Bjog-An International Journal of Obstetrics and Gynaecology最新文献

Objective: To analyse the impact of a comprehensive range of menstrual symptoms-including various physical and psychological symptoms associated with menstruation-on work productivity and quality of life (QoL).

Design: A cross-sectional study.

Settings: A menstrual cycle tracking application in Japan; current app users were recruited via in-app notification provided electronic informed consent from June to August 2022.

Population or sample: Japanese women who have experienced menarche.

Methods: Menstrual Distress Questionnaire (mMDQ) was used to determine severity of menstrual symptoms, and participants with mMDQ score ≥ 103 were grouped as severe. Work productivity was assessed using the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH), and QoL was measured using the 36-Item Short Form Survey version 2 (SF-36v2).

Main outcome measures: Differences in absenteeism, presenteeism, overall work impairment and activity impairment on the WPAI-GH between the severe and normal groups; differences in the summary scores of the SF-36v2; correlation coefficients between scores of symptom groups of the mMDQ, WPAI-GH and the summary scores of the SF-36v2.

Results: Overall, 456/1988 (23.0%) women had severe mMDQ scores (≥ 103). The median overall work impairment was 30% higher in the severe group than in the normal group. In multiple regression analysis, mMDQ severity was significantly associated with increased absenteeism, presenteeism and activity impairment, as well as reduced mental and social QoL. Negative affect, impaired concentration and behaviour change were associated with greater presenteeism, while pain showed weaker correlations. Negative affect was strongly associated with reduced mental QoL.

Conclusion: Our findings demonstrate that, in addition to pain, mental and psychosocial symptoms are significantly associated with both work productivity and QoL.

Hormone replacement therapy (HRT) remains the cornerstone of menopausal symptom management, effectively alleviating vasomotor symptoms and genitourinary syndrome, whilst mitigating long-term risks such as osteoporosis. However, despite an increasing body of evidence on the relative safety of HRT, earlier studies that demonstrated an increased cancer risk have resulted in decades of controversy and reshaped clinical practice and public perception. Concerns around HRT are heightened in cancer survivors or those with strong family histories and genetic risks, and many clinicians remain reluctant to consider HRT due to the potential for promoting cancer. Globally, around 9 million women and an estimated 60 000 women in the UK under the age of 50 are diagnosed with cancer and will receive treatment that results in iatrogenic premature or early menopause or develop hormone-related, menopause-like, side effects, even if not rendered menopausal. Improvements in oncological management have resulted in significant benefits in cancer survivorship, and importantly, an increasing focus on quality of life. This article aims to comprehensively review the evidence and provide an overview for clinicians that can help guide discussions with patients regarding HRT risks and benefits, and promote shared, informed decision making.

Objective: To explore Nigerian women's lived experiences of menopause and identify sociocultural, structural, and health-system factors shaping symptom recognition, care-seeking, and wellbeing, using in-depth qualitative inquiry.

Design: Qualitative interview study.

Setting: Urban, peri-urban, and rural communities across Nigeria.

Participants: Post-menopausal women aged 40-66 years experiencing natural, surgical, or medical menopause.

Methods: As part of the Nigerian arm of the MARIE project, semi-structured qualitative interviews were conducted with purposively sampled post-menopausal women to capture diverse menopausal stages, socioeconomic positions, and geographic contexts. Interviews were analysed using thematic analysis informed by an equity-centred, intersectional framework. Multiple researchers independently coded transcripts, with iterative discussion and triangulation to enhance analytic rigour and validity.

Results: Three interrelated themes characterised menopausal experiences in Nigeria. First, structural health-system inequalities were evident, including limited anticipatory information, inadequate clinician training, fragmented care pathways, and restricted access to hormone replacement therapy and non-hormonal treatments. Second, sociocultural and gendered norms shaped symptom interpretation and disclosure, with menopause often framed as a natural or inevitable life stage requiring endurance rather than care, compounded by stigma and silencing within families and communities. Third, women demonstrated adaptive coping and resilience, relying on peer networks, faith-based practices, and self-management strategies in the absence of formal support. Urban participants reported comparatively better access to information and services, while rural women described pronounced neglect and dependence on informal care.

Conclusions: This qualitative study provides the first in-depth, context-specific account of menopausal experiences among Nigerian women, revealing substantial inequities driven by sociocultural beliefs, economic constraints, and systemic gaps in healthcare provision. The findings underline the urgent need for culturally sensitive, equity-oriented menopause care in Nigeria, including integration into primary healthcare, improved professional training, affordable access to evidence-based treatments, and public health education to reduce stigma and unmet need.

Objective: To evaluate the analytical suitability of different storage and laboratory processes of self-samples for an HPV assay.

Design: Prospective matched study.

Setting: Royal London Hospital Colposcopy Clinic.

Population: One hundred seventy seven patients aged 25-65 years referred to colposcopy due to their screening results (abnormal cytology or recurrent HPV infection).

