Previous studies have mainly examined prevalent metabolic syndrome (MetS) and have reported differing directions for reproductive-timing associations; longitudinal evidence among women already postmenopausal is limited. We analyzed the 2011 and 2015 China Health and Retirement Longitudinal Study waves. Reproductive span was calculated from retrospectively recalled ages at menarche and menopause. Among 1,665 women with classifiable MetS status at both waves, 776 were free of MetS in 2011; of these, 188 had MetS in 2015. One woman with missing smoking status was excluded from the adjusted model, leaving 775 women and 187 events. Log-binomial regression with community-cluster-robust inference and marginal standardization estimated risk ratios (RRs) and risk differences (RDs). For a five-year longer reproductive span, the adjusted RR was 1.13 (95
Upper limb dysfunction remains a frequent challenge for breast cancer survivors following modified radical mastectomy (MRM) with axillary lymph node dissection (ALND). Although alterations in scapular function may be relevant to postoperative shoulder impairment, scapular-region loading patterns and their relationships with upper limb function remain insufficiently understood. This exploratory cross-sectional study examined the associations between scapular-region pressure distribution and upper limb function during shoulder flexion in this population. Twenty-six female breast cancer survivors (mean age, 49.2 ± 11.0 years) who had undergone MRM with ALND and achieved at least 120° of active shoulder flexion were included in this cross-sectional study. A body pressure sensor system recorded scapular-region pressure distribution bilaterally at 0°, 30°, 60°, 90°, and 120° of shoulder flexion under standardized supine conditions. Key variables included the maximum pressure value (MPV), number of peak pressure values (NPPV), and the horizontal distance of the MPV from the center of pressure (HDSMC). Shoulder range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and scapular positioning were also assessed. Side-to-side differences in scapular-region pressure distribution and scapular position were observed. In separate stepwise regression analyses, active shoulder flexion was associated with the DASH score (adjusted R² = 0.190), DIASS at 90° of shoulder flexion (adjusted R² = 0.186), NPPV at 30° (adjusted R² = 0.119), and HDSMC at 90° (adjusted R² = 0.206). However, the association with NPPV30° was not statistically significant in a Spearman sensitivity analysis. Simple linear regression analysis showed that the surgical-to-non-surgical side ratio of MPV at 120° of shoulder flexion was associated with the DASH score (adjusted R² = 0.245). Altered and asymmetric scapular-region pressure-distribution patterns were associated with shoulder mobility and self-reported upper limb disability in this exploratory sample of breast cancer survivors following MRM with ALND. Given the small sample size, cross-sectional design, absence of a healthy control group, and lack of direct measurements of scapular kinematics, these findings should be considered preliminary. Larger prospective controlled studies are needed to validate these pressure-derived measures and determine their clinical relevance.
Chronic pelvic pain is one of the most disabling manifestations of endometriosis and is frequently associated with impaired quality of life, bladder dysfunction, and sexual dysfunction. Pelvic floor muscle (PFM) dysfunction may contribute to a potential contributor to symptom persistence; however, objective evidence regarding its role in women with endometriosis is limited. To examine and compare pelvic floor muscle (PFM) function, assessed using vaginal manometry, together with patient-reported measures of pelvic pain, pelvic floor symptoms in women with and without endometriosis. Secondary aims were to explore preliminary between-group differences and examine the associations between PFM function and symptom severity. In this pilot cross-sectional case–control study, 31 women aged 18–45 years were recruited. One participant was excluded from the control group, resulting in a final sample of ; 30 participants, including 15 women with medically confirmed endometriosis and 15 controls. Participants completed the Pelvic Pain Impact Questionnaire (PPIQ), Numeric Rating Scale (NRS) for pain, and Australian Pelvic Floor Questionnaire (APFQ). Pelvic floor muscle function was assessed using intravaginal manometry, including measures of resting pressure, maximal voluntary contraction (MVC), and the number of rapid contractions performed within 30 seconds. Group differences were examined using univariate analyses and analyses of covariance controlling for age, body mass index, and vaginal delivery history. Spearman correlations were calculated to investigate associations between PFM function and patient-reported outcomes. Women with endometriosis reported significantly higher average and maximal pain intensity, greater pelvic pain-related disability, and more severe bladder and sexual symptoms than controls (all p < 0.05). They also demonstrated significantly higher vaginal resting pressure and lower MVC values. After adjustment for covariates, significant group differences remained for pain outcomes, pelvic pain impact, bladder and sexual function, total APFQ score, and resting PFM tone (p < 0.05). MVC was moderately associated with bladder symptoms (ρ = −0.384, p = 0.036), sexual function (ρ = −0.470, p = 0.009), and overall pelvic floor symptom burden (ρ = −0.435, p = 0.016). No significant associations were observed between PFM parameters and pelvic pain-related disability. Women with endometriosis showed higher symptom burden and differences in selected pelvic floor muscle parameters compared with controls without a diagnosed gynaecological disorder. These exploratory findings warrant confirmation in prospective studies with larger sample sizes. ClinicalTrials.gov Identifier: NCT07713108 (01.07.2026)
