Women's health (London, England)最新文献

Background: Dysmenorrhoea, a common gynaecological issue in women, is characterised by lower abdominal cramps during menstruation impacting quality of life (QoL).

Objectives: This study evaluates the effectiveness, utilisation and safety of Buscopan^® Plus (hyoscine butylbromide (HBB) Plus: 10 mg HBB + 500 mg paracetamol) for self-treating menstrual pain.

Design: This non-interventional, prospective cohort real-world study included women with menstrual pain registered with Carenity, an online patient platform by Else Care SAS.

Methods: Eligible German patients with the mean (standard deviation) age of 34.0 (8.0) years were enrolled between 15 September 2020 and 15 June 2022 and grouped into primary analysis or safety cohorts. A maximum of one to two tablets (thrice daily) were allowed, limited to 3 g paracetamol per day. Primary outcomes were pain intensity difference by mean change and percentage variation in numeric rating scale (NRS) score, percentage of NRS responders and time to pain relief; safety was a secondary outcome. All parameters were measured at 15 min, 30 min, 1 h, or 4 h following the first HBB Plus intake.

Results: Of 1733 eligible women, 94% provided written consent and completed the baseline questionnaire, 56% met all inclusion criteria, 10% completed all intake assessments (primary analysis cohort) and 33% had ⩾1 dose of HBB Plus (safety cohort). Percent decrease in NRS score from baseline was 11.1%, 29.5%, 42.4%, 53.4% and 65.8% at 15 min, 30 min, 45 min, 1 h and 4 h (p < 0.001 at all-time points), respectively. Overall, 90.8% patients were categorised as responders up to 4 h post HBB Plus intake. Median time to first perceptible pain relief and meaningful pain relief was 30.0 and 37.5 min, respectively. In the safety analysis cohort, five non-serious treatment-emergent adverse events were reported.

Conclusion: HBB Plus effectively reduced menstrual pain within 4 h of treatment and was well-tolerated, providing a viable option for self-management of pain and improving QoL.

Background: Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder. However, current lifestyle recommendations may not be appropriate for all individuals with PCOS. To best tailor an intervention for individuals with PCOS, an understanding of their preferred intervention characteristics is needed.

Objectives: To describe preferred intervention characteristics of a weight-neutral lifestyle approach and explore the acceptability of intuitive eating for individuals with PCOS.

Design: Convergent mixed methods analysis.

Methods: Preferred intervention characteristics were explored through an online survey, with semi-structured interviews conducted with a purposively selected group of survey participants. Descriptive statistics were calculated. Qualitative data were analyzed using reflexive thematic analysis. Joint displays were used for mixed methods integration.

Results: Two hundred sixty-seven participants (77.7% white, 86.0% non-Hispanic, mean age 29.7 ± 5.1 years) were included in the analysis. Participants reported interest in a lifestyle program (66.3%) consisting of individual and group (57.7%) sessions, delivered in-person and remotely (46.2%). Although a registered dietitian was the preferred provider to administer the intervention (80.5%), many participants (54.9%) desired an interdisciplinary team. Interest in intuitive eating was high (mean score 7.1 ± 2.7, scale 1-10, higher scores indicate higher interest). The average scores for acceptability, appropriateness, and feasibility of an intuitive eating intervention were 3.7 ± 0.9, 3.3 ± 1.0, and 3.8 ± 0.8, respectively (scale 1-5, higher scores indicate higher acceptability, appropriateness, and feasibility). While intuitive eating was perceived to have several benefits, concerns over letting go of food rules and navigating cravings were heard. A need for an individualized approach, with practical guidance, education, and peer support was identified.

Conclusions: Individuals with PCOS prefer an individualized lifestyle approach. Intuitive eating may be an acceptable weight-neutral lifestyle intervention for PCOS. However, concerns over implementing intuitive eating should be considered in the design of an intervention. Future research should incorporate these findings when developing treatment approaches for PCOS.

Background: Endometriosis is a chronic disease that impacts an estimated 10% of women. It is characterized by endometrial glands and stroma growing outside the uterus. Surgery is a mainstay of diagnosis and treatment. Infection is a leading complication following minimally invasive surgery (MIS) endometriosis excision. Currently, there are limited data on antibiotic prophylaxis for these cases.

