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 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

 You can reach her at mpetronelli@mjhlifesciences.com.

Articles

A novel oral antibiotic, gepotidacin (Blujepa; GSK), has demonstrated its effectiveness in treating uncomplicated urogenital gonorrhea, according to the results of a recent phase 3 clinical trial.

Gepotidacin demonstrates efficacy, safety as treatment for gonorrhea 

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

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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

1rem

Authors

 is an assistant professor in the Department of Obstetrics and Gynecology at UT Southwestern Medical Center in Dallas, Texas.

Learn about the intersection of mental health and contraception, with evidence-based guidance on contraceptive options for patients with psychiatric conditions.

Contraception for patients with mental health conditions

More than half of women ages 30 to 35 are already experiencing moderate to severe symptoms associated with menopause, yet most do not seek treatment until decades later, according to new research from UVA Health and the Flo women’s health app.

The study highlights the prevalence of symptoms during perimenopause, the transition period leading to menopause. Many women in this stage mistakenly believe they are too young to be affected, leading to delayed treatment and prolonged discomfort.

“Physical and emotional symptoms associated with perimenopause are understudied and often dismissed by physicians,” said study co-author Jennifer Payne, MD, an expert in reproductive psychiatry at UVA Health and the University of Virginia School of Medicine. “This research is important in order to more fully understand how common these symptoms are, their impact on women and to raise awareness amongst physicians as well as the general public” (UVA Health & Flo, 2025).

The research analyzed symptoms reported by more than 4,400 American women aged 30 and older who participated in a survey conducted online and through the Flo app. Among women ages 30 to 35, 55.4% reported symptoms that met the criteria for “moderate” or “severe” based on the Menopause Rating Scale (MRS).

 This percentage increased to 64.3% for women ages 36 to 40. Despite these findings, most women do not seek treatment for menopause symptoms until they are 56 or older.

“We had a significant number of women who are typically thought to be too young for perimenopause tell us that they have high levels of perimenopause-related symptoms,” said Liudmila Zhaunova, PhD, director of science at Flo. “It’s important that we keep doing research to understand better what is happening with these women so that they can get the care they need”.

The study found that psychological symptoms, including anxiety, depression, and irritability, often emerge before physical symptoms. These symptoms peak between ages 41-45 and decline in women 56 and older.

 Physical symptoms such as vaginal dryness, bladder issues, and sexual problems become more common in women 51 and older, while classic menopausal symptoms like hot flashes and sweating peak between ages 51-55. The study also highlighted that over 90% of women experiencing perimenopausal symptoms seek medical care at some point.

The researchers emphasize the need for increased awareness and earlier intervention for perimenopausal symptoms. “This study is important because it plots a trajectory of perimenopausal symptoms that tells us what symptoms we can expect when and alerts us to the fact that women are experiencing perimenopausal symptoms earlier than we expected,” Payne said.

Furthermore, the study found that perimenopausal symptoms can last between 5-10 years and significantly impact daily functioning. Symptoms such as sleep disturbances, cognitive issues, and vasomotor symptoms, including night sweats, were reported at high rates. A logistic regression analysis identified key symptoms strongly associated with perimenopause, including cycle irregularity, frequent urination, and heart palpitations.

Despite growing awareness of perimenopause symptoms, many women continue to feel unprepared for this stage of life. The study highlights the importance of further research and medical education to bridge the gap in knowledge and ensure women receive appropriate support earlier in their transition. Experts emphasize that healthcare providers should proactively discuss perimenopause with patients in their 30s and 40s, rather than waiting until symptoms become severe.

Additionally, the study found that many women hesitate to seek care due to misconceptions about perimenopause and menopause. Educational initiatives and increased access to resources can help address this barrier and empower women to seek treatment when symptoms first arise.

1. University of Virginia Health System. Young women suffering menopause symptoms in silence, study reveals. Eurekalert. February 25, 2025. Accessed February 27, 2025. https://www.eurekalert.org/news-releases/1074704

2. Cunningham AC, Hewings-Martin Y, Wickham AP, et al

 Perimenopause symptoms, severity, and healthcare seeking in women in the US. 

