BMC Women's Health最新文献

Background: Family planning facilities provide an extensive choice of assistance that is beneficial for women and the society. It may limit the fatality risk for mothers and babies by reducing the rate of pregnancies and abortions. The Government of Pakistan has been continuously trying to persuade the people about the importance of family planning. The accomplishment of these programs depends upon various aspects associated with the knowledge, availability, and access to contraceptives. This paper has investigated the effect of knowledge and access to contraceptives on the unmet need for family planning (UMNFP) among married women of reproductive age (MWRA) in Pakistan.

Method: The comprehensive dataset of the Pakistan Demographic and Health Survey 2017-18 has been used to investigate the effect of knowledge and access to contraceptives on UMNFP among MWRA in Pakistan by applying Multivariable Logistic regression.

Results: The prevelance of UMNFP is higher among MWRA of 25 to 34 years than other age groups. The likelihood of UMNFP decreases with increase in education above the primary level. The prevalence of UMNFP is found higher among women who belong to the poorer wealth quintile than the women of the poorest wealth quintile. The odds of UMNFP are considerably low among women belonging to the richer and richest wealth quintile, compared to the women of the poorest wealth quintile. Women's participation in decision making for not using contraceptives is a significant factor to reduce UMNFP. The odds of UMNFP are higher among those women who have no knowledge and lack of access to contraceptives compared to those who have knowledge and access to contraceptives.

Conclusions: Both knowledge and access to contraceptives are important factors to determine UMNFP. The government should initiate programs to disseminate knowledge as well as provision of contraceptives for effective family planning.

Background: Most cases of ovarian hyperstimulation syndrome (OHSS) are caused by infertility treatment using human menopausal gonadotropin (HMG) and human chorionic gonadotropin (hCG). OHSS is widely known to have a "spoke-wheel" appearance on imaging, presenting as bilateral symmetric enlargement of ovaries with multiple cysts of varying sizes. When this spoke-wheel appearance is observed in patients not undergoing infertility treatment, tumor-derived hormones such as follicle-stimulating hormone (FSH) and hCG should be measured. However, pitfalls exist in the interpretation of FSH levels.

Case presentation: A 29-year-old, gravida 0, para 0 woman visited her local doctor for irregular menstruation and to seek fertility treatment. At the first medical examination, bilateral ovarian tumors were found by ultrasonography, and she was referred to our hospital. Magnetic resonance imaging (MRI) findings of the bilateral ovarian tumors suggested typical OHSS, and thus levels of serum hormones including FSH and hCG were measured to determine whether endogenous follicle-stimulating hormones were the cause. Estradiol was elevated at 737 pg/ml (normal: 28.8-196.8 pg/ml in follicular phase) and luteinizing hormone (LH) was low at < 0.3 mIU/ml (normal: 1.4-15 in follicular phase, 2.1-88 mIU/ml in ovulatory phase). FSH (18.6 mIU/ml; normal: 3.0-14.7 in follicular phase, 4.5-22.5 mIU/ ml) and hCG (< 1.0 mIU/ml) were within normal ranges for non-pregnant women. Initially, since ovarian neoplasms producing estrogen were suspected, surgical resection was scheduled. However, computed tomography of the neck to pelvic region was performed to rule out metastatic ovarian tumors, and indicated a coincidental pituitary lesion, which was pathologically characterized as an FSH-secreting pituitary adenoma. Consequently, the final diagnosis was OHSS caused by an FSH-producing pituitary adenoma and the scheduled ovarian surgery was avoided.

Conclusions: Awareness of MRI findings of OHSS is important to avoid unnecessary invasive procedures. When treating patients who have suspected OHSS on imaging but whose serum FSH is in the normal range, it is also important to know that an unsuppressed FSH level despite the negative feedback effect of high estrogen should prompt investigation for a pituitary adenoma as a primary consideration.

Background: The role of endogenous estrogen exposure (EEE) in shaping body composition and its implications for cardiometabolic health remain understudied despite its potential significance. This cross-sectional study aimed to investigate the association between EEE and body composition indices among postmenopausal women.

