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Pseudocyesis, also known as false pregnancy, is defined as the belief of being pregnant with physical signs and symptoms in the absence of a confirmed pregnancy. Notable cases include Queen Mary, who suffered from phantom pregnancies under societal pressure to conceive in the 16th century. Although now extremely rare, at its peak it accounted for 1 in 250 pregnancies following the Second World War, and was thought to be linked to heightened gender norms and sociocultural expectations around motherhood during this time. Pseudocyesis presents with complex and unique diagnostic challenges in clinical practice. It differs from delusional pregnancy, which is a fixed belief of pregnancy without physical signs or symptoms. The condition is often associated with infertility, psychological distress and neuro-endocrine conditions affecting the reproductive system. Management requires a multidisciplinary approach, integrating psychological support and addressing underlying reproductive health issues.
Premenstrual symptoms are a cyclic set of symptoms that affect women’s psychological and physical well-being. Growing evidence suggests that micronutrients may contribute to the risk and severity of premenstrual symptoms such as depression. Yet the relationship between folate and premenstrual symptoms remains inconclusive. The objective of this study was to determine the association between folate intake and MTHFR genotype with premenstrual symptoms. Females (n 678) aged 20–29 years from the Toronto Nutrigenomics and Health Study self-reported fifteen premenstrual symptoms. Dietary intake was measured using a validated 196-item Toronto-modified Harvard food frequency questionnaire. DNA was isolated from peripheral white blood cells and genotyped for the C677T MTHFR (rs1801133) polymorphism. Using logistic regression, the odds of experiencing premenstrual symptoms were compared between total folate intake below and above the median (647 mcg/d) and between MTHFR genotypes. We found associations between MTHFR genotype and some premenstrual symptoms. Among women with low folate intake, an additive association was observed between the Tallele of MTHFR and premenstrual depression. Compared with those with the CC genotype, the OR (95 % CI) for depression was 1·66 (0·98, 2·87) for those with the CT genotype and 2·41 (1·08, 5·38) for those with the TT genotype. No associations were observed between MTHFR genotype and premenstrual depression among those with higher habitual intakes of folate. Since the MTHFR genotype is involved in the folate metabolic pathway, these findings suggest that folate or its metabolites may be related to the risk of premenstrual depression.
Due to historical under-recognition of attention-deficit hyperactivity disorder (ADHD) among girls and women, little is known about female-specific factors that may affect individuals with ADHD, including those related to changes in ovarian hormones (e.g. across the menstrual cycle).
Aims
We investigated whether females with a self-reported clinical diagnosis of ADHD are more likely to experience premenstrual dysphoric disorder (PMDD). We also examined associations between PMDD and ADHD defined by a symptom and impairment threshold.
Method
Participants were aged between 18 and 34 years, were assigned female at birth and were recruited via Prolific.com (n = 715). Participants self-reported clinician diagnosis of ADHD, depression and anxiety. ADHD symptoms were assessed via the Adult ADHD Self-Report Scale (ASRS), to which we applied a DSM-5-based symptom and impairment cut-off (‘ASRS-based ADHD’). PMDD symptoms were assessed via the Premenstrual Symptoms Screening Tool (PSST), which identifies provisional PMDD. Using Poisson regression models, we compared risk for provisional PMDD among females with ADHD (self-reported clinical diagnosis [n = 102] or ASRS-based [n = 229]) with a non-ADHD reference group (n = 305). We additionally compared risk for provisional PMDD among individuals with ADHD and depression/anxiety diagnoses, ADHD only and a non-ADHD reference group.
Results
The prevalence of provisional PMDD was elevated among individuals with a self-reported clinical ADHD diagnosis (31.4%), and among participants with ASRS-based ADHD (41.1%), compared with the non-ADHD reference group (9.8%). Individuals with ASRS-based ADHD and depression and/or anxiety diagnoses were at highest risk for provisional PMDD (relative risk 4.53 [3.10, 6.61]) compared with the non-ADHD reference group.
