Women's health (London, England)最新文献

Background: During the menopause transition, one in three women experiences abnormal uterine bleeding. Few studies have evaluated the probability of hysterectomy associated with abnormal uterine bleeding during the menopause transition.

Objectives: To estimate the risk of hysterectomy associated with abnormal uterine bleeding, specifically prolonged or heavy menstrual bleeding, during the menopause transition.

Design: Prospective cohort studyMethods:We used data collected in the Study of Women's Health Across the Nation, a community-based, longitudinal cohort that followed women from pre- to post-menopause. It includes 1200 White (45.4%), Black (15.4%), Japanese (20.8%), and Chinese (18.4%) women, from three study sites that participated in a sub-study and provided at least 1 year of prospectively recorded menstrual calendars. Calendars ascertained bleeding days, menstrual interference with life in four domains (work, daily life, sexual life, and relationships), menopausal hormone therapy, and smoking. At baseline and 12 annual follow-up visits, information on surgeries, body mass index, pelvic pain, and socio-demographic characteristics was obtained. Multivariable Cox proportional hazard models were used to assess the relationships of hysterectomy with prolonged menstrual bleeding, heavy menstrual bleeding, and covariates.

Results: Women who reported prolonged menstrual bleeding had an elevated hazard of hysterectomy (hazard ratio = 2.35, 95% confidence interval = 1.20-4.61), adjusting for pelvic pain, hormone use, and race/ethnicity; hazard ratios were attenuated after adjusting for life interference. The association of heavy menstrual bleeding with hysterectomy was not statistically significant (hazard ratio = 1.34, 95% confidence interval = 0.42-4.30). The adjusted hazard ratio for hysterectomy increased 1.5-fold for each domain in which bleeding interfered with a woman's life. Pelvic pain, hormone therapy, and Black race were also significant predictors of hysterectomy risk.

Conclusion: Prolonged menstrual bleeding during the menopause transition, particularly when accompanied by interference in one or more domains of a woman's life, increased the risk of hysterectomy. Counseling women about non-surgical therapeutic options, and estimating the proximity of menopause, may mitigate against this increased risk.

Background: Research suggests that women with polycystic ovary syndrome (PCOS) are more likely to suffer from mental health disorders, emotional distress, and have altered hormone profiles (e.g., higher androgens). Past research suggests facial emotion processing is affected by hormones (e.g., androgens), mental health-related disorders, and may be altered in PCOS.

Objectives: The present study examined whether facial emotion recognition (FER) differs between women with and without PCOS symptoms.

Design: Observational case-control design.

Methods: Three groups of participants (women with provisional PCOS, women without PCOS, and men; N = 178) completed a FER task that involved identifying emotions (anger, disgust, fear, happiness, sadness, surprise, or neutral) in images of emotional faces. Overall emotion recognition and emotion-specific accuracy were examined. PCOS symptom severity and provisional diagnoses were also assessed in women via self-report measures, including the polycystic ovary syndrome questionnaire.

Results: Women with provisional PCOS had significantly lower emotion recognition accuracy than those without PCOS, and emotion-specific differences were found for fear and disgust. A significant linear effect also emerged for overall FER, revealing men as the least accurate, followed by women with provisional PCOS, and then women without PCOS.

Conclusions: The results suggest that women with PCOS may have difficulty with emotion recognition, especially fear and disgust. The sex difference in emotion recognition was in line with previous research. These findings are consistent with the theory that androgens affect emotion recognition and suggest implications for PCOS symptoms on women's emotional well-being and socioemotional functioning.

Background: Uterine fibroids (UFs) are the most common benign tumours of the uterus and are often asymptomatic. However, there is a high incidence of symptomatic fibroids among Black women, with many presenting late for treatment.

Objective: We examined the patterns and risk factors associated with the late presentation of UF in Black women.

Designs: Mixed methods study design: A quantitative and qualitative approach.

