BMC Women's Health最新文献

Background: Postmenopausal women are at increased risk of developing cardiovascular, muscular, and metabolic dysfunction due to hormonal changes associated with aging. Citrulline, a non-essential amino acid and precursor to nitric oxide, has gained interest as a potential dietary supplement for improving vascular health, muscle function, and metabolic parameters in this population.

Objective: This systematic review aims to evaluate the effects of citrulline supplementation, administered directly or via watermelon products, on cardiovascular, muscular, and metabolic outcomes in postmenopausal women.

Methods: A comprehensive literature search was conducted using PubMed, Web of Science, and Scopus databases to identify randomized controlled trials (RCTs) investigating citrulline supplementation in postmenopausal women. Studies were included if they reported outcomes related to blood pressure, arterial stiffness, endothelial function, muscle strength or mass, metabolic parameters, and safety. Study quality was assessed using the Cochrane Risk of Bias Tool 2. Due to heterogeneity in study designs and reported outcomes, results were synthesized narratively.

Results: Twelve RCTs involving 360 postmenopausal women were included. all conducted in the United States, with study durations ranging from 4 to 8 weeks and participant ages between 50 and 75 years. Seven studies reported blood pressure outcomes, with most showing reductions in systolic blood pressure and mean arterial pressure. Five studies examined arterial stiffness, with mixed findings on pulse wave velocity and augmentation index. Four studies assessed endothelial function, two of which demonstrated significant improvements in flow-mediated dilation. Muscle function outcomes were investigated in two studies, suggesting improvements only when citrulline was combined with resistance training. Six studies assessed metabolic parameters, with no consistent effects observed on body weight, glucose, insulin, or lipid profiles. Across all studies, no adverse effects related to citrulline supplementation were reported.

Conclusion: Citrulline supplementation may offer benefits for blood pressure regulation (up to 9 mmHg SBP reduction in some studies) in hypertensive postmenopausal women, but evidence for arterial stiffness, endothelial function, and metabolic outcomes remains inconsistent. Further large-scale studies are needed before clinical recommendations can be made.

Background: Endometriosis is a chronic condition affecting women of reproductive age and often associated with pain, impaired fertility, and reduced quality of life. Management requires long-term strategies, with medical treatment preferred over repeated surgery. Treatment selection must balance efficacy, cost, patient preference, and safety. Dienogest is a progestin shown to be effective, but real-world data in Thai women remain limited. This study aimed to evaluate the efficacy and safety of dienogest in this population.

Methods: This single-arm, real-world prospective observational study was conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from April 2024 to May 2025. Women with endometriosis received dienogest once daily for 24 weeks. Baseline symptoms, endometriosis-associated pain, and satisfaction were assessed using a visual analog scale (VAS). Follow-up visits were scheduled at 12 and 24 weeks, with reassessment of pain symptoms, satisfaction, and adverse events.

Results: A total of 62 participants were included for analysis, with a mean age of 34.2 ± 7.2 years. Dysmenorrhoea was reported by 86.4% and chronic pelvic pain by 60.6% of participants. The mean overall endometriosis associated-pain VAS decreased significantly from 7.5 ± 1.6 at baseline to 2.8 ± 2.2 at 12 weeks and 1.9 ± 1.7 at 24 weeks (p < 0.001). Satisfaction scores were 7.5 ± 1.9 at 12 weeks and 8.1 ± 1.5 at 24 weeks with discontinuation rate of 3 out of 65 women (4.6%). At 12 weeks, common adverse events included acne (29.0%), depressed mood (16.1%), breast pain (14.5%), and headache (14.5%), while weight gain and hot flushes were less common. By 24 weeks, weight gain (26.7%) and acne (26.7%) were most frequently reported.

Conclusion: Dienogest was associated with reducing pain and good satisfaction in Thai women with endometriosis, with an acceptable safety profile. These findings support its use as a practical long-term management option.

Trial registration: ISRCTN registration approval number ISRCTN68041248 on 13 March 2024.

Background: Women with disabilities are susceptible to compounded discrimination based on gender and disability, which can constrain healthcare access and worsen health outcomes. Quantitative evidence on determinants of unmet healthcare needs in Women with disabilities remains limited. This study aimed to identify predictors of unmet healthcare needs among women with disabilities and to provide evidence to inform improvements in healthcare accessibility.

Methods: We conducted a cross-sectional analysis of 2873 Women with disabilities from the nationally representative 2023 Survey of People with Disabilities in Korea. Guided by Andersen's Behavioral Model of Health Services Use, we examined predisposing, enabling, and need factors associated with unmet healthcare needs using descriptive statistics, chi-square tests, and multivariable logistic regression.

Results: Among women with disabilities, the prevalence of unmet healthcare needs was 19.7%. The most common reasons were difficulty traveling to healthcare facilities (41.2%) and financial constraints (25.8%). In multivariable analysis, the odds of experiencing unmet healthcare needs were higher among those with lower household income, physical disabilities, severe disability, dependence in instrumental activities of daily living (IADL), poor self-rated health, experience of depression, difficulty using transportation, and inability to go out alone.

