Current Women's Health Reviews - Volume 18, Issue 3, 2022

Adolescent girls and young women constitute a vulnerable population worldwide and an easy target to secondary impacts of a pandemic due to societal norms, existing age, and gender- based inequalities, leading to a condition known as “second pandemic”. Due to local and national lockdowns to prevent coronavirus spread, educational institutions, workplaces, health services have been shut down making adolescent girls and women prone to sexual, physical exploitation, gender-based violence, educational, financial loss, lack of sexual and reproductive health services. The present review briefs some of these secondary impacts of the COVID-19 pandemic on adolescent girls and women, which if taken care of can prevent many long-term consequences. Methodology: The literature was searched from governmental, non-governmental sites and agencies, like WHO, UN, UNICEF, Guttmacher Institute, International Labor Organization, and English peer-reviewed journals, using the USA National Library of Medicine (Pubmed) database, the regional portal of Virtual Health Library, and Scientific Electronic Library Online. The data from the onset of the COVID-19 pandemic till March 2021 on the impact of COVID-19 on women and children was searched and studied. The descriptors used were school drop-out children, adolescent girls, women suffering at home/work, unmet need for contraception, unwanted pregnancies, unsafe abortion, child marriages, and female genital mutilation. Results and Conclusion: COVID-19 pandemic has resulted in a “hidden pandemic” against women and children. There is a skyrocketing rise in violence against women/girls, teenage pregnancies, school drop-outs, child marriages, abuse, female genital mutilation. Hence, women and adolescent girls should be protected from the shadowing effects of the pandemic.

Background: Dysmenorrhea or menstrual pain is a commonly occurring disorder in reproductive age women with different proposed risk factors including body mass index. Objective: This study aimed to investigate the association of body mass index and dysmenorrhea using a systematic review and meta-analysis approach. Methods: Academic databases Scopus, PubMed CENTRAL, Embase, ProQuest, Science Direct, and ISI Web of Science as well as Google Scholar- were searched systematically from inception until the end of February, 2020. Original researches published in English with observational designs were included to examine the association of body mass index and dysmenorrhea as a primary outcome. Newcastle Ottawa scale was used to evaluate the methodological quality of the studies. Due to the variation of reported data across studies, all data were converted to Pearson correlation coefficient and corrected by transforming to fisher’s Z score. Then meta-analysis was performed using a random-effects model with Der-Simonian and Laird method. Results: A total of 61 studies with 57,079 participants, of which 25,044 reported having dysmenorrhea were included. The pooled estimated effect size of correlation showed trivial to small correlation between body mass index and dysmenorrhea with corrected fisher’s z score of 0.12 (95% CI: 0.08; 0.17, I2=95%). While publication bias was probable, results were corrected using the fill & trim method. The corrected results based on this method showed that pooled Fisher’s z-score for the association of body mass index and dysmenorrhea was 0.04 (95% CI: -0.009; 0.085). Conclusion: No association was found between body mass index and dysmenorrhea. But this finding should be interpreted with caution considering the included studies' limitations.

Background: Premenstrual syndrome (PMS) and dysmenorrhea are prevalent disabling conditions and affecting the quality of life of women of reproductive age. Melissa officinalis exhibits multiple pharmacological properties, including anti-inflammatory, antispasmodic, analgesic, and antidepressant activities. Objective: The aim of this study was to systematically review the effect of Melissa officinalis on PMS and primary dysmenorrhea. Methods: A systematic search in English (Embase #140;PubMed, ProQuest, Scopus, Clininaltrial.gov, Cochrane Library), and Persian (SID, Magiran, Iran Doc) databases to find articles was carried out in May 2020. All types of clinical trials were included. Two authors independently selected the articles and quality assessments and extracted the data. Standardized Mean Difference (SMD) was described as a measure of effect size due to the application of multiple tools to measure the severity of PMS. The quality of evidence was assessed using the GRADE approach. Results: A total of 978 articles were obtained from databases. Ultimately, 7 articles were included in the study. Based on the results of these 7 studies, the consumption of Melissa officinalis improved the symptoms of PMS and primary dysmenorrhea after treatment, as compared to the control group. Also, from the meta-analysis results, the consumption of Melissa officinalis in the intervention group as compared to the control group, significantly reduced the mean severity of PMS's symptoms following treatment) SMD: -0.93; 95% CI: -.19 to -0.67; P=0. 88; I²=0%). Conclusion: Due to the limited number of articles included in the meta-analysis, conducting well- designed clinical trials with large sample size to ascertain the effect of Melissa officinalis on PMS and primary dysmenorrhea are recommended.