Methods: An interviewer-administered questionnaire was used to obtain information about the late presentation of UF from 138 women at the Gynaecology clinic of the University College Hospital, Ibadan, Nigeria. For the qualitative component, in-depth interviews were conducted with eight women experiencing symptomatic fibroids. The odds of late presentation were analysed across socio-demographic, obstetrics and clinical characteristics, along with the type of diagnosis, using logistic regression with a statistical significance level set at p < 0.05. Qualitative data were examined through an inductive thematic analysis, focusing on emerging themes.

Results: The mean age of participants was 36.80± 7.24 years, with a significant proportion (62.3%) presenting late, more than 6 months after the onset of symptoms and 65.1% having multiple UFs. Factors associated with late presentation included age (AOR = 4.000; 95% CI 0.086-0.0730), parity (AOR = 3.299; 95% CI 1.150-9.464) and presenting with subfertility or infertility (AOR = 0.070; 95% CI 0.020-0.249). The qualitative findings highlighted how situational factors such as inadequate knowledge of the condition, aversion to surgery, negligence, cultural misconception and financial constraints contributed to late presentation.

Conclusion: A significant number of women, particularly older and nulliparous individuals, sought care late for symptomatic UFs. Increased sensitization and targeted educational interventions are needed to encourage early presentation and timely treatment. Implementing effective health strategies that address the reasons for late presentations will improve health outcomes for women with symptomatic fibroids.

Background: Women with disabilities have a similar desire for pregnancy as their non-disabled peers but experience more ambivalence and doubt about their intention to have a child. While many have healthy pregnancies, they face higher risks and trade-offs in health, function, and independence.

Objectives: To review the literature on pregnancy in women with physical disabilities to guide interventions and clinical care guidelines.

Eligibility criteria: Abstracts were reviewed if they were original research on pregnancy involving adult women with physical disabilities. Both qualitative and quantitative studies were included, with no restrictions on language or publication year.

Sources of evidence: PubMed, Scopus, and CINAHL Complete and reference lists of eligible articles.

Charting methods: Abstracts were eligible for full-text review if they were (1) original research, (2) in humans, (3) about pregnancy, and (4) involved adult women with physical disabilities. Data were extracted by independent reviewers using Covidence software and assessed with a customized critical appraisal guide.

Results: Five major topics characterized 171 reviewed articles: (1) rates of pregnancy, fertility, and termination or loss; (2) pregnancy complications and infant outcomes; (3) effects of pregnancy on physical function disease activity; (4) maternal care; and (5) social and interpersonal dimensions of pregnancy. Most studies were conducted in the Americas and Europe, and high-income countries used a quantitative design and were assessed to have a moderate risk of bias.

Conclusions: This review highlights the need for future research to (1) build a stronger evidence base for tailored maternal care, (2) examine disability discrimination's impact on pregnancy outcomes, (3) develop interventions to reduce disability-related inequities, and (4) improve disability competence among maternal care providers.

Background: Black women, relative to their Black male and White counterparts, may be more prone to experiencing racism and sexism in academic and other professional settings due to the "double jeopardy" or stigma of being both Black and a woman. Few studies have quantitatively studied how Black women in academic and professional spaces may mitigate the oppressive circumstances experienced by engaging in a coping strategy called identity shifting.

Objectives: This study used an intersectional framework to investigate the relationships between the strong Black woman (SBW) stereotype, gendered racial identity centrality (GRIC), identity shifting, and mental health outcomes among 289 Black women (M_age = 29.46 years, SD = 10.74). It was hypothesized that there was a significant positive relationship between endorsement of the SBW schema, GRIC, and identity shifting. Additionally, we hypothesized the relationship between SBW and identity shifting is moderated by mental health such that more (a) depressive (b) and anxiety symptoms will result in a stronger relationship between stereotype endorsement and identity shifting strategies.

Design: This study employed a quantitative, cross-sectional design using data collected in 2019 and 2020 from a larger validation study.

Methods: Participants were recruited through emails, campus flyers, text messages, and social media postings. After providing informed consent, participants completed a 30- to 40-min online survey via Qualtrics.

Results: There was partial support for the first hypothesis. While greater endorsement of the SBW stereotype by Black women did result in engagement with more identity shifting strategies, the relationship between these strategies and GRIC was not significant. The second hypothesis was not supported as mental health variables did not moderate the relationship between SBW and identity shifting.

