Current Women's Health Reviews - Volume 20, Issue 1, 2024

Background: Endometriosis is one of the most frequent illnesses and is connected with substantial problems, such as pain and reduced social function. Objective: This study aimed to examine the association between painful endometriosis symptoms and women's quality of life. Methods: This research included 169 endometriosis patients. Data was collected using sociodemographic, ENDO PAIN- 4D, and EHP-30 questionnaires. To examine the relationships between pain symptoms and quality of life, the Pearson correlation test was performed. Also, the general linear model with controlling the probable confounding variables was used for multivariate analysis. Results: The mean (SD) of the overall ENDOPAIN 4D and the overall EHP 30 scores were 66.0 (61.0), and 35.9 (22.4), respectively. In terms of quality of life, the emotional domain had the greatest 42.0 (20.3), and the pain domain had the lowest mean score 7.2 (4.5). The total score of EHP 30 and ENDOPAIN 4D had a substantial positive connection (r = 0.55 and p > 0.001). With an increasing ENDOPAIN 4D score, the quality-of-life score increased (B = 0.2; CI: 95 %: 0.1 to 0.2). Explaining that in the EHP-30 scale, the quality of life worsens as the score increases. Conclusion: This study found that the more intense the painful symptoms of endometriosis, the poorer the quality of life. Thus, it is vital to lessen the painful symptoms and practice self-care to enhance these patients' quality of life.

Background: In recent times, social media has been playing an important role in spreading health awareness including breast cancer awareness. Breast cancer is the most common form of cancer among Indian women. Awareness of its risk factors, symptoms, screening methods and positive attitude towards screening and practices are essential to reduce the advanced stage diagnosis and further its mortality rate. This study aims to evaluate knowledge, attitude, and practice about breast cancer in social media users’ in women in the metro city Delhi of India. Methods: We conducted a cross-sectional study from June to December 2019, obtaining data from 397 women using a structured questionnaire. It had four sections that included the socio-demographic profile, knowledge of the risk factors of breast cancer, symptoms and screening, attitude towards screening methods, and its practice to prevent the disease. Results: The mean age of the respondents was 39.34 (±10.22) years. Interestingly, while 92.4% (367/397) knew about the dreaded disease, only 74% knew about its risk factors. The participants who were married, educated and working had reported significantly higher knowledge scores (p ≤ 0.001) Almost three fourth of these women did have a positive attitude towards breast self-examination and clinical examination, and 58% of them were practicing breast self-examination, on monthly basis. Conclusion: Our study findings revealed that women using social media were having a good awareness of risk factors, symptoms, and screening methods. They also have a positive attitude toward screening methods for breast cancer. It highlights the need for awareness generation for practicing early screening behavior.

Background: Primary dysmenorrhea is a prevalent complaint among women nowadays. Primary dysmenorrhea is a painful disorder that occurs during the menstrual cycle. It is described as unpleasant menstrual cramps or period discomfort that occurs without the presence of any pelvic illness. Primary dysmenorrhea is one of the most common causes of absence from school, work, and social activities. It has an impact on women's daily quality of life. Objective: To investigate the efficacy and safety of non-pharmacological treatments for women suffering from primary dysmenorrhea. Methods: We looked up information on gynaecology in the Cochrane library, PubMed, ScienceDirect, and other databases. We looked at multiple clinical trial databases from the year before as well as systematic reviews that had been done before. Results: As per qualitative assessment, non-pharmacological management for primary dysmenorrhea is extremely effective and wonderful for overall health. Primary dysmenorrhea can be treated with any of the approaches outlined in this study. Conclusion: The study revealed that non-pharmacological approaches, such as yoga, physical activity, heat treatment, massage therapy, water therapy, dietary supplements, acupressure, aromatherapy, massage therapy, and other non-invasive techniques, have a significant role in the management of dysmenorrhoea. It was observed that women who engage in regular physical activity do not experience severe dysmenorrhea. Additionally, it was discovered in this study that dietary nutrients like vitamin D and other nutraceuticals ameliorate the symptoms of dysmenorrhea.