Objectives: To study the utility of prophylactic antibiotic administration in postoperative infection prevention among women undergoing MIS for endometriosis.

Design: This retrospective cohort study included patients who had MIS for endometriosis at a quaternary academic medical center between January 2016 and May 2023. Patients who received antibiotic prophylaxis were compared to those who did not. The primary outcome was the rate of postoperative infections in each group. Secondary outcomes included rates of unscheduled postoperative visits, readmissions, and reoperations.

Results: Of the 729 patients included, 595 (81.6%) patients received antibiotics, and 134 (18.4%) did not. Among women who received antibiotics, endometrioma excision (36.5% versus 23.1%, p = 0.003), ureterolysis (38.0% versus 25.4%, p = 0.007), and concomitant myomectomy (43.5% versus 11.9%, p < 0.001) were more common. The proportion of stage IV endometriosis was higher among women who received antibiotics (22.7% versus 11.9%, p = 0.005). Estimated blood loss, surgery length, and hospital admission times were lower in the no-antibiotics group. There were no infections in the no-antibiotics group and 7 (1.2%) in the antibiotics group.

Conclusion: Infectious complications were rare among patients undergoing MIS for endometriosis. The higher prevalence of infection among patients who received antibiotics likely reflects more severe endometriosis and higher surgical complexity in these cases. No infections in the no-antibiotics group suggest that prophylaxis may be safely omitted in simpler cases. A larger, prospective study is needed to investigate further the potential benefit of antibiotic prophylaxis in more complex endometriosis surgeries.

Sexual and reproductive health and rights (SRHR) are fundamental yet inadequately realized across Africa, undermining well-being, economic stability, and autonomy. This editorial synthesizes findings from 24 studies in a special collection, highlighting persistent challenges and innovative solutions. Key issues in family planning include low contraceptive uptake and discontinuation, particularly among women with HIV and adolescents, exacerbated by social pressures and systemic exclusion of marginalized groups like LGBTQ+ individuals and persons with disabilities. For comprehensive abortion care, access to quality post-abortion services remains low, though provider training shows promise for improving skills. Systemic inequities are evident in limited pre-exposure prophylaxis awareness, HIV-related fertility disparities, and high rates of gender-based violence (GBV), which is linked to adverse outcomes like repeat adolescent pregnancies. Evidence underscores that fragmented interventions fail; progress requires integrated, community-driven approaches. This includes combining HIV, mental health, and family planning services, empowering communities through peer-led networks, and implementing robust accountability mechanisms. Prioritizing the needs of marginalized populations-including adolescents, GBV survivors, and persons with disabilities-through inclusive policies, sustainable financing, and multi-level interventions is essential to building equitable SRHR systems that leave no one behind.

Background: Smoking during pregnancy remains a major public health issue and a leading preventable cause of adverse maternal and fetal outcomes. In France, midwives play a central role in antenatal care and are key actors in smoking cessation support. However, little is known about how smoking cessation is managed in routine maternity care and how organizational and professional factors shape these practices.

Objectives: To explore midwives' experiences in managing tobacco use during pregnancy, identify perceived barriers and facilitators in routine practice, and generate context-specific, practice-oriented recommendations to improve smoking cessation support within a maternity care setting.

Design: A qualitative study using individual semi-structured interviews.

Methods: Nine midwives working in a single French maternity unit participated in semi-structured interviews conducted between March and May 2023. Data were analyzed using a Framework analysis combining deductive coding informed by the capability, opportunity, and motivation-behavior (COM-B) model and the theoretical domains framework, with inductive refinement to capture emerging themes. Data saturation was assessed retrospectively. Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

Results: Midwives described heterogeneous practices in smoking cessation support and reported multiple barriers to optimal care. Three main challenges emerged: limited prioritization of smoking during consultations, insufficient knowledge and confidence in smoking cessation management, and organizational constraints, including lack of time, absence of structured care pathways, and limited coordination with addiction services. Engagement in smoking cessation discussions was often conditional on perceived patient motivation. These findings informed the development of practice-oriented recommendations targeting training needs, organizational improvements, and supportive tools within the maternity unit.