 3, 12 (2025). https://doi.org/10.1038/s44294-025-00061-3

Many women experience perimenopause symptoms in their 30s, but most delay treatment. Early awareness can improve care and quality of life.

Clinical

Study: Perimenopause symptoms common in women as young as 30

There is a lack of knowledge about the link between bariatric surgery and improved fertility, according to a recent survey from Orlando Health.

Only 50% of survey respondents indicated they had knowledge of the benefits bariatric surgery has on fertility, with the other 50% either being unsure or disagreeing with this statement. This indicated a lack of knowledge about these benefits in the general US population.

“When female patients are struggling with obesity and pregnancy, there is typically a correlation between their weight and infertility,” said Alexander Ramirez, MD, FASMBS, director of Orlando Health Weight Loss & Bariatric Institute – Bayfront.

According to the World Health Organization, 1 in 6 individuals are impacted by infertility (WHO).

 Infertility is determined by a failure to achieve pregnancy after at least 1 year of unprotected sexual intercourse. It has been linked to significant distress, stigma, and financial hardship.

WHO has reported underfunding for fertility treatments such as assisted reproductive technology. High costs, social stigma, and limited availability prevent patients from receiving these treatment options.

The report from WHO also highlighted a lack of infertility data in many countries. Authors called for increased availability of national infertility data to highlight patient populations in need of fertility care.

Multiple adverse health conditions have been linked to obesity, such as hypertension, diabetes, sleep apnea, and increased cancer risk.

 Women with obesity may also experience hormone imbalances, irregular menstrual cycles, and polycystic ovarian syndrome (PCOS). These conditions all may contribute to infertility.

“We have many patients with PCOS, a hormonal condition that affects women of reproductive age, many of whom try and fail to get pregnant for many years,” said Ramirez. “After bariatric surgery, their chances of conception drastically increase very quickly as their hormones are regulated and their menstrual cycle normalizes.”

The positive impact of bariatric surgery on pregnancy weight gain was reported in a 

 Patients had a mean early-pregnancy body mass index (BMI) of 29.4 groups, and those with a history of bariatric surgery had decreased pregnancy weight gain vs those with no prior surgery regardless of early-pregnancy BMI category.

Investigators from Orlando Health also noted a lack of knowledge about other weight loss options.

 GLP-1 medications may be used to lose weight, but 64% of respondents were unaware weight gain may occur when stopping GLP-1 injections.

Bariatric surgery leads to a permanent change in the digestive system, with hormone production increased and ovulation improved. For these reasons, Ramirez considers bariatric surgery as the more effective and longer-lasting weight loss option compared to GLP-1 medications.

Ramirez also recommended waiting 18 to 24 months after bariatric surgery before attempting to conceive to give the body time to adjust to changes from the surgery. According to Ramirez, this adjustment period helps reduce the odds of complications such as hypertension, preeclampsia, and gestational diabetes during pregnancy.

“My advice for anyone with obesity, and especially for those who want to have a child, is to ask about bariatric surgery because it's the most powerful tool we have to lose weight in a healthy way and keep obesity in remission,” said Ramirez. “And that is going to increase their chances of having a successful and healthy pregnancy.”

New survey finds over half of Americans are unaware that bariatric surgery can improve fertility. Orlando Health. January 14, 2025. Accessed January 16, 2025. 

https://www.eurekalert.org/news-releases/1069724

1 in 6 people globally affected by infertility: WHO. World Health Organization. Accessed January 16, 2025. 

https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility

Krewson C. Bariatric surgery reduces pregnancy weight gain, study reveals. December 7, 2023. Accessed January 16, 2024. 

https://www.contemporaryobgyn.net/view/bariatric-surgery-reduces-pregnancy-weight-gain-study-reveals

A recent survey highlighted limited knowledge about bariatric surgery's fertility benefits, despite its proven role in addressing obesity-related infertility and improving reproductive health.

Patients found unaware of fertility improvements from bariatric surgery

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.

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.

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.

Courtney C. Baker, MD, MPH

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