Knowledge of the ovulatory period is crucial for effective family planning and fertility management. However, in Somaliland, cultural norms, limited reproductive health education, and inadequate media exposure contribute to poor fertility awareness. This study aimed to assess the level of knowledge about the ovulatory period and identify factors associated with it among women of reproductive age in Somaliland. The study was conducted cross-sectional study was conducted using data from the 2020 Somaliland Demographic and Health Survey (SLDHS). A total of 9,013 women aged 15–49 years were included. Descriptive statistics summarized participants’ characteristics, Chi-square tests examined associations between covariates and ovulatory knowledge, and multilevel logistic regression models identified individual- and community-level predictors. Descriptive analysis revealed that only 21.3
Adnexal torsion is a gynecological emergency in which delayed diagnosis may result in ovarian necrosis and loss of fertility. This study aimed to evaluate the diagnostic and predictive value of preoperative inflammatory indices—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the systemic immune-inflammation index (SII)—in patients operated on for suspected adnexal torsion, with particular emphasis on their role in the pre-imaging clinical setting. This retrospective observational study included 231 patients who underwent surgery for adnexal pathology between 2018 and 2024. Based on intraoperative findings, patients were classified into an adnexal torsion group (n = 90) and a control group with adnexal masses without torsion (n = 141). Preoperative complete blood count parameters obtained within 24 h before surgery were recorded, and NLR, PLR, and SII were calculated. Receiver operating characteristic (ROC) curve analysis and two-step multivariable logistic regression analyses (with and without Doppler ultrasonography findings) were performed to assess diagnostic performance and independent predictive value. Patients with adnexal torsion were significantly younger than controls (p < 0.001). NLR and SII values were significantly higher in the torsion group (p < 0.001 and p = 0.001, respectively), whereas PLR showed no significant difference. ROC analysis demonstrated moderate diagnostic performance for NLR (AUC = 0.680; 95
Genitourinary syndrome of menopause (GSM) is common among women with hormone-dependent malignancies and often requires non-hormonal management. Clinical, cytological, and histological measures assess different aspects of vaginal health, but their relationships and responsiveness to treatment remain unclear. This study compared these assessment methods in women undergoing non-hormonal treatment for GSM. This post hoc secondary analysis of a prospective randomized pilot study included 65 women with hormone-dependent breast or endometrial cancer and symptomatic GSM. Participants received either non-ablative Er: YAG vaginal laser therapy or a vaginal gel containing 0.2
A retrospective analysis was performed to evaluate the clinical efficacy, perioperative indicators and safety of transvaginal natural orifice transluminal endoscopic sacrospinous ligament fixation compared to vaginal sacrospinous ligament fixation in the treatment of pelvic organ prolapse. This study aims to provide a reference for the selection of clinical treatment strategies. A retrospective analysis was conducted on 20 patients (experimental group) who underwent transvaginal natural orifice transluminal endoscopic sacrospinous ligament fixation and 449 patients (control group) who underwent vaginal sacrospinous ligament fixation in the People’s Hospital of Inner Mongolia Autonomous Region from July 2021 to December 2025. Taking age, BMI, etc. as covariates, propensity score matching was conducted at a ratio of 1:4. Eventually, 20 cases in the experimental group and 80 cases in the control group were included in the analysis. Compare the baseline data before and after matching, perioperative indicators, complications, and postoperative anatomical and functional scores, etc. Prior to matching, no significant differences were observed in baseline characteristics (all P > 0.05), although SMDs for BMI, parity and surgical history exceeded the 10
The study explored how contrasting societal expectations of female attractiveness influence body image among young Banyankole women in the Ankole region of Uganda. We conducted narrative, in-depth interviews with 30 women aged 15–24 years and analysed the data using reflexive thematic analysis. Three interrelated themes emerged: navigating contradictory beauty and gender expectations; emerging lifestyles and daily routines that shape young women’s bodies; and shifting standards of physical attractiveness. These findings demonstrate how young women navigate competing appearance ideals, influencing their body image and self-esteem, with significant implications for families, schools, and workplaces.