Methods: Data were obtained from the Tehran Lipid and Glucose Study (TLGS), including 960 women aged over 40 years. EEE was calculated based on reproductive events, and participants were categorized into tertiles. Anthropometric measurements and body composition were assessed using standardized protocols. Linear regression models were employed to evaluate associations, adjusting for potential confounders.

Results: It was revealed significant differences in body composition indices across EEE tertiles, with increasing EEE associated with decreased fat mass, skeletal muscle mass, and fat-free mass. Moreover, women with higher EEE exhibited lower anthropometric and body composition measurements compared to those with lower EEE, even after adjusting for confounding factors. Specifically, for each year of increasing EEE, fat mass decreased by 0.12 kg, skeletal muscle mass by 0.04 kg, fat-free mass by 0.07 kg, and fat mass ratio decreased by 0.003. Comparing tertiles, women with the highest EEE demonstrated significantly lower anthropometric and body composition measurements compared to those with the lowest EEE.

Conclusion: These findings suggest a link between EEE and favorable changes in body composition, highlighting the importance of considering reproductive history in health assessment.

Background: Hysteroscopy is considered the standard for evaluating the uterine cavity. Limited data exists regarding hysteroscopy in Ethiopia. Therefore, the objective of the study was to describe the diagnostic and operative hysteroscopic procedures at St. Paul's Hospital.

Methodology: A three-year retrospective descriptive study examined patients who underwent diagnostic and therapeutic hysteroscopy at the Center for Fertility and Reproductive Medicine, St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia, from June 2018 to June 2021. Descriptive statistics were employed to summarize the findings observed during the hysteroscopy procedures.

Result: A total of 328 patient records underwent review and analysis in the study. The mean participant age was 31.9 years (31.9 ± 5.1 years), with about 81.4% being nulliparous. Primary infertility (48.5%) was the leading indication for hysteroscopic evaluation, followed by secondary amenorrhea (18%), secondary infertility (17.4%), and abnormal uterine bleeding (8.8%). Concerning hysteroscopic procedures, 6.1% of participants exhibited no uterine cavity abnormalities. Primary hysteroscopy findings comprised intracavitary adhesions (48.2%), endometrial polyps (18%), and submucosal myomas (9%). Adhesiolysis stood out as the foremost surgical procedure, conducted in 48.2% of patients, followed by polypectomy in 20.7%, and fibroid removal in 9%. The complication rate was 2.4%, exclusively during operative hysteroscopy, with uterine perforation observed in six patients.

Conclusion: Our hysteroscopic evaluation was predominantly requested for primary infertility cases, with secondary amenorrhea, secondary infertility, and abnormal uterine bleeding also being commonly encountered indications. Adhesiolysis was the leading intervention during hysteroscopy, while uterine perforation was the main complication. The hysteroscopy procedures exhibited a strong safety profile, with few complications noted. Future studies should address factors affecting outcomes in diagnostic and operative hysteroscopy, and common factors linked to intrauterine adhesions.

Background: Central obesity and breast cancer (BC) have been identified as relevant by empirical research. The weight-adjusted-waist index (WWI) is a novel methodology for quantifying central obesity. Inspection of the association between WWI and BC in American adult women was the primary goal of the current investigation.

Methods: Cross-sectional assessments were conducted on information gathered from 10,193 National Health and Nutrition Examination Survey (NHANES) participants from 2011 to 2018. The waist circumference was divided by the square root of the body's mass to compute WWI. Data were assessed via descriptive statistics to present data distributions according to BC grouping and WWI grouping, receiver operating characteristic curves (ROCs) to evaluate the obesity indicators' applied value, logistic regression to reflect associations between WWI and BC prevalence, and restricted cubic splines (RCSs) and subgroup analysis forest plots to visualise and complement the relationships.

