Total hysterectomy and bilateral adnexectomy is the standard treatment for atypical endometrial hyperplasia and early-stage endometrial cancer. However, the recommended surgical treatment precludes future pregnancy when these conditions are diagnosed in women in their fertile age. In these patients, fertility-sparing treatment may be feasible if the desire for childbearing is consistent and specific conditions are present. This review summarizes the available evidence on fertility-sparing management for atypical endometrial hyperplasia and early-stage endometrial cancer. Historically, oral progestins have been the mainstay of conservative management for atypical endometrial hyperplasia and stage IA endometrioid endometrial cancer with no myometrial invasion, although there is no consensus on dosage and treatment length. Intrauterine progestin therapy has proved a valid alternative option when oral progestins are not tolerated. GnRH analogs, metformin, and hysteroscopic resection in combination with progestins appear to increase the overall efficacy of the treatment. After a complete response, conception is recommended; alternatively, maintenance therapy with strict follow-up has been proposed to decrease recurrence. The risk of disease progression is not negligible, and clinicians should not overlook the risk of hereditary forms of the disease in young patients, in particular, Lynch syndrome. Hysterectomy is performed once the desire for childbearing desire has been established. The conservative management of atypical endometrial hyperplasia and early-stage endometrial cancer is feasible, provided a strong desire for childbearing and permitting clinical–pathological conditions. However, patients must be aware of the need for a strict follow-up and the risk of progression with a possible consequent worsening of the prognosis. More homogenous and well-designed studies are necessary to standardize and identify the best treatment and follow-up protocols.

There is evidence that diet and nutrition are modifiable risk factors for several cancers. In recent years, attention paid to micronutrients in gynecology has increased, especially regarding Human papillomavirus (HPV) infection. We performed a review of the literature up until December 2022, aiming to clarify the effects of micronutrients, minerals, and vitamins on the history of HPV infection and the development of cervical cancer. We included studies having as their primary objective the evaluation of dietary supplements, in particular calcium; zinc; iron; selenium; carotenoids; and vitamins A, B12, C, D, E, and K. Different oligo-elements and micronutrients demonstrated a potential protective role against cervical cancer by intervening in different stages of the natural history of HPV infection, development of cervical dysplasia, and invasive disease. Healthcare providers should be aware of and incorporate the literature evidence in counseling, although the low quality of evidence provided by available studies recommends further well-designed investigations to give clear indications for clinical practice.

Purpose: To compare conventional bipolar electrosurgery with advanced bipolar vessel sealing (ABVS) devices for total laparoscopic hysterectomy (TLH). Methods: A systematic review was conducted by searching Scopus, PubMed/MEDLINE, ScienceDirect, and Cochrane Library from January 1989 to November 2021. We identified all studies comparing ABVS devices with conventional bipolar electrosurgery in TLH and reporting at least one of the following outcomes: total blood loss, total operative time, hospital stay, perioperative complications, or costs. Meta-analysis was conducted with a random effect model reporting pooled mean differences and odds ratios (ORs) with related 95% confidence intervals (CIs). Results: Two randomized controlled trials and two retrospective studies encompassing 314 patients were included out of 615 manuscripts. The pooled estimated total blood loss in the ABVS devices group was lower than conventional bipolar electrosurgery of 39 mL (95% CI − 65.8 to − 12.6 mL; p = .004). The use of ABVS devices significantly reduced the total operative time by 8 min (95% CI − 16.7 to − 0.8 min; p = .033). Hospital stay length did not differ between the two groups, and a comparable overall surgical complication rate was observed [OR of 0.9 (95% CI 0.256 – 3.200; p = .878]. Conclusions: High-quality evidence comparing ABVS devices with conventional bipolar electrosurgery for TLH is lacking. ABVS devices were associated with reduced total blood loss and operative time; however, observed differences seem clinically irrelevant. Further research is required to clarify the advantages of ABVS devices over conventional bipolar electrosurgery and to identify cases that may benefit more from their use.

This study aimed to summarize available evidence on the efficacy of vulvovaginal topical estrogen therapy on lower urinary tract symptoms (LUTS) of genitourinary syndrome of menopause. Multiple databases were systematically searched from inception to October 2024 to identify all studies providing pretreatment and post-treatment data for menopausal women with LUTS who received vulvovaginal estrogen therapy. A random effect meta-analysis was conducted (PROSPERO registration number: CRD42024517516). Seventeen studies were included for a total of 2111 patients. The pooled odds ratio for the occurrence of considered outcomes after versus before treatment was 0.14 (95% confidence interval [CI] 0.05-0.36; I² = 73%) for recurrent urinary tract infections, 0.12 (95% CI 0.05-0.29; I² = 62%) for stress urinary incontinence, 0.22 (95% CI 0.16-0.32; I² = 0%) for urge incontinence, 0.11 (95% CI 0.06-0.18; I² = 23%) for urgency, 0.22 (95% CI 0.16-0.23; I² = 0%) for frequency and 0.24 (95% CI 0.17-0.34; I² = 0%) for nocturia. The pooled mean difference for vaginal pH was -1.29 (95% CI -1.66 to -0.91; I² = 96%). Vulvovaginal topical estrogen therapy appears to improve all analyzed LUTS in menopausal women. Available evidence supports current guidelines recommending vulvovaginal topical estrogen therapy for the management of these symptoms in menopausal women.