Background: Lynch syndrome accounts for 3% of newly diagnosed endometrial cancers and colon cancers. Identifying patients with Lynch syndrome is fundamental to enable proper screening and prevention of at-risk malignancies, along with encouraging cascade testing of family members. We aimed to assess medical students' knowledge of Lynch syndrome-associated cancers and screening and prevention measures to decrease malignancy risk in patients with Lynch syndrome. Methods: An anonymous, voluntary, multiple-choice survey was emailed to 14 medical schools throughout the US to evaluate medical students’ knowledge of Lynch syndrome. Results: We surveyed 342 medical students, and 65% were third or fourth-year medical students. Ninety-three percent knew that colon cancer is one of two most commonly diagnosed cancers in Lynch syndrome; however, only 37% knew endometrial cancer was the other most common malignancy in Lynch syndrome patients. Fifty-nine percent of students recognized that 2-5% of all newly diagnosed endometrial and colon cancers are due to Lynch syndrome. Ninety-one percent recognized a family history that would indicate evaluation for Lynch syndrome, but only 49% knew that all patients diagnosed with endometrial cancer prior to age 50 should be evaluated for Lynch syndrome as per the National Comprehensive Cancer Network guidelines regardless of other risk factors. Conclusion: Almost two-thirds of medical students did not recognize endometrial cancer as a common Lynch syndrome malignancy and less than 50% were aware of when to evaluate patients with endometrial cancer for Lynch syndrome; comparatively almost all students recognized the link between colon cancer and Lynch syndrome. Curriculum change with targeted education regarding endometrial cancer and Lynch syndrome during medical school obstetrics and gynecology clinical rotations should be implemented. This call to action is critical in improving the diagnosis of Lynch syndrome, evaluation, screening, and prevention of cancers in both patients and family members to reduce mortality.

Background: Unsafe abortion remains one of the major public health problems, especially in developing countries. The objective of this study was to assess the level of knowledge on the legalization of abortion and the practice of abortion among Nepalese undergraduate female students. Methods: An analytical cross-sectional study was conducted among the 490 female students of Pokhara Valley, Nepal. Study populations from the 10 colleges were selected through purposive and systematic random sampling. The semi-structured questionnaire was used as a data collection technique. Results: Only 34% of students have a good knowledge of abortion legalization, compared to 42% who have poor knowledge. While two-thirds of the participants (66.6%) were aware that abortion is legal in Nepal, only a few were aware of the conditions for legalized safe abortion. During sexual intercourse, almost half of the participants (51.3%) did not use any form of contraception. Unintended conception was the primary cause of abortion (53.3%). Conclusion: The level of knowledge about the abortion law, safe abortion practice, and utilization of abortion services were found to be poor. Age of the participant, autonomy level for decision making, religion, and study background were the associated factors with the level of knowledge and practice of abortion. Community-based health promotion and awareness programs focusing on the youth population should be conducted.

