Open research questions in Gynecological conditions and treatments

What the literature leaves open

• 1 Your support1 of our findings urging further research on the value of ultrasound guidance during surgery is appreciated.

  Further consideration of long‐term outcomes, utilization decisions, and surgical technique could inform clinical guidelines for ultrasound guided uterine evacuation · 2026 · DOI

• We are unsure of the authors' interpretation of this study, as solid conclusions could not be drawn due to insufficient information on previous dilatation and curettage (D&C) or multiple procedures, which are a known risk factor for adhesion formation.

  Further consideration of long‐term outcomes, utilization decisions, and surgical technique could inform clinical guidelines for ultrasound guided uterine evacuation · 2026 · DOI

• Background: Despite its widespread use in women with reproductive disorders, no standardised framework currently exists for reporting of hysteroscopic findings.

  Structured Reporting of Diagnostic Hysteroscopy Findings in Women with Reproductive Disorders: An ESGE–ESHRE–IFFS International Consensus · 2026 · DOI

• It is commonly underrecognized and may be mistaken for anatomical abnormalities such as vesicovaginal fistula or obstructive hydrocolpos, which require surgical intervention.

  Vesicovaginal reflux: a case report and literature overview · 2026 · DOI

• Thrombospondin-1 (THBS1), a matricellular protein linked to fibrotic disorders, has not been extensively studied in IUA.

  Stem cell therapy targets THBS1 to reverse endometrial fibrosis · 2026 · DOI

• This study provided reference values for healthy, fertile conditions and could inform further investigation of alterations due to disorders or intervention strategies.

  Objective and comprehensive characterization of uterine peristaltic activity throughout the menstrual cycle by means of intracavitary electrohysterography, a cohort study · 2025 · DOI

• Surgical treatment for other types of CUAs is not usually recommended as the risks outweigh potential benefits, and evidence for any benefits is lacking.

  Reproductive Implications and Management of Congenital Uterine Anomalies (2024 Second Edition) · 2025 · DOI

• However, women should be informed that there is inconclusive and conflicting evidence regarding the improved likelihood of live births in this context.

  Reproductive Implications and Management of Congenital Uterine Anomalies (2024 Second Edition) · 2025 · DOI

• CONCLUSIONS: Women with MRKH syndrome are often inadequately explored for associated malformations.

  Optimizing care for MRKH patients: From malformation screening to uterus transplantation eligibility · 2024 · DOI

• Having MRKH syndrome can have a profound and multifaceted psychosocial impact that characterizes these women's subjective experiences, although it continues to be qualitatively understudied.

  Illness experience and (unmet) needs of women with Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH): a qualitative analysis of an online forum · 2024 · DOI

• Till date, no studies have reported the outcome of patients with endometrial hyperplasia treated using early-follicular long (EL) protocol and midluteal long (ML) protocol.

  Pregnancy outcomes in infertile patients with endometrial hyperplasia with or without atypia undergoing in vitro fertilization: the early-follicular long protocol is superior to midluteal long protocol · 2024 · DOI

• INTRODUCTION: Intrauterine adhesions (IUA) manifest as endometrial fibrosis, often causing infertility or recurrent miscarriage; however, their pathogenesis remains unclear.

  DKK1 loss promotes endometrial fibrosis via autophagy and exosome-mediated macrophage-to-myofibroblast transition · 2024 · DOI

• Larger randomized controlled trials are needed to confirm the effectiveness of intrauterine PRP.

  Commentary: Regenerative therapies for refractory thin endometrium in in vitro fertilization · 2026 · DOI

• There is a need for non-ablative treatment options for symptomatic cervical ectopy. The existing evidence on non-ablative treatments is limited. The study aims to address this gap by evaluating the effectiveness of vaginal hyaluronic acid therapy.

  Clinical changes in symptomatic cervical ectopy following vaginal hyaluronic acid therapy · 2026 · DOI

• Author contributions This study presents one of the largest reported case series of giant EPs in postmenopausal women without hormonal exposure, compris- ing fifteen well-documented cases including one from our institution and fourteen identified through a systematic literature review. However, some limitations should be acknowledged. First, the sample size remains small because of the rarity of giant EPs in this population. Second, variability in the quality and completeness of reporting across published cases may introduce information bias. Despite these limita- tions, this series provides valuable insights into the clinical behavior and optimal management of giant EPs in postmenopausal women, supporting their generally benign nature while underscoring the need for complete excision and pathological evaluation.

  Giant endometrial polyp in postmenopausal women without hormonal exposure: a case report and literature review · 2026 · DOI

• There is a need to improve the diagnosis and treatment of primary infertility. The current methods of hysterosalpingography may not provide accurate results or may cause discomfort to patients.

  PENATALAKSANAAN PEMERIKSAAN HYSTEROSALPINGOGRAPHY (HSG) PADA KLINIS INFERTILITAS PRIMER DI INSTALASI RADIOLOGI RSU ‘AISYIYAH PONOROGO · 2026 · DOI

• Surgical management of complex septate uteri with associated cervical and vaginal anomalies remains challenging. There is a need for accurate preoperative assessment and tailored surgical planning. The study aims to address this gap by evaluating the effectiveness of a standardized hysteroscopic approach.