Conclusions: Women with disabilities experience high rates of unmet healthcare needs. Limitations in daily living due to physical disability, low socioeconomic status (SES), and mental health vulnerability emerged as major factors underlying unmet healthcare needs among women with disabilities. Integrated policies addressing financial barriers, healthcare accessibility, and women's health are needed to meet the unique needs of women with disabilities.

This study aimed to identify the spatial distribution and its associated factors of unmet need for family planning among women of reproductive age in administrative woredas of Ethiopia, using data from 8,716 married or in-union women in the 2016 Ethiopian Demographic and Health Survey. Spatial analyses, including autocorrelation, hotspot identification, and interpolation, were employed to examine geographical patterns, while a multilevel multinomial logistic regression model identified associated factors. The overall prevalence of unmet need was 21.04% (12.84% for spacing, 8.2% for limiting). Spatial analysis revealed that unmet need for limiting was dispersed, while spacing needs were randomly distributed. Key determinants included knowledge of family planning (spacing: aOR = 1.76, 95% CI:1.21-2.57; limiting: aOR = 2.45, 95% CI:1.41-4.23), having more than four living children (spacing: aOR = 1.40, 95% CI:1.05-1.86; limiting: aOR = 10.04, 95% CI:5.45-18.50), husband's employment (spacing: aOR = 0.44, 95% CI:0.28-0.71; limiting: aOR = 0.35, 95% CI:0.20-0.61), and the interaction of rural residency with husband's employment (spacing: aOR = 1.98, 95% CI:1.17-3.36; limiting: aOR = 2.42, 95% CI:1.28-4.55). The findings indicate that the prevalence of unmet need for family planning in Ethiopia's administrative woredas remains high, greater the acceptable standard defined by global benchmarks. Key factors include women's knowledge of family planning, the number of living children, the husband's occupation, and the contextual influence of rural residency. The spatial heterogeneity, particularly for limiting births, underscores the need for geographically targeted interventions. Therefore, national strategies and woreda-specific programs aimed at reducing unmet need must move beyond uniform approaches. They should prioritize enhancing comprehensive family planning education, addressing high-parity concerns, engaging male partners, and tailoring service delivery to mitigate the specific socio-contextual barriers prevalent in rural settings to ensure equitable access to family planning services across all administrative woredas.

Objective: To evaluate the Swede score for the prediction of high-grade cervical lesions in women undergoing colposcopy without cytology results. This simulates the upcoming scenario in Brazil of HPV-based screening for women testing positive for HPV 16/18.

Methods: This was a partial analysis of an ongoing cross-sectional study that prospectively included 86 women referred for colposcopy due to cytological abnormalities to a public referral center in Rio de Janeiro, Brazil, between September 2023 and June 2025. All women went to colposcopy evaluation. Colposcopy was performed by an examiner blinded to the referral cytology. For this analysis, we included all women with a fully visible squamocolumnar junction (transformation zone types 1 or 2). The gold standard was the histopathological repor. In cases where no biopsy or excisional treatment was performed, classification relied on final colposcopic impression and cytology. Diagnostic performance (sensitivity, specificity, predictive values, and likelihood ratios) was calculated using different Swede score cutoffs. Post-test probabilities were calculated assuming a 20% pre-test probability of CIN2+.

Results: Prevalence of CIN2 + was 33.7%. Swede score ≥ 8 predicted CIN2 + with a positive predictive value (PPV) of 100% and a likelihood ratio of 55.17. Post-test probability in a HPV 16/18-positive scenario without cytology in this threshold was estimated at 93%.

Conclusion: The Swede score cutoff ≥ 8 in women who tested positive for HPV 16/18 and had fully visible transformation zones can be an accurate method to predict that they have CIN2+. These results could support the decision to proceed with immediate treatment without prior cytology or biopsy.

Trial registration: Not applicable. This study does not report the results of a health care intervention.

Little research exists surrounding vulnerable birthing people and their relationships with planning and preventing pregnancy. This study aims to better describe services and barriers that impact family planning choices, including housing, primary care provider accessibility, and insurance access among participants in the Parent Child Assistance Program (PCAP). Participant data was derived from 59 participants enrolled in PCAP, a case management program for birthing people who use substances. Amongst the participants who were recently pregnant, 7/59 (12%) were using birth control around the time of conception of that pregnancy. Of the participants who were not recently pregnant, 53% of clients were using birth control upon intake. This figure rises incrementally by 24 months. Data showed that those with health insurance are almost twice as likely to be using contraceptives at intake. The low prevalence of birth control use even after a recent pregnancy suggests significant barriers still exist in terms of education and access to family planning resources for birthing people. This indicates the need for targeted interventions and supports that empower birthing people to make decisions about their reproductive health.