Background: Maternal and neonatal mortality rates still pose a global challenge. Objectives: The present study aimed to identify the socio-demographic characteristics of mobile users trying to access antenatal care services, transportation to facilities, and postnatal care for mothers and newborns. Methods: This was a cross-sectional study that used data collected from the Bangladesh Demographic and Health Survey (BDHS) 2014. Data were gathered using a questionnaire. Participants comprised 4,494 mothers aged between 14 and 49. Models of logistic regression were used to determine associations. Results: The overall sample size was 4494, with only 22.23% of women using mobile phones. Among these, 29.9% used their mobile phones to obtain health services or advice and 70.1% did not. Women with mobile phones who had a higher level of education used them to receive more health care (secondary and higher: OR = 1.922, 95% CI = 1.225-3.014; primary: OR = 1.982, 95% CI = 1.738-2.654), they were of higher socio-economic status (rich: OR = 1.228, 95% CI = 1.009-1.494; middle income: OR = 1.691, 95% CI = 1.256-2.333), they accessed more prenatal care (yes: OR = 1.993, 95% CI = 1.425-1.987) and antenatal care (yes: OR = 1.951, 95% CI = 1.765-1.998) and they checked their health status after delivery (yes: OR = 1.966, 95% CI = 1.639-2.357). Conclusion: The results of the present study showed that young women who had a higher level of education and income and resided in urban areas were more likely to use mobile phones to receive health care facilities in Bangladesh. Intervention studies are essential for recognising that mobile phone-based facilities improve maternal health care.

Background: Abortion is one of the most common side effects of pregnancy, which has had shown a steady or even growing trend over the past few decades despite extensive efforts in prenatal care. Objective: This study aimed to investigate medical interventions for abortions in pregnant women referring to educational and medical centers in Shiraz, Iran, in 2018. Methods: In this cross-sectional study, 437 pregnant women referred to Shiraz Educational and Forensic Medicine Centers were selected. A questionnaire including demographic characteristics, midwifery information and types of medical interventions was completed for each. Data were analyzed by SPSS software using statistical tests. Results: According to the results of the present study, most subjects were aged 31-40 years (202 (46%)), had a high school diploma (183 (41%)), and were housewives (331 (57%)). Most of their gestational age was in the range of 16-20 weeks (184 (41%)). There was also a significant positive relationship observed between maternal age and gestational age (p = 0.01). Misoprostol and cervical Foley were the most used methods in induced abortions with a forensic permit (44.3%), vaginal misoprostol was the most used method in induced abortions with other indications (43.9%), and most spontaneous abortions involved no intervention (41.9%). Conclusion: Considering the importance of the medical abortion method, it is suggested to be considered for patients with different conditions in interventional studies. Also, the correct use of different family planning methods and identification of factors affecting the use of contraceptives are recommended after an abortion. Women’s education and men’s participation should be considered in the prevention of high-risk and unwanted pregnancies.

Background: Menstruation is a prominent mark of womanhood. It is necessary to explore what factors may develop female attitudes towards this natural phenomenon in different populations. Objective: This study aimed to explore the relationships between gender roles and attitudes towards menstruation and perception of menstrual pain among Iranian women. Methods: This cross-sectional study was conducted on 164 women of reproductive age in Torbat-e Heydariyeh in the east of Iran between September and December 2019. The participants completed the Bem Sex-Role Inventory (BSRI), Menstrual Attitude Questionnaire (MAQ), and Verbal Multidimensional Scoring System (VMSS). Data analysis was then performed in SPSS 16.0. Results: According to the results, menstruation was perceived as a natural phenomenon more significantly by the androgynous group than by the undifferentiated and masculine groups (p<0.05). It was also perceived as a predictable phenomenon more significantly by the feminine women than by the other gender role groups (p<0.05). Furthermore, the gender role groups had no significant differences in the prevalence and severity of menstrual pain (p>0.05). Conclusion: Androgynous women considered menstruation a natural phenomenon more often. Psychological interventions should focus on the correction of attitudes towards menstruation, especially in women with femininity, masculinity, and undifferentiated gender roles.