Cervical cancer remains a major cause of cancer-related mortality among women in low- and middle-income countries. With the expansion of HPV-based cervical cancer screening in Ethiopia, increasing numbers of women are expected to receive HPV-positive results. However, psychological distress following HPV diagnosis remains poorly understood in this setting. This study assessed the prevalence of psychological distress and its associated factors among HPV-positive women in Addis Ababa, Ethiopia. A cross-sectional study was conducted from February to May 2025 in selected HPV screening facilities. A total of 423 women who screened positive for high-risk HPV were recruited using systematic random sampling, including both women living with HIV and HIV-negative women. Psychological distress was measured using the Kessler Psychological Distress Scale (K10), a 10-item tool assessing anxiety and depressive symptoms over four weeks. The questionnaire was administered in Amharic. Descriptive statistics were used to summarize participant characteristics and distress levels. Factors associated with psychological distress were assessed using bivariable and multivariable logistic regression analyses. Variables with p-value < 0.25 in bivariable analysis were considered for inclusion in the multivariable model, and statistical significance was declared at p-value < 0.05. Of 423 participants, the mean K10 score was 24.2 (SD = 11.1). Overall, 146 (34.5
Shoulder pain and decreased glenohumeral joint movement are commonly observed after surgery. The aim of the present study was to evaluate upper extremity functionality, shoulder joint range of motion, and shoulder proprioception in patients who underwent subpectoral and prepectoral implant reconstruction. This study was designed as a cross-sectional study. A total of 80 female patients were included in the study (subpectoral implant surgery, n = 28; prepectoral implant surgery, n = 28; control group, n = 24). Patients who had undergone subpectoral or prepectoral implant reconstruction surgery at least 3 months prior were included in the evaluation. Participants’ upper extremity functional levels were assessed using the DASH; the active normal range of motion of the shoulder joint was measured with a universal goniometer; and shoulder joint proprioception was evaluated with a “Clinometer.” No significant differences were found between subpectoral and prepectoral implant reconstruction regarding DASH, ROM, and 45°-75° ER proprioception (p > 0.05). However, there was a significant difference between healthy and surgically treated female participants (p < 0.05). Proprioception values for the 45° IR angle were significantly different between surgery groups and healthy female groups (p < 0.05). Breast reconstruction surgery had negative effects on upper extremity functionality and normal joint range of motion, which persisted three months post-surgery. However, no significant difference was found between the commonly used SIS and PIS methods. While shoulder joint proprioception was not negatively affected in women who underwent PIS, women who underwent SIS experienced impaired proprioception at the 45° IR angle.