Conclusion: This study highlights how individual capabilities, organizational opportunities, and motivational factors interact to shape smoking cessation support in routine maternity care. By adopting an implementation-focused perspective, it identifies modifiable levers to strengthen midwives' capacity to address smoking during pregnancy. The recommendations proposed are exploratory and context-specific, intended to support local quality improvement initiatives rather than national guideline development.

Background: The United States has one of the highest cesarean section (c-sections) rates among high-income countries. Birthing people who self-report as Black women in the United States are not only are three to four times more likely to die from preventable prenatal challenges, but also are the most prevalent racial group to receive either planned or unplanned c-sections.

Objectives: Our initial aim focused on the lived experiences of prenatal care and the variety of birth types among Black women that was analyzed for a prior publication. In this secondary analysis, we noticed there was a large portion of study participants who discussed their perceptions of cesarean births.

Design: In this specific analysis and due to c-section prevalence among Black women, we solely focused on the perceptions of c-sections, whether of planned or unplanned mode of delivery.

Methods: We analyzed interviews from 25 women in the South Florida region of the United States who had at least one recent pregnancy and/or birth of a living child (<24 months) at the time of data collection. Data were thematically analyzed and coded using NVIVO 12 software by our research team.

Results: Nineteen Black women had high-risk prenatal status, with n = 15 of the 25 Black women having c-sections. Regardless of whether c-sections were planned or unplanned, perceptions of c-sections were expressed as traumatizing and coercive. We also noticed how participants described their experiences with intergenerational trauma from the collective memory and triggers of their familial social groups who also had adverse experiences with c-sections. Participants who desired vaginal-births-after-cesarean sections or wanted to incorporate approaches with midwives or doulas further experienced constrained choices due to their high-risk prenatal diagnosis and limited insurance coverage. Based on our results, we designed a conceptual model to illustrate how our findings can be applied to better understand the overlap between medical racism and obstetric racism, which has implications for the perpetuation of unwarranted c-sections, high-risk pregnancies, negative mental health issues, and racial birth trauma.

Conclusion: Social factors, including medical racism, contribute to obstetric racism and racial birth trauma throughout postpartum and impact mental health.

Background: This protocol outlines the process and implementation evaluation of the SMARThealth Pregnancy (SHP) pragmatic, type 2 hybrid cluster randomised trial conducted in two states in India (Haryana/Telangana). The SHP trial aims to improve the community-level identification, diagnosis, referral and management of women with anaemia, diabetes, and hypertension during pregnancy and in the year after birth.

Objectives: The process and implementation evaluation aims to understand how, why, and for whom the SHP intervention may be effective (or not). It aims to identify contextual factors, barriers, and facilitators relevant to the implementation of the intervention, and understand mechanisms and strategies employed during its implementation.

Design: The study utilised a process evaluation design.

Method: A mixed methods evaluation drawing from realist evaluation, normalisation process theory, the Medical Research Council framework, reach, effectiveness, adoption, implementation and maintenance framework, and Proctor's typology will be employed for understanding the implementation process. The evaluation will involve focus group discussions and semi-structured interviews with healthcare providers (Accredited Social Health Activist, primary care doctors, and auxiliary nurse midwife), women, and field staff. Quantitative process data describing reach, fidelity, dose, and adoption of intervention will be collected. Observations of trial setup and implementation will be conducted. Both qualitative and quantitative data will be analysed iteratively before the effectiveness outcomes of the SHP trial are available and will subsequently be triangulated with the trial primary outcome evaluation data.

Discussion: The findings from this process evaluation will provide an understanding of how the intervention works in practice, its potential to detect and manage anaemia, diabetes and hypertension during pregnancy and in the year after birth, and its scalability as an integrated model for the management of non-communicable diseases in pregnancy/postnatal care.

Background: Healthcare professionals' and students' willingness to provide abortion influences access to care and workforce readiness.

Objective: We conducted a literature synthesis to identify patterns in willingness across various clinical scenarios.

Design: Systematic review and meta-analysis.

Data sources: We searched five databases (PubMed, Scopus, Web of Science, Medline, and CINAHL) and gray literature for studies (January 2014 to February 2025) without language restrictions. Eligible studies reported cross-sectional data on providers' willingness, while we excluded conditionally framed scenarios. Willingness was defined as the intent, readiness, or affirmative response to provide abortion.