Objective: Considering supportive evidence on N-acetylcysteine (NAC) effectiveness in neuropathic pain syndromes, we conducted this study to evaluate its effect on women suffering from chronic pelvic pain syndrome (CPPS). Methods: In a randomized, double-blind study, 106 women with CPPS were assigned to receive NAC+amitriptyline or placebo+amitriptyline treatment. Amitriptyline was administrated at a dose of 25 mg/daily and NAC and placebo at 600 mg twice daily. The effect of treatment was assessed on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and its domain scores, including pain, urinary symptoms, and quality of life impact scores at weeks 4 and 8 after treatment. The global response was also assessed on the 7-point patient-reported global response assessment (GRA) scale at the end of the study. Results: By week 4, comparative improvements were noticed in the two groups' NIH-CPSI total score and domain scores. From week 4 to week 8, we noted the superior efficacy of NAC+amitriptyline treatment over placebo+amitriptyline in improving the NIH-CPSI total score and its domain scores, as the proportion of patients responding to treatment (the subjects with ≥ 6-point reduction in the total NIH-CPSI score), as well those reporting marked or moderate improvements in their overall symptoms on GRA was significantly more significant in patients receiving NAC+amitriptyline treatment relative to those receiving placebo+amitriptyline treatment. Conclusion: These findings provided preliminary evidence regarding the possible role of NAC as an adjunct therapy in the management of CPPS in women, which needs to be validated in future studies.

Introduction: The purpose of this systematic review was to reach a general conclusion regarding the effects of Lamiaceae plants on hirsutism by performing a meta-analysis of the clinical trials. Methods: PubMed, Cochrane Library, Scopus Cochrane Central Register of Controlled Trials databases were searched and selected from the results of clinical studies to evaluate the effect of Lamiaceae plants on hirsutism. Results: Three clinical studies were selected for meta-analysis. In the performed meta-analysis, changes in androgenic hormones levels were non-significant for total testosterone (TT) (SMD = -0.03; 95% CI [-0.68, 0.08]; P= 0.12) and significant for free testosterone (FT) (SMD = -0.85; 95% CI [- 1.45, -0.25]; P= 0.005). On the other hand, FSH level did not reduce (SMD = -0.39; 95% CI [-1.83, 1.06]; P= 0.60), while LH showed a marginally significant increase (SMD = 0.37; 95% CI [-0.007, 0.75]; P= 0.055). Ferriman – Gallway score did not show a remarkable change based on the metaanalysis of two studies (SMD = 0.89; 95% CI [-0.73, 2.51]; P= 0.28). Conclusion: The results showed that the Lamiaceae family can reduce serum levels of some hormones and signs of hirsutism. However, they do not change signs of hirsutism.

Background: Since breast cancer is increasing worldwide and previous risk factors cannot justify such an increasing trend, investigating new environmental factors is necessary for each population. Mammographic breast density (MBD) is a strong risk factor for breast cancer as well as a biomarker for the effect of chemicals on breast tissue. Objective: Given limited data about the association between breast density and cosmetic products containing endocrine-disrupting chemicals (EDCs), the purpose of this study was to evaluate the effects of cosmetic products on MBD in Iranian women. Methods: In this cross-sectional study, women who attended two university hospitals for breast screening mammography and who had been living in the capital city of Iran for the last 3 years or more were recruited. We asked women to fill out a questionnaire containing two parts; the first part was about the women's characteristics and medical history and the second part consisted of cosmetic use. The frequency of cosmetic use was measured using the Likert scale in four scales. One expert radiologist in each center reported the MBD on a four-category scale. Results: The mean age of 813 participants was 50.16 ± 7.65. Three hundred-seven (37.8%) women had low breast density and 506 (62.2%) had high breast density. Based on our results, heavy use of moisturizers, sunscreen, nail polish, eye products, makeup products, and lipstick was associated with increased breast density. In multivariable analysis after adjusting for menopause, excessive use of nail polish, sunscreen, and moisturizing cream was associated with increased MBD. Conclusion: Our study shows a probability of an increased MBD with the excessive use of cosmetic products. Since a small increase in the risk of breast cancer may lead to a considerable public health impact, thus further studies are needed to find new prevention strategies.

