest that many patients with CIN3 might be able to avoid surgery and its potential complications.”

Clearing HPV from the body is linked to a lower chance of the disease coming back. In this study, 10 of the 16 patients tested no longer had HPV16, including all nine whose condition improved. Two patients whose disease did not improve also cleared HPV16, but their lesions were linked to other HPV types. After a median follow-up of 20 months, no patients had a recurrence. The longest disease-free survival time observed was 30 months.

While the results are encouraging, the study limitations included a small sample size, limited follow-up time, and the lack of a comparison group for natural recovery due to ethical reasons. No serious adverse events related to the treatment were observed.

The authors concluded that these results represent an important step forward in the fight against HPV-related cervical cancer. Further research is needed to confirm the vaccine’s effectiveness and safety in larger, more diverse groups.

1. American Association for Cancer Research. A therapeutic HPV vaccine could eliminate precancerous cervical lesions. Eurekalert. January 24, 2025. Accessed January 27, 2025. https://www.eurekalert.org/news-releases/1071497

2. Eerkens AL, Esajas MD, Brummel K, et al. Vvax001, a Therapeutic Vaccine for Patients with HPV16-positive High-grade Cervical Intraepithelial Neoplasia: a Phase II Trial. 

. Published online January 24, 2025. doi:10.1158/1078-0432.CCR-24-1662

Vvax001, a new HPV16 vaccine, offers a potential alternative to surgery for treating precancerous cervical lesions, with promising trial results.

New HPV vaccine shows promise in treating high-grade cervical lesions

Information and guidance for providing care to obstetric patients from nursing leaders or hospital administrators is not being given to emergency department nurses (ED) nurses in states with abortion bans, according to a recent study from the University of Massachusetts Amherst.

This data was discussed at the American Organization for Nursing Leadership 2025 annual conference, leading to informed discussion. According to nurses, the lack of support is leading to feelings of frustration, anger, and moral distress.

“Basically, the nurses felt like they were set adrift with no guidance, no support, no backup, and they were concerned for their patients,” said Lisa Wolf, PhD, lead author and associate professor at the Elaine Marieb College of Nursing.

According to Wolf, the quality of care is impacted by the lack of communication. This includes whether patients receive care at all.

Evaluating nurse perception toward obstetric care

The study was conducted to evaluate how nurses perceive abortion bans in the context of providing obstetric care.

 Participants included ED nurses in states with and without abortion bans, with no exclusion criteria.

Qualitrics, an online platform, was used to obtain participants’ demographic data and information about their practice settings. A semistructured interview was developed using nursing and anthropological perspectives, then performed across 1 hour over Zoom for each participant. These were recorded and transcribed using Zoom software.

Research team members analyzed the data and reached a thematic meaning. Saturation was determined by interview 18, with appropriate geographic representation reached through the final 4 interviews.

Participant demographics and institution communication

There were 22 ED nurses included in the final analysis, 19 of whom worked in a state with some care-limiting legislation. Of nurses, 82% were female, 72.7% White, 50% aged 35 to 44 years, 45% with a bachelor’s degree, and 59% working as general staff nurses.

According to participants, institutions had robust communication structures for most practice changes, including new equipment, new processes, and infection control. On an institutional level, communication structures included staff meetings, emails, communication books, online education, and 1-to-1 instruction.

Of nurses working in states with an abortion ban, 30% did not know if a ban had been implemented in their state. Eighteen of these participants reported not receiving any information about the restrictions from their administration. The 1 other participant only received verbal communication. No written documentation was provided.

While ED nurses reported confusion surrounding the clinical implications of important bans, these participants expressed a belief that other reasons were responsible for this lack of communication. This generated a political theme.

“It's political, it's religious. It just kind of stems on a bunch of issues you don't really want to talk about work,” said one participant. Similar beliefs were expressed by other participants.

Some participants also expressed thoughts that nurses were not informed of a potential threat to their license because of abortion bans to avoid instances where they would leave their practice. Regardless of individual beliefs about the reasons, many participants considered that the decision not to inform nursing staff about abortion was consciously made by administrations.

Nurses reported negative interpersonal effects from this lack of communication, including increased difficulty communicating with patients. Some nurses shared they would not discuss abortion with their patients, generating a theme of silence.

“If somebody else finds out that I gave that patient that information … they could potentially bring a civil lawsuit against me,” said a participant from Texas.

These difficulties led many ED nurses to express distress, with a theme of do no harm. This distress was heightened by the lack of communication, especially in nurses who knew about the care trajectory for pregnancy emergencies such as ectopic pregnancies and incomplete miscarriages. Overall, this highlighted a trend of anger and frustration among ED nurses.

“The overwhelming takeaway for me was the communicative isolation that nurses faced,” said co-author Lynnette Arnold, PhD, a linguistic anthropologist at UMass Amherst.

 “They were essentially operating in the same kind of informational vacuum that all the rest of us are.”