Results: This study enrolled 10,193 participants whose WWI ranged from 8.38 to 14.41, 259 of whom were diagnosed with BC, and the results revealed significant differences in baseline characteristics between the groups. With an area under the curve (AUC) value (95% confidence interval) (CI)of 0.611 (0.577-0.644), WWI was a promising indicator of BC with good application value rather than waist circumference (WC), body mass index (BMI), or waist-height ratio (WHtR). WWI and BC laid out a substantial relationship, yielding an odds ratio (OR) of 1.54 and a 95% CI of (1.34, 1.79), which remained at 1.19 (1.00, 1.42) after considerable adjustments were made, according to the logistic regression analysis. Compared with the lowest quartile of WWI, the highest quartile had a 62% greater in the probability of suffering from BC. With the RCS's inverted U-shape highlighting the importance of considering the nonlinear nature of the relationship and subgroup analyses reflecting variations among populations, all the results demonstrated that WWI was a well-suggestive indicator of BC hazard.

Conclusion: The current investigation revealed a meaningful association between the prevalence of BC and WWI, which was superior to other obesity indicators, albeit one that was more complex than the positive relationship initially derived. There existed a turning point for BC prevalence at WWI of approximately 12 cm/√kg. Nevertheless, maintaining WWI in the lower range is critical for preventing and administering BC and minimizing disease risk.

Background: Endometriosis is the most frequent gynecological diseases and accompanied by both physical and psychological symptoms. An increasing number of studies suggested acknowledging endometriosis as a systematic disease due to the multifactorial effects throughout the body. The chronic disease significantly impacts daily life, including romantic relationships. This study aimed to investigate the associations between health-related quality of life (HRQoL), infertility-related psychological well-being (IPW), constructive communication, and relationship quality in individuals with endometriosis.

Methods: A total of 627 individuals with endometriosis participated in this online cross-sectional study. We measured HRQoL in all participants and IPW specifically in those who reported an unfulfilled wish for a child. Additionally, relationship quality and constructive communication were assessed. We used Pearson's product moment correlation to examine the association of HRQoL/IPW and relationship quality. Mediation analysis was used to assess the role of constructive communication in the association between HRQoL/IPW and relationship quality. In an explorative analysis, differences between subsamples with and without an unfulfilled wish for a child were analyzed.

Results: Poorer HRQoL was associated with lower relationship quality overall (p = .002) and specifically with three subscales of relationship quality: worse sexuality (p = .016), increased mistrust towards the partner (p < .001), and restriction of freedom/independence (p = .003). There was no significant association between IPW and relationship quality. The mediation analysis including constructive communication as mediator showed a full mediation between HRQoL/IPW and relationship quality. The subsamples with and without an unfulfilled wish for a child differed in HRQoL but not in relationship quality or constructive communication.

Conclusion: The findings indicated an association between HRQoL in individuals with endometriosis and relationship quality. In addition, we observed a full mediation between HRQoL/IPW and relationship quality, when constructive communication was considered as a mediator. Therefore, constructive communication plays a key role in effectively managing the impact of the disease within a relationship. Individuals with endometriosis experiencing difficulties conceiving should have access to appropriate psychological counseling.

Introduction: Many studies reported that the factors associated with the intensity of menopausal symptoms vary according to race, culture, and ethnicity. Different instruments, measure severe menopausal symptoms. The present study aims to classify Iranian women between 42 and 60 years according to the similarity of menopausal severity symptoms and then find the risk factors related to allocating in severe symptoms groups.

Method: In this cross-sectional study, 664 women aged 42-60, living in Mashhad, Iran were collected. The Menopause Severity Symptoms Inventory (MSSI-38) was used to collect information about menopausal symptoms. K-Means clustering algorithm was applied to classify women with different menopausal symptoms in separate groups. The baseline category logit model and ANOVA were used to find the associated factors and covariates with clusters.

Result: K-Means clustering algorithm, extracted three major clusters based on different menopausal symptoms. The first cluster involved 301 (45%) women with mild symptoms, the second was a cluster of moderate symptoms women with size 131 (20%). The remaining 232 (35%) of women were placed in the third cluster. The baseline category logit model showed that Compared to Cluster 1, Cluster 2 is associated with a higher underlying diseases (OR = 1.51, P-value = 0.03), lack of physical activity (OR = 1.79, P-value = 0.003), having more than five pregnancies (OR = 2.11, P-value = 0.017), and being peri menopause (OR = 1.71, P-value = 0.03). In contrast, Cluster 3 shows an even stronger association with underlying diseases (OR = 3.71, P-value < 0.001), physical activity (OR = 2.46, P-value = 0.001), insufficient income (OR = 3.43, P-value < 0.001, and being peri menopause (OR = 2.09, P-value = 0.029) or post menopause (OR = 2.02, P-value = 0.044) when compared to Cluster 1.