Conclusions
Clinicians should be aware that individuals with a diagnosis of ADHD, or with high ADHD symptom levels, and who have a menstrual cycle may be more likely to experience PMDD. Future research should investigate the underlying mechanisms that link ADHD and disorders associated with hormonal sensitivity, such as PMDD.
The emergence of “FemTech”, a term used to describe technologically based or enabled applications serving women’s health needs, as a driver of capital investment in the past decade, is a notable development in advancing women’s health. Critics have raised important concerns regarding the pitfalls of FemTech, with privacy concerns being chief among them. This private market, however, should be integrated into creation of systemwide corrections of problems that plague women of color. To do so a derivate FemTech framework (hereinafter the “Framework”) clear limitations must concurrently be overcome to realize its possibilities.
This paper advocates for a holistic approach to the menopause transition and challenges the current dominant narrative that frames this transition primarily in biological terms. It examines the psychological, social and cultural dimensions, addresses the stigma faced by older women and advocates for the vital role psychiatrists have to play in supporting postmenopausal women.
Intermittent energy-restricted diets are used amongst women with overweight and obesity and a healthy weight. For those with overweight and obesity weight control is typically achieved through daily energy restriction (DER) which has reduced adherence and attenuated metabolic benefits over time. Several intermittent energy restriction (IER) regimens have been developed aiming to promote maintained weight loss and additional weight independent metabolic benefits including the 5:2 diet, alternate day fasting (ADF) and time-restricted eating (TRE). This review summarises the potential benefits or harms of these regimens for managing women’s health. 5:2 and ADF diets have equivalent long term (≥ 6-month) adherence, weight loss and metabolic benefits to DER. Current limited evidence suggests IER is a safe weight loss intervention for women which does not affect reproductive or bone health, increase eating disorders or disturb sleep. Adherence and weight loss with both IER and DER are lower amongst younger women compared to older women and men. Weight loss with ADF and TRE has, respectively, improved symptoms of polycystic ovarian syndrome and premenstrual syndrome, but there is no evidence of weight-independent effects of IER on these conditions. There is little evidence of the benefits and/or harms of IER amongst healthy weight women in whom there is a greater potential for adverse effects on reproductive and bone health, fat free mass, eating disorders and sleep. Further research benefits of IER for weight control and metabolic health as well as harms are required.
Post-traumatic stress disorder (PTSD) is characterized by severe distress and associated with cardiometabolic diseases. Studies in military and clinical populations suggest that dysregulated metabolomic processes may be a key mechanism. Prior work identified and validated a metabolite-based distress score (MDS) linked with depression and anxiety and subsequent cardiometabolic diseases. Here, we assessed whether PTSD shares metabolic alterations with depression and anxiety and if additional metabolites are related to PTSD.
Methods
We leveraged plasma metabolomics data from three subsamples nested within the Nurses’ Health Study II, including 2835 women with 2950 blood samples collected across three time points (1996–2014) and 339 known metabolites assayed by mass spectrometry-based techniques. Trauma and PTSD exposures were assessed in 2008 and characterized as follows: lifetime trauma without PTSD, lifetime PTSD in remission, and persistent PTSD symptoms. Associations between the exposures and the MDS or individual metabolites were estimated within each subsample adjusting for potential confounders and combined in random-effects meta-analyses.
Results
Persistent PTSD symptoms were associated with higher levels of the previously developed MDS. Out of 339 metabolites, we identified 29 metabolites (primarily elevated glycerophospholipids and glycerolipids) associated with persistent symptoms (false discovery rate < 0.05; adjusting for technical covariates). No metabolite associations were found with the other PTSD-related exposures.
Conclusions
As the first large-scale, population-based metabolomics analysis of PTSD, our study highlighted shared and distinct metabolic differences linked to PTSD versus depression or anxiety. We identified novel metabolite markers associated with PTSD symptom persistence, suggesting further connections with metabolic dysregulation that may have downstream consequences for health.