Endometriosis substantially impairs disease-specific quality of life across physical, psychological, and social domains, yet evidence regarding family-centered empowerment interventions remains limited. This study evaluated the effect of a family-centered empowerment model-based intervention on patient-reported quality-of-life outcomes measured using the Endometriosis Health Profile-30 (EHP-30) in women with endometriosis. A randomized controlled trial was conducted on 64 women with clinically and ultrasonographically confirmed endometriosis referred to a specialized clinic in Mashhad, Iran. Participants were randomly assigned to an intervention group (n = 32) receiving a 12-week family-centered empowerment program or a control group (n = 32) receiving routine care. The primary outcome was endometriosis-specific quality of life measured using the five core EHP-30 domains (Pain, Control and Powerlessness, Emotional Well-being, Social Support, and Self-image), assessed at baseline and 12 weeks after baseline. Data were analyzed using analysis of covariance (ANCOVA) adjusted for baseline scores, with Bonferroni correction for multiple comparisons (p < 0.01). Baseline characteristics were comparable between groups (all p > 0.05). After the intervention, ANCOVA revealed significant improvements in the intervention group across all five EHP-30 domains, all of which remained statistically significant after Bonferroni correction for multiple comparisons: Pain (adjusted mean difference: −8.87, 95
Shift work inverts the sleep–wake cycle and may perturb circadian-controlled reproductive hormones, yet its effect on ovarian reserve in young women is uncertain, and data on the circadian-sensitive neuropeptides kisspeptin and melatonin are scarce. We compared ovarian reserve and serum kisspeptin, melatonin, and thyroid-stimulating hormone (TSH) between night-active and day-active women. In this cross-sectional study, 90 healthy women aged 18–35 years with normal body mass index were enrolled (46 night-active, 44 day-active). On cycle day 3, ovarian reserve was assessed by ultrasonography (ovarian volume, antral follicle count [AFC]) and biochemistry (FSH, LH, estradiol, anti-Müllerian hormone [AMH]); prolactin, TSH, vitamin D, kisspeptin, and melatonin were also measured. Groups were compared with distribution-appropriate tests and covariate-adjusted ANCOVA. Ovarian reserve was similar between groups: ovarian volume (p = 0.623), AFC (median 6.0 vs. 6.0, p = 0.791), and AMH (2.7 vs. 3.1 ng/mL, p = 0.862) did not differ, nor did FSH, LH, estradiol, prolactin, or vitamin D (all p > 0.05). Night-active women had higher median kisspeptin (889.5 vs. 336.2 ng/L, p < 0.001), melatonin (699.9 vs. 225.1 ng/L, p < 0.001), and TSH (2.0 vs. 1.5 mU/L, p = 0.020), and shorter sleep duration. The kisspeptin and melatonin differences persisted after covariate adjustment; the TSH difference did not. The primary effect of a night-active circadian rhythm was neuroendocrine rather than gonadal: ovarian reserve was not detectably altered in young, normal-BMI women, while kisspeptin, melatonin, and TSH were higher. These neuroendocrine differences are hypothesis-generating: because the groups were sampled at opposite points of the daily rhythm ( 21:00 vs. 09:00), they cannot be separated from a time-of-sampling effect and likely reflect circadian state rather than altered hormone output.
Intimate partner violence (IPV) remains a major public health concern and can constrain women’s reproductive autonomy and reproductive health. Rural women who experience IPV face increased risks of trauma, sexually transmitted infections, and adverse pregnancy outcomes, and may have limited ability to make independent family planning and fertility decisions. Although previous studies have linked IPV to contraceptive use and fertility preferences, evidence remains mixed, partly because most studies treat IPV as a single construct and overlook potential differences across forms of violence. Focusing on rural women in communities of a government cash transfer programme, this study examines the effects of how different dimensions of IPV shapes family planning behaviour and fertility preferences among poor women in northern Ghana. This study uses quantitative methods to analyse a two-wave panel data on 2,202 women in northern Ghana using an instrumental-variable approach (control-function estimations) to address the potential endogeneity of IPV. Models estimated the effects of composite IPV, emotional, physical and sexual violence, together with partner controlling behaviour, on modern contraceptive use, use of implants or injectables, willingness to have another child, and desired number of children. Baseline outcomes were included using an ANCOVA specification, and robustness was assessed through attrition, baseline-only and endline-only analyses. The results show that approximately three out of five women experienced at least one form of IPV. Overall IPV was associated with significantly lower use of modern contraceptive methods, including implants and injectables, lower likelihood of wanting another child, and fewer desired children. However, important heterogeneity emerged across IPV dimensions. Sexual and physical violence were associated with greater use of modern contraception, whereas emotional violence reduced contraceptive use, fertility intentions, and desired family size. Partner controlling behaviour consistently reduced contraceptive use while increasing women’s desire for additional children and larger families. Robustness analyses produced qualitatively similar findings. Different forms of IPV influence women’s reproductive decision-making through distinct behavioural pathways. These findings suggest that poverty reduction alone is insufficient to strengthen women’s reproductive autonomy. Integrating IPV prevention, reproductive health services, and gender-transformative interventions into social protection programmes may improve family planning uptake and support informed fertility decisions among vulnerable women.
