estradiol (Vagifem)

Retraction Statement: Vaginal length and sexual function after vertical versus horizontal closure of the vaginal cuff after abdominal hysterectomy: a randomised clinical trial.

Vaginal cuff dehiscence and bowel evisceration as a late-onset complication of vaginal vault prolapse: a case report.

Schröder Carolin C, Egger Eva K EK, Pantenburg Jakob Friedemann JF, Dohmen Jonas J et al.

Vaginal cuff dehiscence (and evisceration, VCDE) after hysterectomy is a rare, but potentially serious complication. Current medical literature describes the most critical risk factors for VCDE after hysterectomy as surgical technique, use of thermal energy, early mechanical stress (especially sexual intercourse), infection, smoking, and obesity. There is currently no evidence regarding a potential association between VCDE and anti-HER2 therapy. We report a late-onset VCDE in a patient receiving combined antihormonal and anti-HER2 therapy, and discuss the hypothesis-generating question of a potential association, as well as the bowel-preserving surgical management. We report the case of an 81-year-old White woman with hormone receptor-positive breast cancer receiving antihormonal therapy with anti-HER2 treatment and recurrent vaginal vault prolapse who presented with acute vaginal evisceration of the small bowel. She had undergone a vaginal hysterectomy for pelvic organ prolapse 3 years earlier. Emergency surgical management was performed via laparotomy with repositioning of the small bowel, vaginal cuff closure, and concomitant sacrocolpopexy. One week later, re-laparotomy was required due to an open abdomen associated with paralytic small bowel ileus; bowel resection was not necessary. The last follow-up was carried out 21 months postoperatively. The patient was asymptomatic and showed no evidence of recurrent prolapse. This case highlights a rare late-onset VCDE in a patient receiving combined antihormonal and anti-HER2 therapy, a clinical context not previously described. While causality cannot be established, this report raises the hypothesis of a potential association between targeted therapy and impaired tissue integrity.

Is Vaginal Estrogen Treatment Associated with Risk of Thrombosis in Postmenopausal Women? A Scoping Review.

Juul Sofie L SL, Glavind-Kristensen Marianne M, Bor Pinar P, Bor Mustafa Vakur MV

Although the thromboembolic risk associated with oral estrogen is recognized, the risk profile of vaginal estrogen treatment remains inconclusive. This scoping review aims to explore available evidence on the association between vaginal estrogen treatment in postmenopausal women and the risk of thrombosis. We conducted a systematic search of PubMed and Embase, investigating vaginal estrogen treatment and thrombosis, for all records up to May 21, 2025. The process was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) and a preregistered protocol (osf.io/hgecd). We excluded systemic estrogen treatments, contraception, fertility treatments, gender-affirming therapies, and hormone treatments other than estrogen. Eligible study designs included clinical trials, randomized controlled trials, observational, case-control, and cohort studies. The search identified 866 articles, whereof 8 were eligible. Manual searching through citations and references yielded 3 additional studies, resulting in 11 included articles, all observational. One study reported a reduced risk of recurrent myocardial infarction (MI) following discontinuation of vaginal estrogen treatment (adjusted hazard ratio [aHR]: 0.54; 95% confidence interval [CI]: [0.34-0.86]). Remaining studies found no thrombosis risk in vaginal estrogen users. For venous thromboembolism (n = 6), effect estimates ranged from null to reduced risk (aHRs: 0.68 [0.36-1.28], to 1.06 [0.58-1.93]), similar for MI (n = 5; aHRs: 0.52 [0.31-0.85] to 0.83 [0.77-0.89]) and stroke (n = 6, aHRs: 0.68 [0.62-0.70] to 0.96 [0.93-0.99]). This scoping review, including studies of generally moderate to high methodological quality, indicates no increased risk of thrombosis associated with vaginal estrogen use in postmenopausal women. Further prospective, high-quality clinical trials, including high-risk populations and women with prior thrombosis, are warranted.

Defining functional puberty in female C57BL/6J mice using endocrine, cytological and morphological markers.

Chester Mélanie M, Wyckens Noalig N, Airaud Eloïse E, Corre Raphaël R et al.

Puberty marks the transition to reproductive competence and is driven by activation of the hypothalamo/pituitary/gonadal axis, culminating in first ovulation in females. In mice, puberty onset is commonly inferred from vaginal opening and estrous cyclicity, but the precise timing of first ovulation remains unclear. Here, we aimed to define reliable parameters of functional puberty in female C57BL/6J mice by integrating external, endocrine, and morphological measures. Vaginal opening and daily vaginal cytology were combined with daily serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) measurements and ovarian histology using the Pubertal Ovarian Maturation Score (Pub-Score), which estimates ovulation based on follicular development and corpus luteum morphology. Notably, we observed substantial inter-individual variability in puberty-related events, and no link between estrous cytology and first ovulation. Pub-Score analysis indicated that first ovulation occurred between 36 and 54 days postnatal, with a mean around 44 days, with no correlation with vaginal cytology. LH surges were detected in some of the females that had ovulated and showed limited temporal correspondence with vaginal cytology or Pub-Score estimates. Together, these findings demonstrate that puberty in female mice is a gradual, asynchronous process and that external or cytological markers alone are insufficient to define functional reproductive maturity.