Background/Objectives: Over 600,000 hysterectomies are performed in the United States annually, with uterine fibroids being the most common indication. It remains unknown whether removal of the uterus is associated with poor cardiometabolic outcomes. This study aimed to determine whether hysterectomy is associated with adverse cardiometabolic outcomes among patients with uterine fibroids (myomectomy and no surgery as controls). Methods: Retrospective cohort study utilizing MarketScan^® Database of U.S. healthcare claims dataset, including patients aged 18–55 with uterine fibroid diagnosis in 2010 or 2011 and 10 years of continuous enrollment. Patients were stratified into three groups: hysterectomy, myomectomy, and no surgery. Patients were then followed for 10 years to determine incidence of cardiometabolic disorders. The main outcome measures included coronary artery disease, congestive heart failure, cardiac arrhythmia, stroke, hypertension, hyperlipidemia, type II diabetes, and peripheral artery disease, which were defined using the ICD-9, ICD-10, and CPT codes. Results: 34,722 participants with uterine fibroids were identified. Among these, 8,196 (23.61%) patients underwent hysterectomy, 1351 patients (3.89%) underwent myomectomy, and 25,175 (72.50%) patients did not undergo surgery. Hysterectomy was associated with higher age-adjusted odds of developing stroke (aOR = 1.11), hypertension (aOR = 1.14), hyperlipidemia (aOR = 1.14), and type II diabetes (aOR = 1.20) compared to no surgery. Hysterectomy was associated with higher age-adjusted odds of developing hyperlipidemia (aOR = 1.26) compared to myomectomy. Hysterectomy with removal of ovaries versus hysterectomy with retention of ovaries had similar cardiometabolic outcomes. Conclusions: Among patients with fibroids, hysterectomy was associated with higher odds of developing adverse cardiometabolic outcomes compared to myomectomy or no surgery. Retention of the ovaries was not protective among those undergoing hysterectomy.

Sickle cell disease is an autosomal recessive hemoglobin disorder affecting about 100,000 people in the United States, predominantly those of African descent. A point mutation in the β-globin gene in red blood cells causes these cells to sickle under hypoxemic conditions, reducing blood flow and oxygen delivery to tissues. This manifests in the form of painful vaso-occlusive episodes, acute chest syndrome, and acute infarction of various organs, including the spleen, bone, and lung. While sickle cell disease complications such as hemolytic anemia, tissue hypoxia, and chronic organ damage are well studied, attention to the unique reproductive challenges faced by patients with sickle cell disease remains underrecognized and underappreciated. This review aims to explore key reproductive health issues in patients with sickle cell disease, including diminished ovarian reserve, infertility, and obstetric and perinatal risk. Secondly, this review aims to identify key counseling and care opportunities for providers to support patients with sickle cell disease in meeting their reproductive goals.

Human Papillomavirus (HPV) is a highly prevalent sexually transmitted infection associated with malignancies of the cervix, vulva, and vagina. While prophylactic vaccination with Gardasil^®9 is FDA-approved through age 45, no clinical trials have evaluated its use in older adults who remain sexually active and at risk for HPV-related cancers. We describe the case of a woman who presented with recurrent high-risk HPV and received the three-dose Gardasil^®9 series off-label at the age of 67. Following vaccination, her cervical cytology was negative for HPV and subsequent colposcopy did not demonstrate any evidence of intraepithelial lesion or malignancy. As this is a single case report, this temporal association cannot establish that vaccination caused viral clearance. Nonetheless, this case raises important questions regarding age-based HPV vaccination limits. Immunosenescence in older populations may impair viral clearance and could increase cumulative risk of progression from dysplasia to malignancy. Vaccination may therefore serve both prophylactic and potentially therapeutic roles; however, this must be evaluated in further controlled studies. This case highlights the need for further research into HPV vaccination in patients over the age of 45 years with or without history of HPV infection.