Conclusion: Based on these findings, women with underlying diseases, varying levels of physical activity, different income levels, different number of pregnancies, and menopause status in the moderate (Cluster 2) and severe symptomatic groups (Cluster 3) exhibited significant differences compared to those in the mild symptomatic group (Cluster 1). These results underscore the necessity for targeted interventions, such as promoting physical activity and providing mental health support, to alleviate menopausal symptoms. Additionally, further research is essential to identify the causal factors contributing to these symptoms, which could lead to improved care and health policies for women experiencing menopause.

Background: Severely abused nonpatient women report a high number of gastrointestinal (GI) symptoms and GI syndromes. Little is known about whether the abuse‒symptom relationship varies across different life, social, and community conditions.

Objective: To comparatively assess the timing, type and severity of physical and/or sexual abuse and GI symptoms of nonpatient women who contacted a lawyer for legal support with those who sought shelter in antiviolence centers.

Subjects and methods: Forty-six lawyer controls (LCs) (aged 29-80 years) and 67 women (aged 18-58 years) sheltered in antiviolence (V) centers completed an identical anonymous questionnaire with medical and abuse sections. The severity of abuse was assessed with the 0-6 Abuse Severity Measure (ASM). The associations between abuse characteristics and the number of symptoms were assessed with the Poisson regression model.

Results: Among the LC women, 65% experienced physical and/or sexual abuse in childhood and/or adulthood, whereas 100% of the V women did. In both groups, most women experienced combined sexual and physical abuse in childhood and adulthood. The ASM was < 2 in 57% of the LC and 18% of the V women. LC and V women reported an average of 4.9 and 4.6 GI symptoms, respectively. In both groups, women who had been both sexually and physically abused reported a greater number of GI symptoms. Childhood and adulthood abuse were associated with more GI symptoms only in V women. LC women with ASM > 2 reported more GI symptoms than those with an ASM of < 2 (median; IQR: 6.5; 3-11 vs 3; 1-7, p = 0.002). V women with ASM > 5 reported significantly more GI symptoms than control women with ASM < 5 (median; IQR: 6; 4-8 vs 4.5; 2-8, p < 0.001).

Conclusions: In abused "nonpatient" women, the combination of physical and sexual abuse, childhood and adulthood abuse and higher severity scores were associated with a greater number of GI symptoms, irrespective of the social and economic setting.

Purpose: Previous research has documented cognitive deficits in survivors of papillary thyroid carcinoma (PTC).Our longitudinal study with large sample size, aims to assess the impact of menopausal status on cognitive function, elucidate related factors of cognitive impairment, and chart the trajectory of cognitive changes over time in female PTC patients.

Methods: In this longitudinal study, we administered the Montreal Cognitive Assessment (MoCA) to 322 female PTC patients over 40 years old, before surgery and at 3 and 6 months after surgery. Propensity score matching (PSM) was used to adjust for baseline disparities, leading to a final analysis of 228 patients (114 premenopausal and 114 postmenopausal). Cognitive scores were compared between groups using the Mann-Whitney U test, and univariate and multivariate logistic regression analyses were performed to identify independent predictors of cognitive impairment.

Results: Postmenopausal women demonstrated a significantly higher susceptibility to impairment in delayed recall (p = 0.004) and global cognition (p = 0.006) when compared with premenopausal women. Multivariate analysis identified menopause (p < 0.001) and rural residence (p = 0.001) as independent risk factors for cognitive impairment. Furthermore, a gradual improvement in cognitive function over time was observed across both groups over the course of the study.

Conclusions: In female PTC patients, postmenopausal status and rural residence are significant risk factors for cognitive impairment. Postmenopausal women are more susceptible to cognitive deficits than premenopausal women in delayed recall and global cognition.Although cognitive function improves over time, it is crucial for physicians to closely monitor and support these patients to optimize their prognosis.