Supervisor: National Health Commission of the PRC
Sponsored by: Chinese Medical Doctor Association
China Medical University
Sponsored by: Chinese Medical Doctor Association
China Medical University
Perimenopause is a critical window period for weight gain and body composition changes in women. Approximately 70% of women experience weight gain during this stage，accompanied by central obesity，decreased muscle mass，and reduced basal metabolic rate. The decline in estrogen levels is the core driving factor for visceral fat accumulation，while age-related reduction in energy expenditure is the main cause of weight gain. Strengthening the management of body weight and body composition in perimenopausal women has important clinical significance for reducing long-term risks such as metabolic syndrome，cardiovascular disease，and osteoporosis. This article starts with the pathophysiological mechanisms of body composition changes，systematically elaborates on multidimensional management strategies including nutritional intervention，exercise management，menopausal hormone therapy，and novel weight-loss drugs，and proposes individualized management recommendations based on clinical practice.
Abnormal Uterine Bleeding（AUB）is the most prevalent gynecological symptom in women aged 45-55 years，and also represents a major challenge for clinical differential diagnosis and long-term health management. Compared with AUB in reproductive-age women，perimenopausal patients are characterized by a high incidence of ovulatory dysfunction，elevated risk of endometrial malignancy，multiple underlying comorbidities，and limited safety margins for hormonal therapy. Advancing age also increases the prevalence of benign intrauterine lesions such as endometrial polyps and uterine fibroids，which constitute important triggers for perimenopausal AUB. Clinical diagnosis and treatment require comprehensive clinical reasoning. Mere symptomatic hemostasis should be avoided. Clinical management should adhere to the management principles of“ruling out malignancy first，precise classification，stratified intervention，and whole process follow-up”.
Menopausal emotional disorders（MED）are prevalent yet underrecognized complex syndromes affecting perimenopausal women，characterized by core manifestations of depression，anxiety，irritability and emotional lability，which frequently co-exist with somatic symptoms including hot flushes，perspiration and sleep disturbances. Distinct from menopausal syndrome，menopausal emotional disorders do not merely represent a transient condition driven by hormonal fluctuations. Instead，they constitute a clinical entity with stand-alone diagnostic validity，specifically denoting depression and anxiety disorders which first onset or substantial exacerbation during the perimenopausal phase that meet the diagnostic criteria for emotional disorders. Current clinical practice faces prominent challenges：low recognition rates，high misdiagnosis rates and homogeneous intervention approaches. Conventional general screening tools exhibit limited applicability，and multidisciplinary collaboration systems remain immature. Based on the latest evidence-based findings and clinical practical experience，this article systematically elucidates the pathological mechanisms，diagnostic dilemmas and multidimensional management strategies of menopausal emotional disorders.It is proposed to establish interdisciplinary collaborative frameworks and strengthen local-adapted research，so as to advance the mental health care level and overall medical service quality for menopausal women in China.
Healthy sleep is the foundation of physical and psychological well-being. Insomnia is a common chronic disease among peri-menopausal and postmenopausal women，which severely impairs the physical and mental health of middle-aged women. Menopausal insomnia is influenced by multiple factors such as vasomotor symptoms，aging，hormone fluctuations，individual environment and psychological stress.Detailed assessment of insomnia and standardized long-term management of each patient are required in clinical practice.
Premature ovarian insufficiency（POI）is defined as ovarian dysfunction occurring in women before the age of 40；early menopause（EM）is defined as ovarian failure at 40-54 years of age；the age of menopause in both POI and EM is before 45 years，so they are generally called premature menopause，which includes both POI and EM. Women with premature menopause may suffer from menopause-related symptoms such as hot flushes，insomnia and mood lability due to estrogen fluctuation or decrease，and face an elevated risk of chronic diseases such as cardiovascular disorders and osteoporosis. Although guidelines for POI diagnosis and management are available，little is mentioned regarding EM. Therefore，this article analyzes the etiology，diagnosis，health impacts and long-term management strategies for POI and EM in order to better guide clinical practice.
Treatment modalities for cancer patients，including surgery，radiotherapy，and chemotherapy，may lead to premature ovarian insufficiency，a condition known as iatrogenic menopause. The resulting hypoestrogenism is often more severe than natural menopause. This article reviews the management of menopause in cancer patients，focusing on healthy lifestyle，menopausal hormone therapy，non-hormonal options for menopause，and menopausal hormone therapy specifically for cancer patients.