ED nurses report radio silence when it comes to guidance for care of pregnant patients in states with abortion bans. University of Massachusetts Amherst. March 31, 2025. Accessed April 8, 2025. 

https://www.eurekalert.org/news-releases/1078875

Wolf L & Arnold L. Medical-legal communication among emergency nurses in states with abortion bans. 

 2025;55(4):E17-E23. doi:10.1097/NNA.0000000000001562

A new study reveals that emergency department nurses in abortion-ban states are not receiving critical guidance from hospital leadership, leading to confusion, moral distress, and compromised patient care.

Emergency nurses left in the dark on abortion laws

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?

, Shayna Mancuso, DO, FACOG, from Astellas Pharma, outlined current and emerging treatment options for managing menopause symptoms, particularly vasomotor symptoms (VMS), also known as hot flashes and night sweats.

She emphasized that managing menopause is not a one-size-fits-all approach. Instead, treatment must be individualized, taking into account each woman’s personal medical and family history, as well as her treatment preferences.

One of the most effective and widely used treatment options for menopause-related symptoms is hormone therapy. However, hormone therapy isn’t suitable for every patient. Some women may have medical contraindications or may simply choose not to pursue it. For these women, non-hormonal alternatives are available.

Mancuso highlighted fezolinetant (VEOZAH; Astellas Pharma) as a promising, first-of-its-kind, non-hormonal treatment specifically approved by the FDA for moderate to severe VMS due to menopause. Unlike traditional hormone therapy, fezolinetant works by targeting the neurokinin B (NKb) pathway. It blocks the binding of the NKb neuropeptide, which is known to trigger VMS. This mechanism allows fezolinetant to reduce the frequency and severity of moderate to severe hot flashes during both day and night.

Mancuso noted that for some women, fezolinetant can start working in as early as one week, which was seen in clinical studies at 4 and 12 weeks, however, individual results may vary. She also cautioned that fezolinetant may cause serious side effects, including liver-related issues, and therefore requires lab testing before and during use. Patients experiencing symptoms should discontinue use and consult with their physicians. Further safety details, including a Boxed warning and full 

, are available at the drug’s official website, veozah.com.

In closing, Mancuso underscored the broader mission of Astellas, the pharmaceutical company behind fezolinetant. She shared that Astellas is committed to advancing women’s health, particularly during midlife, a demographic that has historically been underserved. The company actively partners with menopause experts and advocacy groups to raise awareness, reduce stigma, and develop targeted, research-backed solutions to support women navigating menopause globally.

New research reveals impact of menopause stigma. Astellas. March 07, 2025. Accessed April 04, 2025. https://www.astellas.com/en/stories/international-womans-day-2025

Discover how fezolinetant (VEOZAH; Astellas Pharma) is helping women manage moderate to severe vasomotor symptoms of menopause with rapid and effective relief.

Hope for menopause hot flashes discussed by Shayna Mancuso, DO

The Menopause Experience and Attitudes Study, as explained by Shayna Mancuso, DO, FACOG, from Astellas Pharma, is a comprehensive, bi-yearly global research initiative designed to better understand societal perceptions, individual experiences, and the persistent stigma surrounding menopause and perimenopause. 

Conducted by Astellas in collaboration with global menopause experts and advocates, the study collected data from approximately 13,800 participants across 6 countries. Notably, each country contributed approximately 2,300 participants, with the US segment focusing on 1,800 women aged 40 to 55 years.

The study yielded several critical findings. One of the most striking revelations was that 67% of respondents felt menopause symptoms are not taken seriously, and 55% still view menopause as a taboo subject. These statistics emphasize the ongoing cultural silence and misunderstanding surrounding the menopausal transition. In addition, 60% of women who had experienced menopause, or were close to someone who had, reported psychological effects such as anxiety, depression, shame, and embarrassment.

The study also highlighted the negative impact of menopause in professional environments. Many women reported decreased productivity and even workplace discrimination linked to menopausal symptoms. Moreover, 93% of women who had direct or indirect experience with menopause reported significant symptom impact, with 60% citing hot flashes and over 50% mentioning night sweats or vasomotor symptoms.

These findings underscore the ongoing societal challenges women face during menopause and highlight a significant need for improved education and support systems. Mancuso emphasized that menopause management should not be approached with a “one size fits all” mindset. Instead, health care providers must recognize the diversity of symptoms and experiences, tailoring care accordingly.

In addressing how clinicians can help, Mancuso stressed the importance of health care providers taking an active role in breaking the stigma and initiating open, judgment-free discussions. Physicians should ensure that women feel safe and heard when sharing their experiences. By providing comprehensive, evidence-based information on available treatments and management strategies, clinicians can empower women to become advocates for their own health during this significant phase of life.

A global study uncovers the widespread stigma, emotional toll, and workplace challenges women face during menopause, highlighting the urgent need for awareness, support, and personalized care.

Angela Beegle

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