  Surgical and Reproductive Outcomes of a Standardized Hysteroscopic Approach to Treat Septate Uterus and Associated Complex Anomalies · 2026 · DOI

• The condition of the entire endometrium is not always reflected by atypia identified within a polyp. There is a need for optimal management of atypical endometrial polyps.

  Hyperplastic Endometrial Polyp with Architectural and Cytological Atypia: Clinical Case and Literature Review · 2026 · DOI

• Cervical insufficiency is a significant factor in recurrent miscarriage and adverse obstetric outcomes. Hysteroscopic adhesiolysis for intrauterine adhesions is a treatment for cervical insufficiency, but the optimal cerclage procedure is unclear.

  Comparative study on the clinical efficacy of laparoscopic cervicoisthmic cerclage and transvaginal cervical cerclage in the treatment of cervical insufficiency after hysteroscopic adhesiolysis for intrauterine adhesions: a retrospective cohort study · 2026 · DOI

• There is a lack of studies comparing the clinical efficacy of laparoscopic cervicoisthmic cerclage and transvaginal cervical cerclage in treating cervical insufficiency after hysteroscopic adhesiolysis for intrauterine adhesions.

  Comparative study on the clinical efficacy of laparoscopic cervicoisthmic cerclage and transvaginal cervical cerclage in the treatment of cervical insufficiency after hysteroscopic adhesiolysis for intrauterine adhesions: a retrospective cohort study · 2026 · DOI

• There is a need for a reliable and effective tool for evaluating postmenopausal bleeding. The study aims to address the gap in the current literature by assessing the effectiveness of diagnostic hysteroscopy in evaluating postmenopausal bleeding.

  Assessment of Postmenopausal Bleeding Using Diagnostic Hysteroscopy · 2026 · DOI

• This study was conducted with a relatively small sample size of 50 patients from a single tertiary care hospital, which may limit the generalizability of the findings to the wider population. Being a crosssectional study, it also provides only a the diagnostic correlation snapshot of without long-term follow-up. In addition, purposive introduce sampling may selection bias and the results depend on operator expertise in performing and interpreting hysteroscopy.

  Assessment of Postmenopausal Bleeding Using Diagnostic Hysteroscopy · 2026 · DOI

• The available evidence is limited to small case series and case reports. No single method has demonstrated clear superiority in preventing recurrence.

  Recurrent Ovarian Torsion in a Premenarchal Girl Managed With Laparoscopic Round Ligament Oophoropexy: A Case Report · 2026 · DOI

• There are no clear guidelines regarding the optimal timing or surgical technique for ovarian fixation. The available evidence is limited to small case series and case reports.

  Recurrent Ovarian Torsion in a Premenarchal Girl Managed With Laparoscopic Round Ligament Oophoropexy: A Case Report · 2026 · DOI

• Future research should investigate the role of candidate genes in endometrial responses associated with benign uterine pathology, - Future research should explore targeted interventions based on the importance of immune and stress-related signaling in the pathogenesis of UFs and EPs

  Comparative transcriptomic analysis of endometrial tissue associated with uterine fibroids and endometrial polyps · 2026 · DOI

Most-cited papers in Gynecological conditions and treatments

• The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions · Fertility and Sterility · 1988 · 1,544 citations
• The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies · Human Reproduction · 2013 · 727 citations
• Asherman syndrome—one century later · Fertility and Sterility · 2008 · 721 citations
• A vaginal fluid simulant · Contraception · 1999 · 640 citations
• The septate uterus: a review of management and reproductive outcome · Fertility and Sterility · 2000 · 552 citations
• The B‐Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported · BJOG An International Journal of Obstetrics & Gynaecology · 1997 · 547 citations
• Reproductive impact of congenital Mullerian anomalies · Human Reproduction · 1997 · 538 citations
• Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification · Human Reproduction · 2003 · 489 citations
• Uterine contractions at the time of embryo transfer alter pregnancy rates after in-vitro fertilization · Human Reproduction · 1998 · 429 citations
• Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study · Fertility and Sterility · 1996 · 377 citations

Most recent work

• Catheter-Directed Sclerotherapy Versus Ovarian Cystectomy for Unilateral Ovarian Endometrioma: A Pilot Randomized Controlled Trial · American Journal of Roentgenology · 2026
• Radical Hysterectomy: A Focus on Querleu–Morrow Type B · Annals of Surgical Oncology · 2026
• Clinical embryology in the United States: current landscape and considerations for professional development and standardization · Fertility and Sterility · 2026
• Structured Reporting of Diagnostic Hysteroscopy Findings in Women with Reproductive Disorders: An ESGE–ESHRE–IFFS International Consensus · Facts Views and Vision in ObGyn · 2026
• Vesicovaginal reflux: a case report and literature overview · Frontiers in Pediatrics · 2026
• Stem cell therapy targets THBS1 to reverse endometrial fibrosis · Frontiers in Cell and Developmental Biology · 2026
• Commentary: Regenerative therapies for refractory thin endometrium in in vitro fertilization · Frontiers in Cell and Developmental Biology · 2026
• Unraveling the fibrotic microenvironment in intrauterine adhesions through integrated metabolomics and proteomics · BMC Women's Health · 2026
• Clinical changes in symptomatic cervical ectopy following vaginal hyaluronic acid therapy · Frontiers in Medicine · 2026
• Giant endometrial polyp in postmenopausal women without hormonal exposure: a case report and literature review · Frontiers in Medicine · 2026

Related topics in Medicine