Objective To investigate the effect of immediate administration of compound norethisterone enanthate injection after medical abortion in early pregnancy on uterine recovery-related outcomes. Methods A dual-center，prospective cohort study design was adopted，enrolling 139 patients who underwent early-pregnancy medical abortion at the Obstetrics and Gynecology Hospital of Fudan University and Xuzhou Maternal and Child Health Hospital between January 2025 and January 2026 and met the inclusion and exclusion criteria. The observation group（n=69）received 2 mL of compound norethisterone enanthate injection immediately after medical abortion；the control group（n=70）did not use any hormonal contraception after abortion. The duration of vaginal bleeding after medical abortion，time to first menstruation，residual uterine tissue at 2 weeks after medical abortion，and curettage rate were compared between the two groups. Subgroup analysis was performed on patients with residual tissue of average diameter ≤3 cm at 2 weeks after-abortion，and multivariate logistic regression was used to assess the relevant factors for their outcome. Results There were no statistically significant differences in baseline characteristics between the two groups. The first menstrual period returned significantly earlier in the observation group than in the control group [（25.51±6.77）days vs.（33.80±7.71）days，P<0.001]. The proportion of vaginal bleeding lasting ≤2 weeks was higher in the observation group than in the control group（97.1% vs. 84.3%，P=0.021）. At the 2-week follow-up after medical abortion，the proportion of no retained products of conception was higher in the observation group than in the control group（44.9% vs. 27.1%，P=0.038），and the retained product volume was smaller. At the post-menstrual follow-up，the rate of no retained products of conception was significantly higher in the observation group than in the control group（76.8% vs. 55.7%，P=0.011）. The curettage rate was lower in the observation group than in the control group（1.4% vs. 7.1%），but the difference was not statistically significant. In patients with residual tissue of average diameter ≤3 cm at two weeks after medical abortion，the negative conversion rate was statistically significant in both the observation and control groups upon follow-up（P<0.05）. At the end of follow-up，the proportion of patients with normal uterine cavity recovery was higher in the observation group than in the control group（59.5% vs. 43.5%）. Multivariate analysis showed that vaginal bleeding duration >2 weeks was associated with a decreased probability of negative conversion of residual tissue of average diameter ≤3 cm（aOR 0.08，95%CI 0.01-0.68，P=0.021）. Conclusions Immediate administration of compound norethisterone enanthate injection in early pregnancy after medical abortion results in shorter duration of vaginal bleeding，faster menstrual recovery，smaller residual tissue，and a higher proportion of normal uterine cavity recovery after menstruation. This regimen may provide additional benefits to uterine cavity recovery after medical abortion in addition to implementing post-abortion contraception.
Objective To investigate the microbial alterations in vulvar and vaginal secretions of patients with vulvar lichen sclerosus（VLS）. Methods A total of 63 adult women in Shanghai Renji Hospital of Shanghai Jiao Tong University School of medicine from March to September 2025 were enrolled，including 20 healthy controls and 43 patients with VLS. Vulvar and vaginal secretion samples were collected for 16S rRNA high-throughput sequencing to analyze microbial composition，alpha diversity，beta diversity，and differential microbiota. Results Bacillota was the dominant phylum in both groups. Compared with the control group，the VLS group showed a decreased Lactobacillus and increased Finegoldia，Streptococcus，Prevotella，and Enterococcus in vulvar secretions，accompanied by increased alpha diversity and significantly altered beta diversity. In vaginal secretions，Lactobacillus was also reduced，while Streptococcus，Enterococcus，and Acinetobacter were increased；however，no statistically significant differences were observed in alpha or beta diversity. Conclusion Both vulvar and vaginal microbiota are altered in patients with VLS，with more pronounced microecological imbalance in the vulvar region，suggesting that it may be involved in the development and progression of VLS.