Background: Common causes of maternal deaths are direct obstetric complications that can be managed by healthcare providers in health facilities. Women giving birth at home have a higher contribution to maternal mortality and morbidity as well as a poor fetal outcome. Sub-Saharan Africa accounts for an estimated 66% of all maternal deaths. This study aimed to explore why pregnant mothers prefer to deliver at home after antenatal care follow-up in South Ethiopia. Methods: Phenomenological study design was used to explore the factors that push women to home delivery despite antenatal care being provided. A purposive technique was used to recruit the twenty pregnant mothers for the focused group discussion and ten healthcare providers for an in-depth interview. The data saturation approach determined the sample size. A focused group discussion was commenced with women who had ANC follow-ups during pregnancy gave birth at home and came for immunization services in health facilities. The in-depth interview was done with physicians, midwives, health officers, and traditional birth attendants. Data were translated into English by a bilingual translator and analyzed thematically using Open Code software. The result was presented in a table and text. Results: The study includes a total of 20 women for FGDs, seven health professionals, and three traditional birth attendants from selected health facilities. The age of most FGD participants was 25-35 years. The ideas of the participants were grouped into five themes and subthemes. Fear of health professionals’ disrespect and abuse, a family decision on the place of delivery, lack of transport and money, traditional birth attendants’ acceptability by the community, and sociocultural influences were commonly raised as barriers to institutional delivery. Conclusion: Most of the barriers are related to behavioural issues, and effort should be made to change the behaviour of the community in general. Improving the quality of the antenatal care service and adequate counseling may be an appropriate intervention to increase health facilities' delivery.

Background: Gestational diabetes (GDM) is a pregnancy-related endocrinopathy. Its etiology is not well understood. Obesity and insulin resistance coexist in GDM. Apelin is an adipocytokine secreted by fatty cells and expressed in many organs; it can modulate blood glucose. According to research, apelin levels are higher in obese and type 2 diabetes patients. We aimed to examine the value of serum apelin as a reliable marker for GDM at 24-28 weeks of pregnancy. Methods: A case-control study recruited 120 pregnant women in an age range of 20-40 years with a singleton pregnancy at 24-28 weeks of pregnancy; all were matched in BMI and gestational age. They are divided into 2 groups: 60/120 GDM cases based on the International Association of Diabetes and Pregnancy and 60/120 matched controls at a gestational age of 24-28 weeks at Al-Yarmouk Teaching Hospital. Demographics data, serum biochemical permeates including HbA1c, fasting blood sugar (FBS), fasting insulin level, 1 h plasma glucose, and 2 h plasma glucose, following a 75-gram glucose loading, and a fasting insulin level were recorded. Results: None of the demographic criteria were significant between the two groups at P < 0.05. FBS, fasting insulin, OGTT-1 and 2 hours, HbA1c, and serum apelin were significantly higher in GDM cases with P < 0.0001. Pearson's correlations show that Apelin has a statistically significant correlation with BMI, FBS, fasting insulin, OGTT-1 and 2 hours, and HbA1c, with r = (0.34, 0.71, 0.65, 0.72, and 0.63) and P < 0.0001. ANOVA confirmed an insignificant effect of BMI centile on serum apelin, P < 0.072. ROC estimated the apelin cut-off at > 11.3 (ng/l), associated with 84% sensitivity and 100% specificity, P < 0.001. Conclusion: Strong and significant apelin correlations with parameters for screening GDM make it a valuable marker, especially when its levels are unaffected by body mass index. Further studies are recommended to unveil therapeutic avenues for apelin.