Background: Pap tests can detect changes inside the cells of the cervix before cancer develops. Objective: To compare the risk factors and determinants for abnormal cytological changes in Pap test results among women with and without atypical cytological findings in their Pap test, and to determine the clinical manifestations associated with those changes. Methods: A multicenter case-control study was conducted in four clinics of gynecology and oncology in Iran. Of a total of 201 women with a result of Pap smear, 51 were cases (atypical cytological findings) and 150 women were control (benign/reactive changes). The data was collected by a researcher-designed tool through the interview, observing medical records and clinical examinations. Results: According to the logistic regression, the women’s age (OR= 1.08), age at the menarche (OR= 0.75), number of deliveries (OR= 1.44), and BMI (OR= 2.60) are the determinants of the Pap test cytological changes in Iran. Taking hormonal contraceptives, using IUD, sexual activity, and having a family history of cancer are not determinants (p>0.05). The clinical manifestations as having an unhealthy cervix, painful sex, low abdominal pain, pelvic pain, and low back pain were significantly higher (P< .001) in the case group than those of the control group. Conclusion: The Pap test cytological changes in Iranian women are associated with age, age at the menarche, number of deliveries, and BMI. This information can help healthcare providers to predict their patients' health situation for taking a suitable and quick action.

Background: There is a paucity of research on knowledge, attitude, and practice regarding the harms of exposure to Environmental Tobacco Smoke (ETS) among pregnant women. Objective: This study, therefore, aimed to examine the knowledge, attitude, and avoidance behavior towards ETS exposure at home among Iranian pregnant women. Methods: This cross-sectional study was conducted on 150 non-smoking pregnant women with smoking husbands in Urmia, Iran, in 2019. The participants were selected through a multi-stage process. The data were collected using a researcher-made questionnaire that measured demographic data, knowledge, attitude, and behaviors in avoiding ETS. The data were analyzed using Pearson- ’s correlation coefficient, t-test, and ANOVA by SPSS-16 at a significance level of 0.05. Results: The majority of participants (54.7%) had sufficient knowledge about ETS. The women's attitude and efforts to prevent ETS exposure were moderate in 50% and 60% of the cases, respectively. The participants’ knowledge had a significant association with their level of education, employment status, and family income (P<0.05). Knowledge had a significant and positive relationship with attitude (P=0.001, r=0.280) and efforts to prevent ETS exposure (P<0.001, r=0.403). Conclusion: Knowledge about ETS was significantly correlated with attitude and avoidance behavior of ETS exposure. Therefore, pregnancy care providers to improve the attitude and practice of pregnant women should implement interventional programs. Public health initiatives are also needed to empower women and encourage them to reduce ETS exposure.

Introduction: Today, the issue that is challenging cesarean delivery is its overuse as the conventional method of birth in the world, especially in developing countries. The Iranian health system implemented the Health Sector Evolution Plan (HSEP) in 2014 to reduce CS rates. Objective: The objective of the study was to evaluate the effect of the implementation of the HSEP on the rate of CS in an Iranian subpopulation (Qom province) in 13 years. Methods: In this longitudinal retrospective study, the trend of CS rate over 13 years (2005-2017) in Qom province has been studied by using an interrupted time series analysis. Results: In the period after implementation of the HSEP, the rate of CS decreases by 0.1% monthly compared to the previous period, which was not statistically significant. This trend is more definite among governmental hospitals. In contrast, the pattern observed in non-governmental hospitals has a monthly increased trend. Conclusion: After more than four years of implementation of the HSEP, it has not been able to significantly reduce the overall CSs during this period in Qom province and has failed to reach the plan's goals.

