Women, Volume 6, Issue 3 (September 2026) – 11 articles

The widespread adoption of in vitro fertilization (IVF) has profoundly transformed the management of infertility and established IVF as the most effective assisted reproductive technology for many clinical indications. Nevertheless, intrauterine insemination (IUI) remains widely used because of its lower invasiveness, reduced treatment burden, lower costs, and broader accessibility. The contemporary role of IUI in an IVF-dominated era remains a subject of ongoing debate. This narrative review aims to critically evaluate the current role of IUI in modern reproductive medicine by examining its clinical indications, effectiveness, limitations, cost-effectiveness, and patient-centered implications in comparison with IVF. A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Relevant studies, systematic reviews, meta-analyses, randomized controlled trials, and international guidelines published primarily between 2010 and 2025 were identified and synthesized. Particular attention was given to recommendations from the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM). Current evidence supports the use of IUI, particularly when combined with ovarian stimulation, as an appropriate first-line treatment in selected couples with unexplained infertility, mild male-factor infertility, and minimal-to-mild endometriosis. Although IVF generally provides higher live birth rates per treatment cycle and remains the preferred option for several infertility diagnoses, IUI continues to offer meaningful clinical benefits in appropriately selected patients. Beyond effectiveness, treatment decisions should also consider cost-effectiveness, accessibility, treatment burden, safety, and patient preferences. Recent evidence increasingly supports individualized and prognosis-based approaches to fertility treatment selection. Evidence also highlights the importance of female age, infertility duration, and ovarian reserve in determining the relative benefit of IUI versus IVF. Despite the clinical dominance of IVF, IUI remains an evidence-based and clinically relevant component of contemporary fertility care. Rather than being viewed as competing interventions, IUI and IVF should be considered complementary treatment options within a personalized infertility management strategy. Appropriate patient selection, particularly considering female reproductive prognosis, remains essential to maximize reproductive outcomes while minimizing treatment burden and healthcare costs. Full article

Endometriosis is a chronic, estrogen-dependent inflammatory disorder characterized by the functional engraftment of endometrial-like stroma and glands outside the uterine cavity, encompassing a heterogeneous phenotypic spectrum that ranges from deep infiltrating lesions to subtle, atypical or non-pigmented peritoneal implants. Emerging evidence suggests an association between endometriosis and cutaneous melanoma. The aim of this study was to evaluate whether women with endometriosis have an increased risk of developing melanoma and to explore potential biological mechanisms underlying this association. This review was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, and the Cochrane Library was performed for studies published in English up to 1 February 2025. Eligible studies were restricted to cohort and casecontrol designs evaluating the association between histopathologically radiologically verified endometriosis comprising distinct phenotypes and subtle atypical lesions and histologically confirmed cutaneous melanoma. Two independent reviewers executed study selection based on these strict eligibility criteria, and due to marked clinical heterogeneity, data were synthesized qualitatively. A total of 326 records were identified, of which 17 studies met the inclusion criteria. Genetic and biomolecular evidence revealed shared susceptibility loci and common molecular pathways, including TP53, PTEN, CDKN2A, and estrogen receptor mediated signaling, suggesting a biological link between the two conditions. Epidemiological studies consistently reported a modestly increased risk of melanoma in women with endometriosis, with hazard ratios ranging from 1.50 to 1.82 (95% Confidence Interval [CI]: 1.21–2.41). This association appeared more pronounced in younger women and in those with a personal or family history of dysplastic nevi or melanoma. Limited data also suggest a reverse association, with increased occurrence of endometriosis among women with melanoma. Endometriosis and melanoma share distinct genetic architectures, characterized by shared susceptibility loci at the chromosome 9p21 region (encompassing CDKN2A/B), alongside convergent hyperestrogenemic signaling via estrogen receptor-beta (ERβ) and systemic natural killer (NK) cell immunotolerance axes. These shared molecular pathways support a biologically plausible correlation, although causal links remain unproven due to pervasive study heterogeneity and surveillance biases. Current evidence suggests a modest epidemiological link; however, heterogeneity among studies limits definitive conclusions. Full article