Methods: Each participant provided a first void urine sample (10 mL/20 mL, Collipee), two vaginal self-samples (Copan FLOQSwabs transported 'dry' and 'wet'), and a clinician-collected cervical sample. Samples were processed immediately or after 1 or 2 weeks stored at room temperature. HPV testing used BD Onclarity.

Main outcome measures: Genomic DNA Quality Score (GQS), detection of HPV, and HPV cycle threshold (Ct) values.

Results: DNA quality of dry samples was not significantly lower than wet samples when resuspended within 2 weeks (median GQS dry vs. wet: 3.35 vs. 3.41, immediately; 3.00 vs. 3.14, 1 week; 3.45 vs. 2.78, 2 weeks; all p [one-sided] > 0.05). Urine samples had lower HPV positivity compared to other sample types and had higher HPV Ct values (median 30 vs. 27 for dry/wet/clinician samples).

Conclusion: Dry self-samples from a Copan FLOQSwab taken in clinic are likely to have sufficient DNA quality and accuracy for HPV testing compared with wet self-samples and clinician-collected samples if resuspension takes place up to 2 weeks, with storage at room temperature, and using the BD Onclarity assay. Urine samples using the Colli-pee device are likely to be less sensitive for HPV detected from clinician-collected samples.

Objective: To assess temporal trends in outcomes of pregnancies with maternal or paternal type 1 diabetes compared to the general population.

Design: Register-based study.

Setting: Denmark.

Population: 1 551 893 pregnancies from 1997 to 2021, hereof 5478 with maternal and 8072 with paternal type 1 diabetes.

Methods: Crude and adjusted logistic regression analyses allowing for interaction between diabetes and time compared outcomes of pregnancies with maternal or paternal type 1 diabetes to the general population and evaluated temporal trends over a 25-year period.

Main outcome measures: Hypertensive disorders of pregnancy, caesarean delivery, preterm delivery (< 37-week gestation), very preterm delivery (< 34-week gestation), large for gestational age (LGA) (birth weight > 90th percentile) and extreme LGA (birth weight > 97.5th percentile).

Results: We observed an increasing prevalence of maternal (0.3%-0.4%) and paternal (0.5%-0.6%) diabetes during the study period. From 1997-2001 to 2017-2021, pregnancies with maternal diabetes had decreasing odds of preterm delivery (aOR 0.62, 95% CI 0.51;0.74), very preterm delivery (aOR 0.62, 95% CI 0.44;0.87) and extreme LGA (aOR 0.73, 95% CI 0.61;0.88) but remained associated with higher odds of each considered pregnancy outcome in both first and last period (aOR 3.59-18.86) compared to the general population. Pregnancies exposed to paternal diabetes were comparable to the general population.

Conclusions: Despite a decline in adverse outcomes in pregnancies with maternal type 1 diabetes over the last 25 years, the odds remain greatly increased. These findings support a predominant role of maternal diabetes management rather than parental diabetes genes for pregnancy outcomes.

Objective: To establish a better triage strategy using SOX1/PAX1 methylation detection for high-risk HPV (hrHPV)-positive women than cytology.

Design: A cohort study.

Setting: Population-based cervical cancer (CC) screening cohort.

Population: A total of 5684 women were enrolled.

Methods: SOX1/PAX1 methylation was detected by quantitative methylation-specific PCR using cytologic residue from hrHPV-positive women at baseline in a 3-year CC screening cohort. Risk stratification ability was evaluated by the immediate and cumulative cervical intraepithelial neoplasia (CIN) grade 2/3 or worse (CIN2+/3+) risks.

Main outcome measures: CIN3+ and CIN2+.

Results: At baseline, 682 hrHPV-positive women were included with 63 CIN2+ and 39 CIN3+. Over 3 years, 109 CIN2+ and 62 CIN3+ were detected. Methylation demonstrated better risk stratification than cytology among hrHPV-positive women. When compared with current practice triage strategy (Strategy A), post hoc re-triage analysis showed that methylation triage for all hrHPV-positive women (Strategy C) significantly increased sensitivity (97.44%/83.87% vs. 84.62%/64.52%, p = 0.0476/0.014), specificity (83.36%/85.00% vs. 73.41%/73.55%, p = < 0.001/< 0.001), positive predictive value (26.21%/35.86% vs. 16.18%/19.61%, p = 0.022/0.001), and negative predictive value (99.81%/98.14% vs. 98.74%/95.40%, p = 0.040/0.012) in detecting immediate and 3-year cumulative CIN3+. Similar improvements were observed for methylation triaged for HR12-positive (Strategy B) and for combined HPV and cytology primary screening (Strategy D). More importantly, all methylation-based triage strategies reduced colposcopies and postponed follow-up intervals compared to Strategy A over the 3-year period of CC screening.

Conclusion: SOX1/PAX1 methylation showed better risk stratification compared with cytology and enabled more efficient management of HPV-positive women, though external validation and head-to-head comparisons with other triage methods are needed.