Background: Different strategies have been suggested to increase successful breastfeeding, including establishing child-friendly hospitals, prenatal training courses, and various counseling models in breastfeeding self-efficacy enhancement in women with gestational diabetes. Objective: This study aimed to determine the effect of counseling on breastfeeding self-efficacy in women with gestational diabetes.. Methods: The present study was a quasi-experimental intervention that was conducted on 100 pregnant women with gestational diabetes after obtaining informed consent. The intervention group received breastfeeding counseling based on the GATHER approach in the third trimester of pregnancy between 32 and 33 weeks and between 35 and 36 weeks of pregnancy, respectively. The follow- up process was performed in 4 sessions after delivery: 14 to 16 days after delivery, and 28 to 30 days after delivery for 60 to 90 minutes. The control group, on the other hand, only received routine care. After counseling, self-efficacy was examined at the end of the study and after the third month. The data were analyzed using statistical independent t-tests and chi-square. Results: The mean score of self-efficacy of breastfeeding at the end of the study was 55.12 in the experimental group, which was higher than that of the control group (46.16) (P =0.0001). The frequency percentage of exclusive breastfeeding was 58% in the experimental group and 22% in the control group (P =0.0001). Conclusion: Considering the effectiveness of breastfeeding counseling on increasing self-efficacy and continuity of breastfeeding in diabetic breastfeeding mothers, it is suggested to use prenatal and continued in postnatal for diabetic mothers.

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, participated in the study in 2015. The required data were gathered from hospitals which had the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interesting outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with a higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28-2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia, but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with a higher risk of unintended pregnancy, preterm birth and cesarean section, but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

Aims: Improving sexual function in women with disability such as multiple sclerosis was aimed. Background: Sexual dysfunction and the consequent low satisfaction is very common in females with Multiple Sclerosis (MS). Objectives: This study aimed to investigate the effectiveness of Relationship Enhancement Therapy (REP) on sexual function and satisfaction of females with MS. Methods: The present study was an educational design with two groups, in which 44 females with MS participated and their spouses (N= 88) participated and randomly divided in two groups of intervention (N= 22 couples) and control (N= 22 couples). They signed written consent forms and were included in the project. The intervention group received the REP in six 90-minute sessions. The groups completed standard questionnaires of sexual dysfunction and sexual satisfaction in three stages of pretest-posttest and 3 months later. The Descriptive and inferential statistics (Twoway repeated measures ANOVA, chi-square, t-test and Mann-Whitney U test) were used to analyze data. Results: The results of analysis showed that there was a clinically significant difference between the scores of sexual dysfunction in different phases of the assessment between two groups (p <0.05). Also sexual satisfaction was higher in the intervention group vs. in the control (p <0.05). Conclusion: According to the findings, marital enrichment program was effective in improvement of sexual function and sexual satisfaction of females with multiple sclerosis. It is recommended to healthcare providers to use enrichment alongside medical services to improve patients' sexual life.

Background: Ultrasound has become an invaluable tool in our daily practice. Its role in screening for adhesions has been tested since the 1990s. Objective: This study aims to determine the role of the visceral slide test as a screening method to predict abdominal wall adhesions in women undergoing gynecological surgery. Methods: We conducted a prospective observational cohort study from August 2017 to July 2019 in women undergoing elective abdominopelvic surgery for a gynecological indication. Preoperatively, a visceral slide test was performed in 5 specified zones on the abdomen and the test results were clinically correlated with the presence, severity, and extent of adhesions intra-operatively. Results: Results were reported as mean, standard deviation, range of values or number and percent. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy (including 95% confidence interval for all) of visceral slide test were calculated to determine intra- abdominal adhesions . We also found a correlation between the number of negative slide tests and PAI scores using Spearman’s correlation test. Of the 339 women who completed the study, 41.2% had a previous history of abdominopelvic surgery. In this study, the visceral slide test was found to have a sensitivity of 70.87% (95%CI 62.15-78.59), specificity of 86.32% (95% CI 80.95-90.64), Positive Predictive Value (PPV) of 75.63% (95% CI 68.49-81.59), negative predictive value (NPV) of 83.18%(95% CI 78.95-86.70) and diagnostic accuracy of 80.53%(95% CI 75.91-84.61)with p-value less than 0.001. The number of negative slide tests positively correlated with the Peritoneal Adhesion Index score (r = 0.662, p < 0.001) and also with increasing operative time and intraoperative blood loss. Accuracy and positive predictive value of the test were significantly higher in patients with a history of abdominal surgeries, endometriosis and PID. Conclusion: Visceral slide test is an easy, rapid, non-invasive and reliable screening test to predict abdominal adhesions in women undergoing gynecological surgery. The presence of risk factors for adhesions increases the accuracy of the test.s