Cervical cancer remains a major public health problem worldwide particularly in low- and middle-income countries. Human Papillomavirus (HPV) self-sampling is a promising strategy to increase screening participation. However, evidence regarding its acceptability among Thai ethnic communities is limited. This study aimed to estimate the proportion of acceptability of HPV self-sampling for cervical cancer screening among the ethnic women living in border areas of Thailand and determine its associated factors. A cross-sectional study was conducted from January to May 2024 among 341 ethnic women aged 30–60 years, who held Thai citizenship and residing in Pai, Mae Hong Son, Thailand. A questionnaire assessed demographics, healthcare accessibility, knowledge about HPV and cervical cancer, and attitudes toward cervical cancer screening. Acceptability of self-sampling was defined as willingness to accept self-sampling alone or both self-sampling and clinician-based sampling. Factors associated with acceptability were analysed using univariable and multivariable binary logistic regression analyses. The median age of participants was 43 years (interquartile range: 36–49). Most of them were 185 (54
Intrinsic capacity (IC) is a multidimensional indicator of an individual’s physical and psychological functional reserves. Reproductive factors may be associated with IC in later life, although epidemiological evidence remains limited. This study examined the associations between reproductive factors and IC among Chinese women aged 45 years or older. The study included 7,251 participants from the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression analyses, restricted cubic spline models, and two-piecewise logistic regression models were applied to assess the associations of reproductive factors with low IC, including potential dose–response relationships and threshold effects. Low IC was identified in 66.64
Simple and feasible screening strategies are needed to identify sarcopenia in postmenopausal women, particularly in settings where comprehensive body composition or functional assessment may not be readily available. This study aimed to compare the diagnostic accuracy and clinical utility of screening strategies based on arm circumference, calf circumference, and the SARC-F questionnaire for identifying Asian Working Group for Sarcopenia (AWGS)-defined sarcopenia in postmenopausal women. A total of 794 postmenopausal women were recruited from Boai Hospital in Zhongshan between January 1, 2022, and December 31, 2023. Sarcopenia was defined according to the 2019 Asian Working Group for Sarcopenia consensus criteria. The dataset was randomly divided into a development set and an internal test set at an 80:20 ratio. Five screening strategies based on arm circumference, calf circumference, SARC-F, and their combinations were evaluated. Receiver operating characteristic curve analysis was used to assess discrimination, and the area under the curve (AUC) was calculated for each strategy. Calibration analysis and decision curve analysis were performed to evaluate agreement and potential clinical utility. Among the 794 postmenopausal women, 59 met the AWGS-defined criteria for sarcopenia. In the development set, calf circumference-based strategies showed numerically higher AUCs than arm circumference or SARC-F alone. The combinations of calf circumference plus SARC-F and arm circumference plus calf circumference plus SARC-F both achieved an AUC of 0.884 in the development set. In the internal test set, calf circumference plus SARC-F and the combination of all three tools showed favorable discrimination, with AUCs of 0.921 and 0.918, respectively. Calibration analysis showed acceptable agreement between estimated and observed sarcopenia status, and decision curve analysis suggested potential net benefit across low-to-moderate threshold probabilities. Adding arm circumference to calf circumference and SARC-F resulted in a similar AUC. Calf circumference-based combined screening strategies showed favorable internal diagnostic performance for identifying AWGS-defined sarcopenia in this single-center cohort of postmenopausal women. CC + SARC-F and AC + CC + SARC-F showed similar numerical AUCs. Given its use of fewer components, CC + SARC-F may represent a practical preliminary screening approach in resource-limited settings. However, external validation in larger multicenter cohorts is required before routine clinical implementation.