Lipedema is a chronic disorder characterized by the abnormal and disproportionate accumulation of painful subcutaneous adipose fat, primarily affecting the lower limbs and occurring almost exclusively in women. The aim of this controlled cross-sectional study was to compare body image, psychological distress, and psychological well-being in women with (n = 77) and without lipedema (n = 32). Psychological functioning was assessed using validated measures of depressive symptoms (PHQ-9), eating attitudes (EAT-26), perceived stress (PSS), medically unexplained symptoms (M.U.S.), psychological well-being (WHO-5), life satisfaction (SWLS), psychological flexibility (AAQ-II), pain intensity (VAS), together with measures of body image, lifetime psychological burden, maladaptive cognitive beliefs, symptom severity, and anthropometric parameters. Compared with controls, women with lipedema reported significantly greater body image dissatisfaction, perceived distress, M.U.S., depressive symptoms, disordered eating attitudes, and pain, together with lower psychological well-being, life satisfaction, and psychological flexibility (all p < 0.001). Within the lipedema group, PHQ-9 scores were significantly predicted by M.U.S. scores, maladaptive cognitions, and pain intensity (VAS), whereas EAT-26 scores were predicted by PHQ-9 scores and maladaptive cognitions. These findings indicate that lipedema is associated with a substantial psychological burden and support integrating psychological assessment and intervention into multidisciplinary care. Full article

Endometriosis is a chronic gynecological disease affecting about 10% of reproductive age women, with a significant impact on socio-economic sphere and quality of life. It is a multifactorial phenomenon, in which genetic predisposition, immunologic malfunction, hormone imbalance, and environmental insult play an important role in disease development and progression. The aim of this review is to report the current evidence from the literature related to the association between endometriosis and endocrine disruptors. This study was designed as a systematic review and meta-analysis investigating the association between exposure to endocrine disruptors and the risk of endometriosis. The review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The systematic search identified 428 records from national and international scientific databases. The included studies were published between 2001 and 2020, with most studies classified as fair-to-good quality. The overall random-effects meta-analysis demonstrated a statistically significant association between exposure to endocrine-disrupting chemicals and endometriosis. This systematic review and meta-analysis provides evidence of a significant association between exposure to endocrine-disrupting chemicals and endometriosis, with the strongest and most consistent association observed for polychlorinated biphenyls. Full article

This study aims to assess the impact of an 8-week multidisciplinary intervention on the physical and psychosocial health in active women over 55 years old, paying attention to the need of supervision. Eighty-one women were assessed for pelvic floor strength (using PERFECT’s guidelines), body composition and satisfaction with life, and later blindly assigned to a supervised or reduced-supervision pelvic floor exercise program (i.e., therapeutic exercises guided by a professional, twice a week, or identical exercises performed at home). All of them received six additional educational sessions together, interspersed along the program, for nutritional and psychological counseling. Twenty-eight women of 36 [66.50 (4.68) years] in the supervised group, and another 20 of 34 [64.65 (5.12) years] (reduced-supervision) ended the intervention. Although both groups improved in all four dimensions of pelvic floor muscle strength, with endurance showing differences between-groups. Completion rate was lower in the reduced-supervision group (58.8% vs. 77.7%). Lack of motivation was their main reason to leave. No significant changes were found in body composition or life satisfaction. However, the results suggest that comparable pelvic floor strength benefits can be achieved with fewer resources when health awareness is emphasized. Ongoing supervision appears important to minimize dropout in these sensitive interventions. Multidisciplinary, movement-based programs show strong potential for public health promotion in older women. Pelvic floor training should be incorporated into preventive care for this population and supervised or follow-up formats seem essential to support adherence and long-term effectiveness. Full article