Background: The purpose of intrapartum fetal monitoring by cardiotocograph (CTG) is to identify early signs of developing hypoxia so that appropriate action can be taken to improve the perinatal outcome. Although CTG findings are well known to monitor the progress of the labor due to the paucity of recommendations, there has always been a clinical dilemma as the term fetuses respond differently than a preterm fetus. However, umbilical cord blood pH can distinguish the infant at high risk for asphyxia and related sequel. Therefore, because of differences in fetal physiology in term and preterm fetuses, CTG findings vary, and hence the validity of CTG to determine fetal acidosis should be different. Aims and Objectives: This study aimed to correlate abnormal intrapartum CTG findings with umbilical cord blood pH in term and preterm labor and thus evaluate the success of CTG in predicting fetal acidosis during labor. Methods: The present study included 210 women in labor (70 preterm and 140 term) with abnormal intrapartum CTG that was classified as per 2015 revised International Federation of Gynecologists and Obstetrician (FIGO) guidelines. Immediately after delivery, 2 ml Umbilical artery cord blood sample was taken in a pre-heparinized syringe for analysis, pH <=7.2 was taken as acidosis and pH >7.2 was taken as normal. The measured data were general maternal characteristics which included gravida status, associated comorbidities, method of induction and character of liquor, the intrapartum CTG tracings recorded, the cord arterial blood pH and the neonatal characteristics such as APGAR score and neonatal outcome. Results: Data from 70 preterm labor was compared with 140 term labor. In this study, 20.9% of the babies had acidosis. Suspicious CTG due to decreased variability were more common in the preterm group than in the term group (21.4% vs. 8.6% p<0.05). Positive predictive value (PPV) of abnormal CTG for fetal acidosis in the preterm group was found to be higher than that in the term group, PPV of pathological CTG being even higher than suspicious CTG. Women with suspicious CTG had 82% less risk of fetal acidosis as compared to pathological CTG. Women with Bradycardia had 5.9 times the risk of fetal acidosis as compared with normal and tachycardia. Conclusion: Abnormal CTG should be managed appropriately without any delay to prevent acidosis and cord blood pH should be done in all labors with abnormal CTG. However, our findings of a higher incidence of lower cord blood pH and suspicious CTG due to decreased variability alone highlight the limitation of criteria currently used for interpretation of CTG in preterm labors.

Background: Menstruation-related symptoms (MRSs) have been observed to result in absenteeism from either work or education, more commonly among women below 21 years than women of any other age group. Despite its high prevalence and associated ill effects, it is generally ignored even by medical students. Objectives: This study was conducted to assess the pattern, determinants, and treatment practices of menstrual disorders among undergraduate medical students. Methods: This was a cross-sectional study conducted among 215 female medical students from first to final year. Data were collected by using a self-administered questionnaire. The height and weight of participants were measured using standard procedures. Results: The most common menstrual disorders reported by participants over the past six months were dysmenorrhoea (191(88.8%)) followed by irregular cycles (43(20.0%)). In multivariable analysis, the presence of polycystic ovarian syndrome (PCOS) and excessive consumption of coffee was associated with irregular menstrual cycles; the presence of anaemia was associated with menorrhagia, the presence of fibroids and age of participants were associated with polymenorrhoea, excessive chocolate consumption was related to intermenstrual bleeding, excessive chocolate consumption, presence of anaemia, and low body mass index (BMI) were associated with premenstrual syndrome. Self-medication was reported by 15 (42.9%) out of the 35 participants on treatment. Conclusion: Dysmenorrhoea and menstrual irregularities were common among participants. They need to limit potential risk factors like excessive consumption of coffee and chocolates. Additionally, screening for anaemia, PCOS, fibroids and low BMI needs to be done. Self-medication practices need to be also dissuaded in the setting.