Worldwide, ovarian cancer (OC) is one of the leading causes of cancer-related death among women. Despite the recent progress in the treatment of advanced OC, oncologists in many parts of the world still face several difficulties and constraints in the daily management of their patients. In addition to the shortage of resources and expertise, non-adherence to the up to date international guidelines has been identified as a major obstacle towards the improvement of treatment outcomes in the majority of developing countries, including the Middle East and North African (MENA) countries. A multidisciplinary gynecological oncology panel from the MENA region met virtually in December 2020 to discuss the challenges and hurdles faced by the community oncologists in the management of advanced OC. This manuscript reviews the key molecular and clinical studies that shaped the current international guidelines and suggests several modifications to make them more adaptable to the health status of developing countries of this region.

Background: Fatigue accumulates throughout the labor period and often occurs in conjunction with pain and anxiety during childbirth, resulting in negative effects on laboring women. Objective: The purpose of this study is to investigate the effectiveness of an integrated symptomrelated fatigue management program (ISFMP) on pain, anxiety, fatigue score and lactate levels in a low-risk pregnant woman during childbirth. Methods: This quasi-experimental study was conducted from August of 2021 to March of 2022 at Prachuap Khiri Khan Hospital. Sixty-five low-risk pregnant women with 32–41⁺⁶ weeks gestation were selected by the stratified random-sampling and matching techniques. They were then randomly assigned to either comparison or intervention groups. Data were collected using a demographic questionnaire and a visual analogue scale for pain, anxiety and fatigue. Lactate Pro 2 was used to evaluate lactate levels. Data were analyzed through statistical software (SPSS-26) using independent t-test, chisquare, repeated measure ANOVA and repeated measure multivariate analysis of variance (MANOVA). The significance level was set at p <.05. Results: The participants in the comparison and experimental groups had varying pain, anxiety, fatigue scores and lactate levels throughout their progression of labor. Pain, anxiety and fatigue in the experimental group were significantly lower than in the comparison group (p < .001). There were no statistically significant differences in lactate levels between the two groups. Conclusion: The ISFMP was shown to be effective in lowering the symptoms of pain, anxiety and fatigue in women in labor. Midwives should apply the ISFMP in their clinical practice when caring for low-risk pregnant women.

Background: Since there was no study on the effect of auriculotherapy on reducing the use of oxytocin and labor length, the present study is aimed to investigate this issue. Methods: The present study was a randomized clinical trial with two parallel arms, without blinding, which was performed on 93 nulliparous women. Setting this study was done in one of the referral hospitals in Qom, Iran. The samples were randomly assigned to two groups: oxytocin (n = 47) or auriculotherapy and oxytocin (n = 46). After hospitalization of mothers in the active phase, in one group, 10- unit oxytocin was administered for augmentation, and in the second intervention group, the auriculotherapy technique, in addition to oxytocin, was performed. the master points zero, Shenmen, endocrine, thalamic, uterine, prostaglandin points, vagina on the earlobe area. The points were stimulated with the Pointer Plus electric device for 30 seconds, and 60 minutes later, the other ear was stimulated. The results were analyzed by SPSS 22, T-test statistical analysis, and Chi-square test. Results: Regarding the main purpose of the study, the results showed that the length of the active phase indicated a significant decrease in the auriculotherapy group compared to the oxytocin group (244.86 ± 64.19 vs. 284 ± 62.75, p = 0.01). The other purpose of the study showed that the mean of oxytocin consumption significantly decreased in the auriculotherapy group. Conclusion: It seems that auriculotherapy is an appropriate alternative method for labor augmentation.

Background: China officially launched the universal two-child policy in January 2016. No studies in China have examined the characteristics of pregnant women since the implementation of the new family planning policy. Methods: We conducted a retrospective cohort study in Chengdu, China, to examine pregnant women's sociodemographic and obstetric characteristics satisfying the new policy requirements. Two thousand pregnant women were enrolled in the case group, 2016-2017. The comparison group included 2,000 pregnant women from the same institutions. Maternal and clinical information was extracted from medical records. Results: Compared to comparisons, the case group tended to have a higher household income and work in a non-state-owned enterprise/institution. Additionally, cases were more likely to be older (OR=1.36; 95% CI 1.09-1.70), have a history of cesarean section (OR=31.68; 95% CI 24.76-40.54), and suffer from gestational hypertension (OR=3.35; 95% CI 1.56-7.19), gestational diabetes mellitus (OR=1.61; 95% CI 1.24-2.10) and placenta previa (OR=4.45; 95% CI 2.70-7.34) than comparisons. Conclusion: We suggest emphasizing the importance of reproductive counseling and assessment, particularly targeting those satisfying the universal two-child policy requirements.

