Gynecology & Obstetrics

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ResearchSource: Obstetrics & GynecologyNov 1, 2026

Estrogen-Only Therapy Linked to Lower Breast Cancer Risk Post-Hysterectomy

A meta-analysis of 10 randomized trials involving 14,282 participants at population risk found that estrogen-only therapy was associated with a lower breast cancer diagnosis rate than placebo (3.6% vs 4.7%; relative risk 0.77; 95% CI, 0.65-0.91, P=.002). A separate matched prospective cohort study of 676 patients with BRCA mutations and intact breasts reported a 15-year cumulative breast cancer incidence of 24.3% among estrogen-alone users versus 47.3% among nonusers of menopausal hormone therapy (P<.0001). The source notes that more data specifically evaluating estradiol therapy in patients who have undergone hysterectomy are needed.

Relevant to:Gynecology & ObstetricsPatients who have undergone or are planning hysterectomy for benign gynecologic conditions, including those with BRCA pathogenic variants, who are considering menopausal hormone therapy.

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ResearchSource: Obstetrics & GynecologyNov 1, 2026

ACOG Issues Guideline on Menopause Vasomotor, Sleep, Mood Symptoms

ACOG developed a Clinical Practice Guideline providing evidence-based recommendations for managing vasomotor, sleep, and mood symptoms related to spontaneous or induced menopause. The guideline was built using a GRADE evidence-to-decision framework by a writing team including reproductive endocrinology subspecialists and an obstetrics-gynecology specialist, and includes graded recommendations on pharmacologic and nonpharmacologic interventions along with ungraded Good Practice Points where evidence was insufficient for a formal recommendation.

Relevant to:Gynecology & ObstetricsPerimenopausal and postmenopausal individuals assigned female sex at birth, including those with induced menopause at or beyond age 40, experiencing vasomotor, sleep, or mood symptoms.

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ResearchSource: New England Journal of MedicineOct 27, 2026

First-line IVF Outperforms IUI in Unexplained Infertility Trial

A multicenter randomized controlled trial compared intrauterine insemination (IUI) with ovarian stimulation versus in vitro fertilization (IVF) as first-line treatment for unexplained infertility. The trial reported that after stage 1, the cumulative live-birth rate was 31% with IUI versus 55% with IVF, meaning IUI was not noninferior to IVF; however, after couples who had not achieved a live birth were allowed further IVF cycles in stage 2, cumulative live-birth rates became similar (70% vs 71%). The trial also reported more serious adverse events in the IVF group than the IUI group, most related to oocyte retrieval or hyperstimulation.

Relevant to:Gynecology & ObstetricsCouples with unexplained infertility considering first-line treatment choice between IUI with ovarian stimulation and IVF.

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ResearchSource: American Journal of Obstetrics and GynecologyOct 26, 2026

Iodine staining during LEEP linked to more positive margins

A randomized controlled trial comparing loop electrosurgical excision procedure (LEEP) with versus without intraoperative Lugol's iodine staining (IOS) found higher rates of involved resection margins in the IOS group (17.5% vs 7.0%). The trial reported no differences in most procedural outcomes or satisfaction, though the IOS group had less postoperative bleeding intensity and shorter bleeding duration at 14-day follow-up. The authors concluded that LEEP with IOS should not be used routinely in clinical practice based on these findings.

Relevant to:Gynecology & ObstetricsPatients undergoing colposcopy-directed excisional treatment for cervical dysplasia.

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ResearchSource: American Journal of Obstetrics and GynecologyOct 24, 2026

Trial finds IVF outperforms surgery for endometriosis-related infertility

A partially randomized patient preference trial across three Italian centers compared IVF with surgery in infertile women with ultrasound-diagnosed ovarian and deep infiltrating endometriosis who had no prior surgery or IVF. The trial was stopped early after 130 enrollments due to investigators' increasing awareness of markedly higher success with IVF; live birth rates were 57% vs 26% in the randomized cohort and 64% vs 28% in the preference cohort, with a combined relative risk of 2.29 (95% CI 1.41-3.70) favoring IVF. The authors conclude that in this trial, IVF was more effective than surgery for treating infertility in this population.

Relevant to:Gynecology & ObstetricsInfertile women under 40 with ultrasound-diagnosed ovarian endometriomas or deep infiltrating endometriosis who have not previously undergone endometriosis surgery or IVF.

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