Cesarean scar niche (CSN) is associated with abnormal uterine bleeding after cesarean delivery, but tissue-level differences at the scar-endometrial interface remain poorly defined. We compared CSN tissue with adjacent endometrium from the same uterus, treating the latter as an internal anatomical comparator rather than disease-free control tissue. This retrospective paired study included 44 surgically treated patients with CSN and 44 paired specimen sets (88 specimens) obtained during clinically indicated surgery between June 2020 and April 2022. Adjacent endometrium was defined as endometrial tissue immediately outside the hysteroscopically visible niche margin and was used only as an internal anatomical comparator. Seventeen immunohistochemical markers were scored on a four-level ordinal scale (0–3). The primary analysis compared lesion and adjacent-endometrial scores using two-sided Wilcoxon signed-rank tests with Benjamini-Hochberg false discovery rate (FDR) adjustment. Clinical and ultrasound analyses were secondary or exploratory and used complete cases. Fourteen of 17 markers differed between CSN tissue and adjacent endometrium after FDR adjustment. The largest lesion-enriched shifts involved inflammation-associated, vascular/growth-factor-associated, hypoxia-associated, and matrix-remodeling markers. Progesterone receptor reached FDR significance despite a median paired difference of 0 and was interpreted cautiously. No exploratory clinicopathological correlation remained significant after FDR correction. Retrospectively recorded binary symptom-improvement status was available for all 44 patients, whereas recorded postoperative bleeding/symptom duration was available for 39 complete pairs within the 40-patient bleeding-duration analysis subset and paired 3-month residual myometrial thickness for 14 patients. CSN tissue differed locally from adjacent endometrium across multiple immunohistochemical markers. Without disease-free or asymptomatic controls, molecular validation, or an independent cohort, these paired observations cannot establish disease-specific pathway activation, causality, or biomarker prediction. Prospective controlled studies should use standardized sampling and outcome assessment.
Hormone therapy (HT) is an effective treatment for menopausal symptoms, but its use has changed substantially since publication of the Women’s Health Initiative report in 2002. Long-term real-world data on HT and concomitant medication prescribing in Japan remain limited. We conducted a 20-year retrospective database study using electronic prescription records from a tertiary university hospital in Japan. The primary analytic population comprised women aged 45–60 years with ICD-10-coded menopausal disorders. Prescription-level temporal trends in HT and six concomitant medication categories were evaluated using the Cochran–Armitage trend test. Patient-level logistic regression was used to examine characteristics associated with ever receiving HT. Among 1,167 women with menopausal disorders, 268 (23.0
Serum cotinine objectively reflects recent nicotine uptake, but a single measurement does not capture cumulative smoking exposure. We evaluated the cross-sectional association with bone mineral density (BMD) among U.S. women aged 50 years and older while accounting for the NHANES complex survey design. This cross-sectional analysis pooled NHANES 2013–2014 and 2017–2018 and accounted for the multistage complex survey design. Serum cotinine was log2-transformed; coefficients represent the adjusted BMD difference per twofold higher concentration. Primary outcomes were total femur, femoral neck, and the official total L1–L4 lumbar-spine BMD. Survey analyses used WTMEC2YR/2, the NHANES masked variance strata and primary sampling units as documented in the analysis code, Taylor series linearization, and domain estimation. The prespecified primary family comprised women-specific model-2 estimates adjusted for age and body-mass-index splines, race/ethnicity, cycle, poverty-income ratio, alcohol use, physical activity, diabetes, estimated glomerular filtration rate, reproductive status, and hormone therapy; Benjamini–Hochberg false-discovery-rate (FDR) correction covered the three sites. Outcome-specific women samples were 1,699 for the two hip sites and 1,065 for official spine BMD. Per cotinine doubling, adjusted differences were − 0.0010 g/cm² (95
Breast cancer (BC) survivors face elevated osteoporosis risk. The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance(IR), correlates with bone mineral density (BMD) in general populations but remains unexamined in BC women. This retrospective cross-sectional study included 848 female BC patients from the Affiliated Hospital of Nanjing University of Chinese Medicine (2021–2023). TyG index was calculated as Ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Femoral neck (FN) BMD was measured by dual-energy X-ray absorptiometry. Associations were examined using Spearman correlation and hierarchical multivariable linear regression, with subgroup analyses by age and TyG quartiles. The median age was 60.0 years, the median TyG index was 8.78 (IQR: 8.43–9.15), and the median FN BMD was 0.68 g/cm² (IQR: 0.61–0.76). In univariate analysis, the TyG index was not significantly correlated with BMD (r = -0.045, P = 0.193). However, after comprehensive adjustment for demographic and metabolic covariates, an elevated TyG index showed a modest inverse cross-sectional association with BMD (β = -0.083, 95