Objective To investigate the differences in fertility outcomes and their influencing factors between young patients with borderline ovarian tumors（BOT）and early-stage ovarian carcinoma（OC）who underwent fertility-sparing surgery（FSS）. Methods A retrospective analysis was performed on the postoperative fertility outcomes of 42 young patients with BOT or OC who received FSS at the Affiliated Hospital of Nantong University from January 2015 to September 2024. Logistic regression analysis was used to identify the independent factors affecting postoperative pregnancy. Results Statistically significant differences were observed between the two groups in terms of FIGO stage，maximum tumor diameter，papillary structure，proportion of solid components，postoperative chemotherapy，surgical approach，and lymphadenectomy（P<0.05）. The postoperative pregnancy rate was 27.78%（5/18）in the BOT group and 20.83%（5/24）in the OC group，with no statistically significant difference in fertility outcome indicators between the two groups（P>0.05）. Multivariate logistic regression analysis showed that preoperatively having given birth and postoperative adjuvant chemotherapy were independent risk factors for postoperative pregnancy. Conclusions Preoperative reproductive history and postoperative adjuvant chemotherapy affect the pregnancy status of patients after FSS. For patients with early-stage BOT and OC，chemotherapy should be avoided or delayed as much as possible in clinical practice without compromising tumor prognosis.
Objective To analyze the clinical efficacy of apatinib combined with pegylated liposomal doxorubicin（PLD）liposome in the second-line treatment of platinum-resistant recurrent/metastatic cervical cancer（r/m CC）. Methods A total of 120 patients with r/m CC admitted to Wuhan Jiangxia District People's Hospital from June 2021 to May 2024 were selected and divided into a control group（n=68）and a study group（n=52）based on patient treatment preference and clinician assessment. The control group was treated with PLD，while the study group was combined with apatinib on the basis of the control group. One treatment cycle is three weeks，and both groups are treated for three cycles. The clinical efficacy，serum tumor marker levels，quality of life，survival prognosis and occurrence of adverse reactions were compared between the two groups. Results The DCR，ORR，and total improvement rate of quality of life in the study group were all higher than those in the control group（P<0.05）. After treatment，the levels of serum SCCA，CA15-3，and CA724 in both groups decreased，and those in the study group were even lower（P<0.05）. The median PFS and median OS in the study group were both prolonged compared with those in the control group [10.18（9.57-10.78）months vs. 8.65（7.81-9.50）months；11.50（11.01-11.95）months vs. 9.94（9.10-10.57）months [Log-rank χ2=7.739，8.773；both P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）. Conclusion The second-line treatment of apatinib combined with PLD can improve the therapeutic effect of platinum-resistant r/m CC to a certain extent，reduce the levels of tumor markers，improve the quality of life of patients，prolong the survival period.
Objective To explore the application value of copy number variation sequencing（CNV-seq）combined with quantitative fluorescent polymerase chain reaction（QF-PCR），compared with conventional karyotyping analysis and single nucleotide polymorphism（SNP）array，in genetic diagnosis of spontaneous abortion. Methods Chromesome detection by conventional karyotyping analysis，CNV-seq combined with QF-PCR，and SNP array analysis was performed on tissue samples from 286 cases of spontaneous abortion undergoing curettage，which were collected from Fujian Maternity and Child Health Hospital between April 2018 and May 2020.The detection rates of chromosome abnormalities and the accuracy of the three methods were analyzed. Results Among the 286 products of conception，the detection success rates of conventional karyotyping，CNV-seq，and SNP array were 80.1%（229/286），100%（286/286），and 100%（286/286），respectively. Among the 229 samples with valid results obtained by all three methods，the detection rates of chromosomal abnormalities were 52.0%，55.4%，and 51.1%，respectively，while the detection rate of aneuploidy was 45.0% for all three methods. CNV-seq detected six cases of mosaicism，whereas SNP array detected one. The five additional microdeletions/microduplications identified by CNV-seq were all variants of uncertain significance（VUS）. Five cases of tetraploidy detected by conventional karyotyping were not identified by either CNV-seq or SNP array. Conclusions CNV-seq combined with QF-PCR has a high detection success rate and can identify some low-level mosaicism and submicroscopic copy number variants，however，it may fail to detect certain cases of tetraploidy. Given the respective advantages and limitations of different detection techniques，the choice of testing strategy in clinical practice should be guided by the diagnostic objectives，sample characteristics，and technical performance. When necessary，combined application of multiple techniques may improve the accuracy of identifying the genetic causes of spontaneous miscarriage.