Perimenopause is a complex, multidimensional biopsychosocial transition characterized by endocrine fluctuations that interact with psychological vulnerabilities, sleep disturbances, and physical symptoms, significantly impacting women’s health-related quality of life (HRQoL). While hormonal therapies remain a viable option, there is an increasing demand for acceptable and accessible non-pharmacological interventions. This structured narrative review synthesizes recent randomized controlled trial (RCT) evidence evaluating integrative non-pharmacological interventions for mental health and HRQoL during the menopausal transition. A structured search was performed in MEDLINE via PubMed, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) for RCTs published between 1 January 2021 and 30 June 2026. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale: Nineteen RCTs met the eligibility criteria and were categorized into five domains: (i) lifestyle and structured exercise interventions, (ii) psychological, educational, and coaching-based interventions, (iii) mind–body and meditative movement interventions, (iv) acupuncture and traditional technique-based interventions, and (v) herbal and nutraceutical interventions. Overall, physical activity, Mediterranean- or DASH-oriented dietary counseling, cognitive behavioral therapy (CBT), health coaching, mindfulness-based stress reduction (MBSR), yoga, and Tai Chi were associated with favorable findings for depressive and anxiety symptoms, perceived stress, insomnia, sexual functioning, and menopause-specific quality of life. Acupuncture, moxibustion, and specific nutraceuticals yielded positive but highly heterogeneous or formulation-specific outcomes. The breadth of reported effects appeared to vary according to comparator selection, with broader findings generally observed against inactive controls than against active or sham comparators. Current evidence supports integrating tailored non-pharmacological strategies within patient-centered perimenopausal care. However, substantial heterogeneity in perimenopause definitions, small sample sizes, high attrition in select trials, and a lack of long-term follow-up limit generalizable conclusions. Future research requires standardized staging, active comparative-effectiveness designs, and implementation evaluation within multidisciplinary healthcare settings. Full article

Polyendocrine metabolic ovarian syndrome (PMOS) is a prevalent and complex endocrine disorder, often underdiagnosed due to its heterogeneous clinical presentation and diagnostic criteria. Lifestyle interventions, including dietary modifications and physical activity, are widely recommended as first-line strategies to manage cardiometabolic risk; however, their effects on hormonal regulation remain less clearly defined. The aim of this systematic review is to synthesize current evidence on the effectiveness of dietary and physical activity interventions in adult women diagnosed with PMOS and to critically examine the consistency of their effects across metabolic and hormonal outcomes, addressing an important gap in the scientific literature. This review was prospectively registered in PROSPERO (ID: CRD420251246379) and follows PRISMA guidelines, and was conducted in December 2025 using PubMed, Web of Science, and ScienceDirect databases. Methodological quality of each study was assessed using the NIH Quality Assessment Tool for Controlled Intervention Studies. As results, 1054 records were identified, and 22 studies met the inclusion criteria. Lifestyle modifications, particularly energy-restricted diets, structured exercise programs, and their combination, were associated with improvements in body composition and metabolic parameters. However, a more heterogeneous and less predictable response was observed in hormonal outcomes, suggesting a partial dissociation between metabolic improvements and endocrine regulation in women diagnosed with PMOS. This variability reflects the complexity of PMOS and the influence of factors such as phenotype and baseline metabolic status. Overall, while diet and physical activity strategies effectively improve metabolic health, their impact on hormonal balance is less consistent, highlighting the need for more personalized approaches and well-designed trials with standardized criteria and longer follow-up. Full article

Spirituality and religiosity are increasingly recognized as important factors influencing mental health, particularly among women exposed to diverse vulnerabilities such as interpersonal violence, trauma, HIV infection, homelessness, and socioeconomic disadvantage. This systematic review aimed to synthesize evidence on the associations between spiritual or religious resources and mental health outcomes in these populations. A systematic search was conducted in Scopus, PubMed, and Web of Science to identify studies examining the association between spirituality, religiosity, and mental health outcomes in vulnerable women. A total of 28 studies were identified, including cross-sectional, longitudinal, and mixed-methods designs, which measured spirituality and religiosity using validated instruments such as SWBS, DUREL, FACIT-Sp-12, and Brief RCOPE, alongside standardized mental health measures. Narrative synthesis revealed that the majority of studies (n = 15) reported that higher spiritual well-being, intrinsic religiosity, and adaptive religious coping were associated with lower depression, anxiety, and post-traumatic stress, and with higher resilience, quality of life, and post-traumatic growth. These associations appeared to be shaped by contextual factors, including the type and severity of trauma, cultural and religious frameworks, and the lived experiences of the populations studied. Negative associations were primarily linked to negative religious coping (n = 5 studies), rather than religiosity per se. Additional factors that attenuated or reversed the expected positive effects included higher trauma severity or ongoing adversity (n = 4), reactive patterns in which greater psychological distress was associated with increased use of religious coping (n = 3), maladaptive religious beliefs such as interpretations of trauma as divine punishment (n = 2), and cultural or contextual influences (n = 3). Overall, the evidence suggests that spirituality and specific dimensions of religiosity (e.g., intrinsic religiosity, religious coping) can support mental health among vulnerable women, though personal, cultural, and situational factors shape their impact. These findings suggest the potential value of integrating spiritual resources into interventions and the need for further longitudinal and culturally sensitive research. Full article

