Abstract As anomalias Müllerianas têm uma baixa prevalência na população geral, mas um impacto marcado nos desfechos reprodutivos. O septo uterino é a malformação mais frequente, no entanto, mantém-se a ausência de consenso das sociedades médicas internacionais quanto aos critérios diagnósticos e orientação clínica. Embora menos frequente, a agenesia da vagina interfere de forma significativa na identidade feminina. Independentemente da técnica de neovaginoplastia escolhida, é fulcral tentar normalizar a função sexual.

Resumo Müllerian anomalies have a low prevalence in the general population, but a marked impact on reproductive outcomes. The uterine septum is the most common malformation, however, there remains a lack of consensus from international medical societies regarding diagnostic criteria and clinical guidance. Although less common, vaginal agenesis significantly interferes with female identity. Regardless of the neovaginoplasty technique chosen, it is essential to try to normalize sexual function.

Abstract Objective Pain is the primary limitation to performing hysteroscopy. We aimed to evaluate the predictive factors of low tolerance to office hysteroscopic procedures. Methods Retrospective cohort study of the patients who underwent office hysteroscopy from January 2018 to December 2020 at a tertiary care center. Pain tolerance to office-based hysteroscopy was subjectively assessed by the operator as terrible, poor, moderate, good, or excellent. Categorical variables were compared with the use of the Chi-squared test; an independent-samples t-test was conducted to compare continuous variables. Logistic regression was performed to determine the main factors associated with low procedure tolerance. Results A total of 1,418 office hysteroscopies were performed. The mean age of the patients was 53 ± 13.8 years; 50.8% of women were menopausal, 17.8% were nulliparous, and 68.7% had a previous vaginal delivery. A total of 42.6% of women were submitted to an operative hysteroscopy. Tolerance was categorized as terrible or poor in 14.9% of hysteroscopies and moderate, good, or excellent in 85.1%. A terrible or poor tolerance was more frequently reported in menopausal women (18.1% vs. 11.7% in premenopausal women, p = 0.001) and women with no previous vaginal delivery (18.8% vs. 12.9% in women with at least one vaginal birth, p = 0.007). Low tolerance led more often to scheduling a second hysteroscopic procedure under anesthesia (56.4% vs. 17.5% in reasonable-to-excellent tolerance, p < 0.0005). Conclusion Office hysteroscopy was a well-tolerated procedure in our experience, but menopause and lack of previous vaginal delivery were associated with low tolerance. These patients are more likely to benefit from pain relief measures during office hysteroscopy.

Abstract The medical treatment of uterine fibroids is a subject of growing interest, often associated to difficult decisions, especially in women who wish to preserve fertility and the uterus. The existing treatments are only used for short or limited periods, due to the evidence paucity on the benefits and risks of long-term use. New molecules are being tested showing improved efficacy in the management of uterine fibroids associated symptoms, especially in abnormal uterine bleeding and good safety profiles. The recent data which supports the new treatment options for symptomatic uterine fibroids, particularly in the control of abnormal uterine bleeding, are reviewed herein.

Resumo O tratamento médico dos miomas uterinos sintomáticos continua a ser um dos grandes desafios, existindo cada vez mais a preocupação da preservação anatómica e da fertilidade. Os tratamentos existentes são utilizados apenas por períodos curtos e limitados, devido à escassez de evidências sobre os benefícios e riscos do uso a longo prazo. Novas moléculas inovadoras têm sido investigadas, mostrando melhorias no controlo da hemorragia uterina anormal e perfis de segurança apropriados. Os dados recentes que suportam as novas opções de tratamento para miomas uterinos sintomáticos, particularmente no controlo da hemorragia uterina anormal, são aqui revistos e sistematizados.

Overview and aims: This article addresses the diagnosis of anemia in the context of abnormal uterine bleeding and reviews the treatment options of iron deficiency anemia. This topic was worked out as a section of the Portuguese Consensus on Abnormal Uterine Bleeding, endorsed by the Portuguese Society of Gynaecology. The working group established recommendations that provide guidance to the medical society to better decision making concerning the treatment of iron deficiency anemia. We expose here evidence based guidelines consigning the diagnosis and management of this disease. Study design and Methods: A group of experts in the field performed a thorough systematic search of the publications on the treatment of iron deficiency anemia and a quality assessment of the included papers. On this basis a proposal was drawn up and later on was discussed and approved on consensus meeting with all members of the guidelines developing group reaching the final version of the recommendations. Conclusions: The present clinical practice guidelines on treatment of iron deficiency anemia may improve the diagnosis and management of this high prevalent disease.

Objective: The aim of this study was to assess the performance and accuracy of sonovaginography (SVG) for preoperative diagnosis and characterization of deep infiltrating endometriosis (DIE) lesions. Study Design: A prospective study was conducted between January 2014 and January 2016, including all premenopausal women with clinical and/or imaging suspicion of DIE that underwent laparoscopic surgery. We performed consecutive evaluation with transvaginal ultrasound complemented by SVG of all women with clinical suspicion of DIE and assessed for suspected lesions in the anterior compartment (bladder and vesicouterine pouch), rectovaginal septum (RVS), pouch of Douglas (POD), uterosacral ligaments, vagina and rectosigmoid colon. Accuracy of SVG to identify lesions of DIE was assessed for the different sites of DIE, relative to laparoscopic and histological findings. The sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were determined. Results: Fifty nine women were evaluated by SVG and 19 (32%) underwent laparoscopic surgery. Median age was 35 years (range 26-42 years), nine women (47.4%) were nulliparous and five (26.3%) had infertility. Most common symptoms were dysmenorrhea (14/19) and deep dyspareunia (14/19). DIE was confirmed in all patients, 18/19 (94.7%) had involvement of the posterior and 3/19 (8.9%) of the anterior compartments. We found high sensitivity for the diagnosis of lesions involving the POD (92%) and RVS (90%). Our diagnostic sensitivity was lower for DIE lesions involving the anterior compartment (67%), rectosigmoid colon (50%), vagina (50%) and uterosacral ligaments (23%). Conclusions: SVG is a simple, non-invasive method with good diagnostic sensitivity for DIE lesions involving particularly RVS and POD. This technique has a relatively short learning curve for experienced operators and provides an effective alternative to other more invasive and expensive imaging techniques.