Background: COVID-19 is an emerging, highly contagious disease caused by the SARSCoV- 2 virus. Pregnant women appear to be at greater risk for COVID-19 infection and complications. Considering the importance of maternal and fetal healthcare, this study aims to evaluate some of the maternal, fetal, and neonatal outcomes in pregnant women with COVID-19. Methods: Pregnant women at the gestational age of 20 weeks or more were recruited and divided into two groups: cases (those with COVID-19 infection) and controls (those without the infection). Maternal complications during the current pregnancy, delivery factors, and fetal/neonatal complications were recorded and compared between the groups. Results: Maternal COVID-19 infection was highly associated with the need for emergency cesarean surgery (p = 0.005), preterm labor (p = 0.017), and the need for NICU admission for newborns (OR = 0.05, p = 0.000). Also, high rates of vertical transmission of the infection were observed in the cases. Conclusion: Maternal COVID-19 disease could be associated with a range of complications for both the mother and her newborn. The vertical transmission rate was also observed to be higher than previously reported in the literature. Further studies are required to evaluate this phenomenon.

Background: Breast Cancer is one of the most frequently diagnosed cancers among women all over the world. Objective: The purpose of this study is to identify determinants of breast cancer and evaluate the effectiveness of return to work as a result of early diagnosis. Methods: A cross-sectional survey was conducted in a university hospital dedicated to women's health and gynecology. It investigated the return to work among women diagnosed with breast cancer at least two years and at most five years before the onset of the survey. Results: At the time of the investigation, 72% of patients returned to work. The initially occupied workstation was regained by 5% of women. The loss of the position occupied before cancer diagnosis was significantly associated with the age at diagnosis time (p = 0.02), the prívate working sector (p = 0.014), and with blue-collar professional category (p = 0.02). Nevertheless, the higher likelihood of returning to active life after breast cáncer was significantly associated with early diagnosis and better health assessment (p = 0.01). Conclusion: Returning to work among breast cáncer survivors is important for everyday life recovery. The professional recovery may be improved by early diagnosis and multidisciplinary interventions.

Purpose: Hookah (water pipe) smoking, an ancient tobacco smoking method, is gaining widespread popularity worldwide. Although research in this field is still lacking, its harmful effect on human health through the increased risk of cardiovascular disease, infection, and cancer has been proven. Cigarette smoking has been found to have a detrimental effect on reproductive function. However, data about the effect of hookah smoking on human fertility or reproductive outcomes are scarce. In this study, we aimed to determine if smoking hookah has a harmful effect on the human ovarian reserve test, anti-Mullerian hormone levels, and cycle regularity. Materials and Methods: A total of 100 healthy non-cigarette smoking women in the 25-35 age range undergoing laboratory investigations were randomly chosen to participate. After obtaining consent, they completed a questionnaire about smoking habits and menstrual data. Blood samples were withdrawn for anti-Mullerian hormone testing. The anti-Mullerian hormone levels of 50 women hookahonly smokers were compared to 50 non-smoking women. Results: There were no significant differences in mean anti-Mullerian hormone levels and cycle regularity between hookah smokers and non-smokers. However, period pain was significantly associated with hookah smokers relative to non-smokers (p = 0.036). There was an inverse relationship between log10 anti-Mullerian hormone levels and log10 hookah smoking index. This correlation was significant as measured by Spearman’s rho test, and the correlation coefficient was -0.331 and p-value = 0.02. Moreover, binary logistic regression for cycle regularity showed that hookah smoking was associated with an increase in the likelihood of having an irregular cycle, but the effect was not significant (p = 0.514) for hookah smoking. Conclusion: Under the conditions of this study, no significant association between hookah smoking and neither AMH levels nor cycle regularity could be observed.