Introduction:The most appropriate and effective method of breast cancer screening is breast self-examination. The aim of this study was to determine the effect of group counseling based on reality therapy on women's selfefficacy of breast self-examination. Methods:This was an educational trial with a pretest-posttest design that was conducted in Shazand city in 2020. The study sample consisted of 30 women who were recruited from five health centers via available sampling. Participants were randomized into two groups of intervention (14 people) and control (16 people). Both groups completed personal, demographic, and selfefficacy of breast self-examination questionnaires. The intervention group received 8 sessions (two 90-min sessions per week) of group counseling based on reality therapy. One month after the intervention, both groups completed the self-efficacy of breast self-examination questionnaire again, and changes in the mean scores were examined.Results: There was no statistically significant difference between the groups in terms of demographic characteristics such as age, level of education, marital status, menstrual age, age at marriage, and gestational age. The mean score of female self-efficacy of breast self-examination before intervention was 58.9 ± 19.8 in the control group and 58.4 ± 21.2 in the intervention group (no difference). After the intervention, the mean score of female self-efficacy in breast self-examination was 59.9 ± 18.8 in the control group and 85.7 ± 9.7 in the intervention group (P < 0.05). Using analysis of covariance (ANCOVA), the effect size of counseling was calculated at 46%. Conclusion:The results of the study indicate that group counseling based on reality therapy can improve women's self-efficacy of breast self-examination. Since this approach can be achieved in a shorter time than other types of counseling, the use of this method in important health behaviors such as breast self-examination is recommended.

Abnormal vaginal bleeding is one of the complaints of women during menopause. Various diseases such as endometrial atrophy, polyps, and endometrial cancers may lead to postmenopausal vaginal bleeding. This report describes a case of postmenopausal vaginal bleeding caused by pregnancy. A 54-year-old woman referred to the prenatal clinic in Arak, Iran, with postmenopausal vaginal bleeding in 2018. Transabdominal ultrasound revealed an uterine pregnancy. At 28 weeks of gestation, she referred to the health center and her prenatal care began in the midwifery clinic. She gave birth to a baby girl at 34 weeks through a cesarian section. This case reminds practitioners and midwives that pregnancy may be one of the etiologies of postmenopausal vaginal bleeding especially in women with sexual activity. Therefore, a free beta-subunit human chorionic gonadotropin (HCG) hormone measurement should be conducted and if found to be elevated, followed by appropriate imaging tests.