Conclusion: The importance of examining the gendered racial experiences of Black women is discussed, along with the importance of addressing SBW and identity shifting in academia and in professional workspaces.

Background: Limited emergency contraception (EC) use contributes to unintended pregnancies and health risks among adolescents and young adults in conflict-affected regions. In Northern Uganda's post-conflict setting, there is a need for research on EC utilization among adolescents and young adults.

Objective: We assessed emergency contraceptive utilization and associated factors among adolescents and young adults in Gulu East Division, Northern Uganda, following 25 years of post-conflict recovery.

Methods: A community-based cross-sectional study was conducted among 400 adolescents and young adults in Gulu East Division using self-administered questionnaires. Data analysis involved descriptive statistics and logistic regression using STATA (StataCorp LLC) to identify factors associated with EC utilization.

Results: Among 400 participants, 322 (80.5%) were aware of EC, but only 173 (43.3%) utilized it. Correlation analysis revealed negative correlations between age and employment status and living arrangement, and a positive correlation between education level and marital status. Multivariate analysis showed that EC utilization was significantly associated with age, education level, employment status, living arrangement, and EC service offer. Women aged 14-19 years and those not offered EC services were less likely to use EC (adjusted odds ratio (aOR) = 0.47), while women with secondary education (aOR = 3.05), employed women (aOR = 2.76), and those living alone (aOR = 9.76) were more likely to use EC.

Conclusion: There is a gap between awareness and utilization of EC among adolescents and young adults in Gulu East Division. Targeted interventions are needed for adolescents and those with limited access to EC services to increase utilization and prevent unintended pregnancies.

Background: Although the survival rate has increased among women with breast cancer, many women experience psychological sequelae, including stress, which affects their quality of life. Healthy lifestyle behaviors are essential for reducing stress in breast cancer survivors and minimizing long-term treatment complications.

Objective: This study examined the temporal relationships among health-promoting lifestyle behaviors (HPLBs) and perceived stress in women with early-stage breast cancer.

Design: This research was a secondary analysis of a longitudinal biobehavioral study of women with early-stage breast cancer funded by the National Institute of Nursing Research.

Methods: This study included a sample of 73 participants. Measures of the study were evaluated at five-time points beginning just before the initiation of chemotherapy until 24 months from the first chemotherapy treatment. General linear mixed models and regression were used for analysis.

Results: Study results showed an inverse association among the health-promoting lifestyle profile (HPLP) with perceived stress (p = <0.0001). The health-promoting lifestyle subscales with the highest means were interpersonal relationships and spiritual growth. In addition, the results demonstrated changes in perceived stress levels from baseline assessment until 24 months from the initial chemotherapy treatment.

Conclusions: This study indicated that HPLBs, selected demographics, and clinical factors have a role in the perception of stress among women with early-stage breast cancer. Future studies, with larger samples, are needed to confirm these findings.

Background: Postpartum women worldwide, despite wishing to delay or avoid pregnancies, often resume sexual activity without family planning, contributing to 121 million unintended pregnancies annually, particularly in sub-Saharan Africa. Postpartum family planning (PPFP) can prevent 71% of unintended pregnancies and reduce maternal and neonatal morbidity and mortality. However, uptake in Uganda is low, at 35%, and data on its use are scarce. Sociocultural barriers, limited access to quality healthcare, and systemic inequities further hinder uptake.

Objective: To assess the level of utilization of PPFP and the contributing factors among postpartum women attending health facilities in a rural district of Northern Uganda.

Methods: A descriptive cross-sectional study was conducted among 483 women within 12-month postpartum, recruited from 5 randomly selected health facilities between October and November 2022. Quantitative data were collected using interviewer-administered questionnaires. Data were analyzed using STATA version 17.0, with descriptive statistics and multivariate logistic regression performed at a 95% confidence interval (CI) to identify predictors of PPFP utilization.