Menstrual hygiene management (MHM) is an important but often neglected aspect of women’s health worldwide, especially in developing and disaster-prone countries, such as Bangladesh. This qualitative study aimed to investigate awareness, attitudes, and practices related to MHM among girls in the Haor region, particularly during floods. The study adopts a phenomenological approach, and data were collected using purposive sampling from 33 women aged 15 years and above who resided in the Haor region. Thematic analysis was employed to identify the patterns, themes, and subthemes within the qualitative data. The study reveals a significant lack of widespread knowledge about menstruation among girls in the Haor area, which is associated with unfavourable family and social attitudes, and stigma or taboos. Natural hazards, cultural barriers, access to the market, economic incapacity, and inadequate infrastructure make it very difficult to manage menstruation, which is especially aggravated during floods due to displacement and shelter on the roadside, primary schools, and other people’s houses. This research emphasises the need for tailored MHM programmes from the government to address the unique challenges faced by women in Haor regions. Provision of sanitary napkins and essential medicines, maintaining stock in shelters, and equipping community clinics with MHM-related healthcare services are essential. Finally, NGOs should prioritise MH within their scope of work.
Recent guidance from UK health authorities strongly cautions against the use of valproic acid (VPA) in persons under 55 because of reevaluated risk of teratogenicity.
Objective
To summarize the extant literature documenting VPA-associated anatomical, behavioral, and cognitive teratogenicity.
Method
Pubmed, Medline, Cochrane Library, PsychInfo, Embase, Scopus, Web of Science, and Google Scholar were searched in accordance with PRISMA guidelines. Collected data covered study design, participant characteristics, anatomical, behavioral, or cognitive effects, and folic acid outcomes.
Results
122 studies were identified meeting inclusion comprised of studies evaluating anatomical (n = 67), behavioral (n = 28), and cognitive (n = 47) teratogenicity. Twenty studies were identified reporting on the risk mitigation effects of folic acid supplementation. Prenatal VPA exposure is associated with anatomical teratogenicity including major congenital malformations (odds ratio [OR] 2.47–9.30; p < 0.005). Behavioral teratogenicity including autism (OR 1.70–4.38), impaired motor development (OR 7.0), and ADHD (OR 1.39) are also significantly associated with VPA exposure. VPA was associated with intellectual disability and low IQ (hazard ratio [HR] 2.4–4.48, verbal intelligence: Spearman’s ρ = −0.436, respectively). Teratogenic effects were dose-dependent across all domains and were significant when compared with controls and other antiepileptic drugs (eg, carbamazepine, lamotrigine, and levetiracetam). Folic acid supplementation does not significantly reduce the hazard associated with VPA.
Conclusions
VPA is significantly associated with anatomical, behavioral, and cognitive teratogenicity. Folic acid supplementation does not abrogate the risk of teratogenicity associated with VPA exposure. Available evidence supports recommendations to reduce VPA exposure in women of reproductive age.
Gestational diabetes mellitus (GDM) poses significant health concerns for women and their offspring, with implications that extend beyond pregnancy. While GDM often resolves postpartum, a diagnosis of GDM confers a greater risk of future type 2 diabetes (T2D) and other chronic illnesses. Furthermore, the intergenerational impact of GDM predisposes offspring to increased chronic disease risk. Despite the awareness of the short- and long-term consequences of GDM, translating this knowledge into prevention strategies remains challenging. Challenges arise from a lack of clarity among health professionals regarding roles and responsibilities in chronic disease prevention and women’s lack of awareness of the magnitude of associated health risks. These challenges are compounded by changes in the circumstances of new mothers as they adjust to balance the demands of infant and family care with their own needs. Insights into behaviour change strategies, coupled with advances in technology and digital healthcare delivery options, have presented new opportunities for diabetes prevention among women with a history of GDM. Additionally, there is growing recognition of the benefits of adopting an implementation science approach to intervention delivery, which seeks to enhance the effectiveness and scalability of interventions. Effective prevention of T2D following GDM requires a comprehensive person-centred approach that leverages technology, targeted interventions and implementation science methodologies to address the complex needs of this population. Through a multifaceted approach, it is possible to improve the long-term health outcomes of women with prior GDM.