Methods: Summary-level data on theme-specific willingness were extracted and re-coded into binary or proportional format (yes/no or n/N). Estimates were pooled using random-effects models. Meta-regression and publication bias assessments were performed. Study quality was assessed using a novel in-house tool tailored for survey-based research.

Results: We included 36 studies (n = 18,779), reporting 137 estimates across 24 themes. Willingness to provide was highest for lethal fetal anomalies (88.7%, 95% CI: 76.1%-95.1%) and maternal physical health risks (88.6%, 95% CI: 55.7%-98.0%) but substantially lower for on-request scenarios (33.1%, 95% CI: 14.9%-58.4%), surgical abortion (32.1%, 95% CI: 11.6%-63.0%), and social reasons (range 20.1%-32.0%). Multilevel modeling captured both converging and diverging response patterns across categories. Meta-regression indicated that students had consistently higher willingness than professionals. Dominant religion was also observed to be more strongly associated than legal status and other country-level indices. Evidence of small-study effects was limited apart from in a few themes. Risk of bias was high in 31% of studies, with our tool showing strong structural overlap with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) frameworks.

Conclusions: Providers often prioritized abortion in life-threatening contexts but hesitated in non-urgent scenarios. Values-based training and systemic reforms are needed for equitable access to and expansion of abortion care.

Registration: PROSPERO: CRD42025634868.

Weaning is commonly understood as a practical transition, yet it carries significant emotional implications that remain largely absent from maternal mental health discussions. Drawing on existing literature and clinical observations, this editorial explores the psychological dimensions of weaning, including guilt, sadness, relief, confusion, and emotional disconnection. The lack of professional visibility of this transition may invalidate maternal emotional experiences, potentially impacting mental health. Recognizing weaning as a meaningful emotional and developmental moment can foster more empathetic, inclusive, and supportive maternal care.

Background: Health-related quality of life (HRQoL) measures may help incorporate patient preferences and deliver individualized care for older breast cancer survivors. However, few studies have used clinically meaningful thresholds to evaluate the various characteristics associated with HRQoL in older women.

Objectives: To examine sociodemographic and clinical characteristics associated with HRQoL and minimal clinically important differences (MCIDs) among female breast cancer survivors aged ⩾65 years.

Design: A cross-sectional study.

Methods: We used 2006-2015 Surveillance, Epidemiology, and End Results data linked to the Medicare Health Outcomes Survey (SEER-MHOS) for U.S. women aged ⩾65 years diagnosed with stages I-III invasive breast cancer. Descriptive statistics were used to summarize data. Generalized linear regression models were fitted to identify characteristics associated with the HRQoL physical component summary (PCS) and mental component summary (MCS) scores from the Veterans RAND 12-Item Health Survey scale. Missing values were imputed using chained equations. A threshold of two points was used to identify clinically meaningful between-group differences.

Results: The median age at diagnosis was 72 years (interquartile range: 68-76) among 3218 breast cancer survivors. Obesity (mean difference (MD): -2.42; 95% confidence interval (CI): -3.34, -1.49), older age (⩾80 years; MD: -2.05; 95% CI: -3.15, -0.96), difficulty with ⩾1 activities of daily living (ADL; MD: -11.70; 95% CI: -12.42, -10.99), and cardiovascular (MD: -2.27; 95% CI: -3.02, -1.53) and musculoskeletal disease (MD: -3.88; 95% CI: -4.67, -3.09) were associated with clinically meaningful lower PCS scores. Less than high school education (MD: -3.43; 95% CI: -4.53, -2.33), annual household income ≤$19,999 (MD: -4.08; 95% CI: -6.00, -2.16) and $20,000-$39,999 (MD: -2.71; 95% CI: -4.63, -0.79), no surgery (MD: -3.03; 95% CI: -5.33, -0.72), difficulty with ≥1 ADL (MD: -6.71; 95% CI: -7.52, -5.89), and obesity (MD:2.06; 95% CI: 1.00, 3.12) were associated with MCIDs in MCS scores.

Conclusion: Clinically meaningful differences in HRQoL were observed across sociodemographic and clinical characteristics in older female breast cancer survivors. These results may help identify women in need of interventions to improve HRQoL post-diagnosis.