Results: The utilization of PPFP was 41.61% (95% CI: 37.17-46.15). Independent predictors or contributing factors to PPFP utilization included education level (primary-adjusted prevalence ratio (APR): 0.753; 95% CI: 0.641-0.883; p = <0.001), partner's age (APR: 1.203; 95% CI: 1.004-1.443; p = 0.05), parity (APR: 0.755; 95% CI: 0.635-0.897; p = 0.001), uncertainty about timing for next pregnancy (APR: 1.994; 95% CI: 1.09-3.646; p = 0.03), and advice from friends about PPFP methods (APR: 1.358; 95% CI: 1.171-1.575; p = <0.001).

Background: Human immunodeficiency virus (HIV) remains one of the biggest health challenges facing the world, with approximately 39 million people reported to be living with the virus. Despite low prevalence rates in the Middle East and North Africa region, Jordan faces a growing trend of new infections driven by factors such as refugees, migration, and socioeconomic status. Premarital examination is a requirement for Jordanian couples to get married and would play a role in sexually transmitted disease (STD) awareness and prevention, including HIV.

Objectives: The purpose of this research is to assess the impact of premarital examinations on HIV knowledge, attitudes, and stigma in ever-married women aged 15-49 in Jordan.

Design: Cross-sectional design.

Methods: Data were retrieved from the most recent Jordan Population and Family Health Survey, a nationally representative survey of health dynamics. Premarital examinations and comprehensive HIV knowledge were assessed by survey modules covering history of premarital examination and tests performed and respondents' understanding of HIV transmission and prevention. Participants were categorized based on their responses to five key statements about HIV/AIDS.

Results: In this study, there were 14,689 respondents. The mean age (±SD) of the participants was 34.5 (±8.5) years. Most of them (92%) were currently married. More than half of the respondents underwent premarital medical checkups. However, discriminatory attitudes toward people living with HIV were high among respondents. Only 8.7% of the respondents showed adequate comprehensive HIV knowledge; their level of understanding regarding modes of transmission and misconceptions about prevention also varied. The adjusted model showed that there was no significant difference in HIV knowledge between those who had a premarital exam and those who had not. However, higher education levels were associated with better HIV knowledge.

Conclusion: The findings indicate that the level of HIV knowledge among Jordanian women is poor and was not associated with undergoing premarital examination and counseling. This suggests redesigning the mandatory premarital examination and counseling to have stronger STDs and HIV awareness and prevention components. This change may improve knowledge and encourage safer health behaviors, thus helping to combat stigma and misinformed views about HIV in Jordan.

Background: The menopausal transition is a critical phase in a woman's life marked by hormonal fluctuations that can result in a wide variety of physical and psychological symptoms. These symptoms vary in strength and their negative impacts on women's health and well-being. One of the most severe impacts of (peri)menopause is increased vulnerability to suicidality in some women, yet no systematic review has examined the holistic relationship regarding this potential link.

Objectives: To examine the relationship between the menopausal transition and suicidality, and identify menopause-related factors contributing to increased suicide risk.

Design: A systematic review was conducted in accordance with PRISMA guidelines.

Data sources: MedLine, CINAHL, PsychINFO, Web of Science and Cochrane Library were searched for studies addressing both menopause and suicidality. Studies were screened independently by two reviewers. Data extraction focused on suicidal ideation, attempts, and completed suicide among menopausal women. The quality of included studies was assessed using the Mixed Methods Appraisal Tool.

Results: Nineteen studies published between 1987 and 2025 met the inclusion criteria. Of the 19 studies, 16 (84%) reported an association between the menopausal transition and increased suicidality, with 7 studies specifically noting this association in perimenopausal women. Hormonal changes, pre-existing mental health conditions, physical symptoms, and limited social support emerged as key factors associated with increased suicide risk. Three studies did not find a significant link.

Conclusion: There is some evidence of an association between the menopausal transition and suicidality, particularly during perimenopause, though conclusions are limited by study design and heterogeneity. The review highlights the importance of integrating mental health support within menopause care and suggests further research to clarify the mechanisms underpinning suicide risk during the menopausal transition. Enhanced screening and supportive interventions may benefit menopausal women experiencing suicidality.