To understand young women’s views of cervical screening, what obstacles they face, and what encourages them when considering attending their cervical screening.
Background:
Cervical screening figures have been steadily decreasing in the United Kingdom (UK). There is limited research on this trend, especially around views and knowledge of young women, aged 20–24 years, have before they are eligible for cervical screening.
Methods:
This qualitative study conducted 15 semi-structured Zoom in-depth interviews to discuss young women’s knowledge and perceptions of cervical screening in 2022. Participants were based in the UK. Thematic analysis was used to systematically manage, analyse, and identify themes including cervical screening knowledge; perceptions of cervical screening; barriers to cervical screening; and facilitators of cervical screening.
Findings:
The findings demonstrate significant gaps in knowledge and negative perceptions of cervical screening. Barriers to attending cervical screening were perceived pain and embarrassment. Facilitators suggested to promote attendance were ensuring access to appointments, creating pop-up clinics, and utilising incentives. The level of knowledge demonstrated by the participants, their negatively framed perceptions; and the vast number of barriers identified present substantial factors that could affect future attendance to cervical screening. Overall, action needs to be taken to prevent decreasing cervical screening attendance rates and eradicate any barriers women may experience.
Edited by
Laurie J. Mckenzie, University of Texas MD Anderson Cancer Center, Houston,Denise R. Nebgen, University of Texas MD Anderson Cancer Center, Houston
Cancer treatments can induce temporary or permanent menopause and lead to persistent menopausal symptoms. In reproductive age women, cancer treatment may impair fertility but evaluating fertility and managing contraception can be complex. Managing menopausal symptoms and contraceptive decisions after cancer treatment can be challenging for women and their care providers. In this chapter, we present concepts for managing these consultations and some specific advice for women in particular situations.
Cardiovascular diseases (CVDs) are a major health concern for women. Historically there has been a misconception that men are at greater risk because CVD tends to occur earlier in life compared to women. Clinical guidelines for prevention of heart disease are currently the same for both sexes, but accumulating evidence demonstrates that risk profiles diverge. In fact, several CVD risk factors confer an even greater risk in women relative to men, including high blood pressure, obesity, diabetes and raised triglycerides. Furthermore, many female-specific CVD risk factors exist, including early menarche, pregnancy complications, polycystic ovary syndrome, reproductive hormonal treatments and menopause. Little is known about how diet interacts with CVD risk factors at various stages of a woman’s life. Long chain (LC) n-3 polyunsaturated fatty acid (PUFA) intakes are a key dietary factor that may impact risk of CVD throughout the life course differentially in men and women. Oestrogen enhances conversion of the plant n-3 PUFA, alpha-linolenic acid, to LCn-3 PUFA. Increasing the frequency of oily fish consumption or LCn-3 PUFA supplementation may be important for reducing coronary risk during the menopausal transition, during which time oestrogen levels decline and the increase in CVD risk factors is accelerated. Women are under-represented in the evidence base for CVD prevention following LC n-3 PUFA supplementation. Therefore it is not clear whether there are sex differences in response to treatment. Furthermore, there is a lack of evidence on optimal intakes of LC n-3 PUFA across the lifespan for CVD prevention in women.
Women are the fastest-growing population of people who use drugs in the US. As a group, they are more likely than men to experience stigma, poverty, and negative mental health outcomes. This article discusses the unique needs of women drug users in the US and provides suggestions on how to leverage national attention — and federal funding — to make harm reduction services in the US more gender sensitive, and, as a result, more effective in reducing harm for women who use drugs in this country.
Recent studies on the quality of life in women with breast cancer show a high prevalence of signs and symptoms that should be the focus of palliative care (PC), leading us to question the current role they play in addressing breast cancer. Therefore, the objective of this review is to map the scope of available literature on the role of PC in the treatment of women with breast cancer.
