Addressing anti-syncytin antibody levels, and fertility and breastfeeding concerns, following BNT162B2 COVID-19 mRNA vaccination

ObjectiveTo determine whether antibodies against the SARS-CoV-2 spike protein following BNT162B2 (Pfizer-BioNTech) COVID-19 mRNA vaccination cross-react with human syncytin-1 protein, and if BNT162B2 mRNA enters breast milk. MethodsIn this observational cohort study of female front-line workers with no history of COVID-19 infection, we amplified BNT162B2 mRNA in plasma and breast milk and assayed anti-SARS-CoV-2 neutralising antibodies and anti-human syncytin-1 binding antibodies in plasma, at early (1-4 days) and late (4-7 weeks) time points following first-dose vaccination. ResultsFifteen consented participants (mean age 40.4 years, various ethnicities) who received at least one dose of BNT162B2, including five breast-feeding women and two women who were inadvertently vaccinated in early pregnancy, were recruited. BNT162B2 mRNA, detected by amplifying part of the spike-encoding region, was detected in plasma 1-4 days following the first dose (n=13), but not 4-5 weeks later (n=2), nor was the mRNA isolated from aqueous or lipid breast milk fractions collected 0-7 days post-vaccination (n=5). Vaccine recipients demonstrated strong SARS-CoV-2 neutralising activity by at least four weeks after the first dose (n=15), including the two pregnant women. None had placental anti-syncytin-1 binding antibodies at either time-point following vaccination. ConclusionsBNT162B2-vaccinated women did not transmit vaccine mRNA to breast milk, and did not produce a concurrent humoral response to syncytin-1, suggesting that cross-reactivity to syncytin-1 on the developing trophoblast, or other adverse effects in the breast-fed infant from vaccine mRNA ingestion, are unlikely. What are the novel findings of this work?COVID-19 vaccination with BNT162B2 did not elicit a cross-reacting humoral response to human syncytin-1 despite robust neutralising activity to the SARS-CoV2 spike protein, and while vaccine mRNA was isolated from plasma, it was not found in breast milk. What are the clinical implications of this work?Our work directly addresses the fertility and breastfeeding concerns fuelling vaccine hesitancy among reproductive-age women, by suggesting that BNT162B2 vaccination is unlikely to cause adverse effects on the developing trophoblast, via cross-reacting anti-syncytin-1 antibodies, or to the breastfed neonate, via mRNA breast milk transmission.

Menopause, hormone therapy and cardiovascular and cerebrovascular disease

<p><b>INTRODUCTION</b>Cardiovascular disease is the leading cause of death and morbidity among postmenopausal women, and oestrogen deficiency may be an important factor in its development. The role of oestrogen replacement in preventing cardiovascular disease is controversial. The aim of this descriptive review is to analyse the available data and to recommend evidence-based practice guidelines pertaining to hormone therapy in the context of cardiovascular and cerebrovascular health.</p><p><b>MATERIALS AND METHODS</b>Relevant clinical trials were identified by computerised literature search. The collated data were presented to fellow gynaecologists for review, analysis of results and discussion in a series of meetings dedicated to finding the best evidence in menopause management. The evidence was used to formulate clinical practice guidelines for the management of women with significant cardiovascular risk factors.</p><p><b>RESULTS</b>Evidence from animal studies and observational trials supported a cardio-protective effect of postmenopausal hormone therapy. More recent randomised clinical trial data have shown no significant reduction of coronary heart disease, and have confirmed a higher incidence of stroke and venous thromboembolism.</p><p><b>CONCLUSIONS</b>The evidence is widely divergent regarding postmenopausal hormone therapy and cardiovascular risk. More consistent data are available reporting an increased risk in the incidence of venous thromboembolism and stroke. It is important to be clear about the indications of hormone use and to utilise alternative modalities to promote cardiovascular health in the postmenopausal population.</p>

An unexpected presentation of endometriosis--a "parasitic" cyst of the bowel in a menopausal woman on hormone therapy

<p><b>INTRODUCTION</b>This report describes a "parasitic" endometriotic cyst of the small bowel.</p><p><b>CLINICAL PICTURE</b>A menopausal woman with a pelvic mass presenting years after commencing hormone therapy.</p><p><b>TREATMENT</b>We performed laparoscopic excision of a cystic tumour attached to the small bowel with a solitary vascular pedicle.</p><p><b>OUTCOME</b>Histology confirmed it to be an endometriotic cyst of ovarian origin, probably resulting from spillage during previous surgery and reactivation with hormone therapy.</p><p><b>CONCLUSIONS</b>We discuss the possible aetiology of this unusual presentation of endometriosis and review the literature on parasitic gynaecological tumours.</p>

Care of women in menopause: sexual function, dysfunction and therapeutic modalities

<p><b>INTRODUCTION</b>The physiological changes that occur in menopause alter sexual function and affect well-being. Hormonal changes contribute significantly to reduced sexual function in older women and sexual dysfunction may well be amenable to treatment with exogenous hormones or other agents.</p><p><b>MATERIALS AND METHODS</b>Relevant clinical studies were identified by a computerised literature search. The collated data were presented to fellow gynaecologists for review, analysis of results and discussion in a series of meetings dedicated to finding the best evidence in menopause management. The evidence was assessed and used to prepare guidelines around the management of women who are affected by sexual dysfunction in menopause.</p><p><b>RESULTS</b>Hormone therapy benefits many women who have dyspareunia related to vaginal atrophy, reduced libido and decreased satisfaction, particularly if these symptoms adversely affect their quality of life. Alternative agents such as tibolone and sildenafil citrate can be useful adjuncts.</p><p><b>CONCLUSIONS</b>It is increasingly important to recognise postmenopausal sexual dysfunction. Treatment of this syndrome must be individualised to the specific complaints of each woman. Hormones and other agents are relevant treatment options for properly-selected women.</p>