Physical activity (PA) participation among university women is influenced by behavioural, psychosocial, and contextual factors. This study aimed to identify hierarchical profiles associated with PA participation using exploratory segmentation methods. A multicentre cross-sectional study was conducted with 417 university women from Chile, Spain, Italy, and Mexico (mean age = 22.2 ± 5.1 years). Participants completed validated questionnaires assessing habitual PA (IPAQ-SF), perceived barriers to PA (BBAQ-21), dietary quality (HEI), and health-related characteristics. Classification and Regression Trees (CART) and Exhaustive Chi-square Automatic Interaction Detection (CHAID) analyses were performed. Self-reported PA change since the pandemic emerged as the first-order segmentation variable within both exploratory models. Women reporting reduced PA since the pandemic had lower observed compliance with WHO recommendations (62.7%) than those reporting stable or increased PA (85.8%). Lack of energy (χ² = 18.61, p < 0.001) and lack of willpower (χ² = 28.63, p < 0.001) were the barriers most strongly associated with less favourable PA profiles. These findings support the value of segmentation-oriented approaches for understanding behavioural heterogeneity and informing gender-sensitive health-promotion initiatives in higher education settings. Given the cross-sectional and self-reported design, findings should be interpreted as exploratory segmentation patterns rather than predictive or causal evidence. Full article

Toxoplasmosis remains one of the most common parasitic infections affecting humans, with significant implications for pregnancy and fetal health. Maternal primary infection during gestation can result in transplacental transmission of Toxoplasma gondii, leading to a wide spectrum of congenital disease. The risk of vertical transmission increases with gestational age, whereas disease severity is inversely related—early infections causing severe neurological and ocular damage, and late infections often resulting in subclinical forms. Advances in serological testing, including IgG avidity assays and molecular diagnostics such as PCR on amniotic fluid, have improved early detection and management. Prenatal treatment with spiramycin or pyrimethamine–sulfadiazine–folinic acid combinations has been associated with reduced transmission and less severe fetal disease in several studies, although the magnitude of benefit remains debated. Long-term follow-up is essential, as late-onset manifestations, particularly chorioretinitis and neurodevelopmental impairment, are common. This narrative review was based on a comprehensive literature search of major medical databases and summarizes current knowledge on the epidemiology, pathophysiology, diagnosis, treatment, and outcomes of toxoplasmosis in pregnancy. Particular emphasis is placed on high-prevalence countries, where greater parasite genetic diversity, distinct epidemiological patterns, and a higher burden of congenital disease pose unique clinical and public health challenges. Despite progress in understanding parasite biology, pathogenesis, and treatment efficacy, congenital toxoplasmosis continues to be underdiagnosed and underreported, especially in low-resource settings. Ongoing challenges include optimizing screening strategies, ensuring access to standardized therapies, and strengthening surveillance systems. Full article

Menopause marks a complex biopsychosocial transition defined by the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. South Asian women tend to experience menopause earlier (45–47 years) than North American women, yet limited culturally appropriate interventions exist to address their symptoms. While hormone replacement therapy can reduce discomfort, its associated risks and limited cultural feasibility restrict its use in this population. There is a growing need to explore non-pharmacological and culturally relevant alternatives. Physical activity has been associated with potential well-being benefits during menopause. This study examined the prospective acceptability of a pedometer-based walking intervention, encouraging 10,000 steps daily, among South Asian immigrant women. The study was conducted in 2024 and completed within approximately seven months. A cross-sectional survey was conducted with 64 South Asian women aged 40–70+ years, who completed a questionnaire assessing the prospective acceptability and perceived barriers to participation. Overall, participants reported moderate to high levels of acceptability of the proposed walking intervention. Some participants perceived potential benefits for well-being; however, given the study design, effectiveness and symptom management outcomes were not assessed. Sociocultural factors—such as family responsibilities, modesty concerns, and limited access to supportive environments—were identified as potential barriers to participation. These findings suggest that a pedometer-based walking intervention may be acceptable to some South Asian immigrant women, though acceptability was not uniform and may be influenced by contextual factors, including opportunity costs. Further research using longitudinal or interventional designs is needed to evaluate feasibility, uptake, and effectiveness. Full article