Methods
This is a methodologically guided scoping review by the Joanna Briggs Institute and adapted to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist for report writing. Systematic searches were conducted in 8 databases, an electronic repository, and gray literature. The searches were conducted with the support of a librarian. The study selection was managed through the RAYYAN software in a blind and independent manner by 2 reviewers. The extracted data were analyzed using the qualitative thematic analysis technique and discussed through textual categories.
Results
A total of 9,812 studies were identified, of which only 136 articles and 3 sources of gray literature are included in this review. In terms of general characteristics, the majority were published in the USA (35.7%), had a cross-sectional design (44.8%), and were abstracts presented at scientific events (19.6%). The majority of interventions focused on palliative radiotherapy (13.6%). Thematic analysis identified 14 themes and 12 subthemes.
Significance of results
Our findings offer a comprehensive view of the evidence on PC in the treatment of breast cancer. Although a methodological quality assessment was not conducted, these results could guide professionals interested in the topic to position themselves in the current context. Additionally, a quick synthesis of recommendations on different palliative therapies is provided, which should be critically observed. Finally, multiple knowledge gaps are highlighted, which could be used for the development of future studies in this field.
The purpose of this study is to focus on changes in anxiety symptoms among women treated in women’s health practices and under a collaborative care model.
Background:
Research on collaborative care has largely focused on improving depressive and anxiety symptoms among adults in primary care settings. The applicability of collaborative care in other healthcare settings is underreported with limited research investigating if collaborative care has advantages in subpopulations treated in both traditional primary care settings and other healthcare settings, such as women’s health practices.
Methods:
This study, completed through secondary data analysis of the electronic record of N = 219 women across three women’s healthcare centers, evaluated if instituting a collaborative care model is associated with reduced anxiety symptoms and which factors (eg, primary diagnosis, duration of care, and use of psychotropic medications) are associated with anxiety outcomes. Anxiety symptoms were assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7) at entry into and at termination from collaborative care services.
Results:
Overall, there was a significant reduction in average anxiety scores from baseline to termination of collaborative care (t(218) = 12.41, P < 0.001). There was a main effect for the duration of time receiving collaborative care services on anxiety score reduction (β = −0.28, SE = 0.06, P < 0.001) with a significant reduction in anxiety symptoms at the 90-day mark (t(218) = 10.58, P < 0.001). Therefore, collaborative care can be useful in women’s health practices in reducing anxiety symptoms over a 90-day time period.
Adult women of reproductive age are highly engaged with social media, suggesting its utility for conveying health information to this population, at scale. This scoping review aimed to describe health promotion interventions conducted via social media and assess their effectiveness to improve health outcomes, engagement and acceptability in adult women of reproductive age.
Design:
Six databases were searched on 13 May 2022. Two reviewers independently screened studies. Data were extracted and risk of bias assessed using the Joanna Briggs Critical Appraisal Tools.
Setting:
Eligible studies conducted an intervention primarily via social media, with or without a comparison intervention, and reported health-related outcomes/behaviours pre- and post-intervention. Results were presented in narrative form.
Participants:
Adult women (mean age 18–45 years).
Results:
Nine eligible studies were identified: six randomised control trials, two quasi-experimental studies and one cross-sectional study. Interventions focused on prenatal, antenatal or postpartum health or physical activity. Seven studies utilised Facebook for intervention delivery, one conducted a digital campaign across four platforms and one used WeChat. Studies reported significant improvements in a range of outcomes, including increased parenting competence, longer duration of breast-feeding and higher rates of physical activity. Social media interventions had greater engagement than control interventions.
Conclusions:
We identified nine diverse health promotion interventions conducted via social media, which appear acceptable and effective for improving various health outcomes in adult women of reproductive age. While this supports the utility of social media to convey health information, further research is required to prove effectiveness and superiority over other intervention strategies.