Uterine fibroid embolization is generally considered a standard treatment option for uterine fibroids. Thromboembolic complications, such as stroke, have been reported, but the incidence is rare. A 41-year-old woman presented with refractory menorrhagia due to a uterine fibroid and underwent uterine fibroid embolization via transradial access. On the second day after uterine fibroid embolization, she developed acute neurological deficits, including left-sided weakness, blurred vision, and ataxia. Magnetic resonance imaging revealed multiple posterior circulation infarcts without large vessel occlusion. Extensive workup, including echocardiography and telemetry, ruled out cardioembolic sources or arrhythmias. She was managed with therapeutic anticoagulation, neuroprotective agents, and physiotherapy, and had complete visual and neurological recovery at 6-month. This case illustrates a rare complication of uterine fibroid embolization and highlights the importance of awareness and detailed pre-operative counseling regarding this complication.

Intravenous leiomyomatosis (IVL) is a rare benign ovarian tumor that predominantly affects women of reproductive and perimenopausal age, and is often accompanied by uterine fibroids. Patients typically present with symptoms such as menorrhagia, anemia, dysmenorrhea, abdominal pain or a palpable abdominal mass. In its early stages, the clinical manifestations of this disease are highly nonspecific and lack typical features, leading to a high rate of underdiagnosis or misdiagnosis in clinical practice. IVL is classified as a borderline tumor due to its histologically benign characteristics but biologically malignant behaviors, such as vascular invasion and distant spread. When the lesion extends to involve the inferior vena cava or even the heart, recurrent syncope may become the predominant clinical manifestation. With disease progression, sudden cardiac arrest of a fatal type may occur. Surgical resection remains the primary treatment for this condition. Given its high recurrence rate, post-operative follow-up should be conducted in a manner similar to that for malignant tumors, with regular imaging surveillance. To enhance clinical awareness of IVL, the present study describes a case of IVL in a patient whose chief complaint was increased menstrual flow, an atypical presentation. By reviewing the current case, practical insights may be provided into the diagnosis and management of IVL.

Pulsed field ablation (PFA) is an emerging modality for atrial fibrillation management, offering rapid pulmonary vein isolation and the possibility of the left atrial posterior wall ablation. Combining PFA with left atrial appendage occlusion (LAAO) represents a holistic strategy for managing heart rhythm abnormalities and minimizing stroke risk, particularly in patients with high thromboembolic and bleeding risks.

Female reproductive disorders influence women's physical and mental well-being, and the sustainability of the family. However, it is unclear whether lifestyle factors, including sedentary behaviors and physical activity, could impact them. Here, we performed sex-stratified genome-wide association studies of 5 lifestyle factors in European participants from UK Biobank, including self-reported leisure screen time (LST), sedentary behaviors at work and during commuting, time spent in driving, and daily physical activity. We identified 18 novel sex-stratified variants associated with these exposures and showed that LST was more heritable in women (8.6%) than in men (6.9%). Mendelian randomization (MR) analyses using women-related instruments on 4 female reproductive outcomes demonstrated that per 1-h longer LST a day was robustly associated with elevated risks of menorrhagia (odds ratio [OR] = 1.31, 95% confidence interval [CI] = 1.10 to 1.55), endometriosis (OR = 1.34, 95% CI = 1.11 to 1.60), polycystic ovarian syndrome (OR = 3.05, 95% CI = 1.65 to 5.65), and ectopic pregnancy (OR = 1.35, 95% CI = 1.11 to 1.65), while little evidence was found for sedentary behaviors at work or during commuting. Mediation MR showed that the associations with these outcomes were independent from body mass index, except polycystic ovarian syndrome. Nonlinear MR suggested that LST ≥4 h/day was robustly associated with increased risks of endometriosis and menorrhagia. The findings were independently validated using additional genetic data from the European population and survey data from the National Health and Nutrition Examination Survey. In summary, a simple and actionable lifestyle modification, sitting less, is likely to have independently beneficial influences on multiple reproductive disorders.

Endometriosis is a complex gynecological condition affecting nearly 10% of reproductive-aged women. This report updates a 2017 MSMR report of gynecological conditions, including endometriosis, from 2012 through 2016 among U.S. active component service women. The current report utilized medical encounter data from 2017 through 2024 to assess the incidence of endometriosis and its health care burden among U.S. active component service women. Factors related to co-occurring gynecological conditions, deployment, parity, and contraceptive use were also examined. Crude incidence rates and incidence rate ratios with 95% confidence intervals were calculated. The overall crude rate of endometriosis was 32.8 cases per 10,000 person-years and increased approximately 42.0% from 2017 to 2024. Incidence rates increased with age and were higher among nulliparous and never-deployed service women. Additionally, obese and underweight service women had higher incidence rates. Menorrhagia was the most common co-occurring condition, with oral birth control the most common form of contraceptive among incident cases. Identification of at-risk service women may help formulate targeted policies for earlier diagnosis to improve both quality of life and military readiness. Incidence of endometriosis increased during the surveillance period, from 28.7 cases per 10,000 person-years in 2017 to 40.7 cases per 10,000 person-years in 2024, coincident with a general increase of medical encounters for endometriosis, from 2,740 medical encounters in 2017 to 3,864 medical encounters in 2024. Service women who were older, obese or underweight, nulliparous, and never deployed had higher incidence rates.

Endometrial stromal sarcoma is a rare malignancy that can be difficult to diagnose due to its nonspecific presentation. Unfortunately, the presenting symptoms of abnormal uterine bleeding (AUB), anemia, and pelvic pain overlap with symptoms of benign uterine fibroids, which can delay diagnosis. Additionally, initial evaluations with imaging or even a negative endometrial biopsy may provide false reassurance. Due to novelty, mimicry of benign uterine processes, and high false-negative endometrial biopsy rates, this malignancy is often diagnosed at advanced stages. In this case vignette, we describe a case of metastatic high-grade endometrial stromal sarcoma (HG-ESS) presenting with menorrhagia, pulmonary embolism, and recurrent pneumothoraces in a 42-year-old G1P1 woman.