Women

This paper assesses the correlates of perceived well-being among young women aged 18 to 30 in five Balkan cities: Athens, Greece; Plovdiv, Bulgaria; Bucharest, Romania; Nis, Serbia; and Shtip, North Macedonia, by integrating urban, travel behavioural, and socio-economic features. A cross-sectional survey was employed using standard questionnaires including the Warwick–Edinburgh Mental Well-being Scale (WEMWBS), the short version of the International Physical Activity Questionnaire (IPAQ), and the adapted ALPHA environmental questionnaire. To answer research questions, linear regression models were developed to analyse predictors of well-being at both regional and national levels. Results show that neighbourhood and mobility features play a significant role in shaping mental well-being. Access to walkable sidewalks, green spaces, mixed land-use structure, and attractive local facilities (e.g., shops, recreational centres in the neighbourhood) were consistently associated with higher levels of well-being. Conversely, perceived insecurity, especially at night or regarding bicycle theft, significantly reduced well-being. Physical activity levels, particularly days of walking and vigorous activity, showed strong positive associations, underscoring the role of active lifestyles in promoting mental health. Socio-economic variables, including financial status, relationship status, and work status, were also found to be linked to perceived well-being. Cycling-related variables may affect Greek well-being up to 16.5 times. Perception of crime during the night may negatively affect both Bulgarian and Serbian well-being (up to 10 times), while Romanian well-being is mostly affected by the existence of shopping facilities. Finally, the most impactful factors for well-being in North Macedonia refer to cycling safety and scooter accessibility. Full article

This study seeks to provide insight into the comprehensive efforts aimed at advancing gender justice, eliminating period poverty, and exposing stigmatizing views toward women’s bodies, specifically in relation to menstrual health. Menstruation is a normal bodily process for all women and girls, but the availability of menstrual products, dignity, and justice during menstruation remains a worrying concern. Menstruators still suffer from adverse circumstances when they menstruate, adding to their sufferings of experiencing pain and distress on a monthly basis. Menstrual hygiene requires the use of standardized menstrual products to maintain cleanliness during menses. However, women experiencing economic hardship and women who are marginalized bear the burden of inadequate hygiene amenities, basic hygiene services, and affordable menstrual products; they are victims of period poverty. The failure to recognize and effectively address menstrual issues perpetuates the idea that menstruation is a burden unique to women. In other words, government inaction on menstrual issues strengthens the perception that menstruation is an individual problem that women must manage independently. This study argues that when menstruation is identified as a bodily problem or a neglected subject, it perpetuates gender inequities and restricts access to well-suited hygiene material, which is known to cause urogenital infections. Given these challenges, the study recommends recognizing menstrual health as a serious health challenge. The absence of robust legal and international norms that specifically address menstrual health perpetuates neglect and the ongoing failure to meet the needs of menstruating women. Full article

Despite growing interest in humanized childbirth practices, there is still little qualitative research exploring women’s perspectives on vocalization during labor. The present study aims to analyze women’s experiences with the use of vocalization in the first and second stages of labor. A descriptive and exploratory qualitative study was conducted using semi-structured interviews with 16 women in the postpartum period between February and April 2024. Participants were recruited by convenience sampling, and data saturation was achieved when no new themes emerged from the interviews. Thematic analysis was performed using IRaMuTeQ (version 0.8 alpha 7) software. The textual corpus generated allowed classification into five thematic categories: Vocalization as an instinctive expression in natural childbirth; Functionality of vocalization during labor; Medicalized childbirth and natural childbirth; Fears during childbirth and their contributing factors; Typology of vocalization in labor. We conclude that many women reported that vocalization during labor is instinctive and functional, providing pain relief, but also serving as a means of communication, empowering women. Its expression can be strongly influenced by sociocultural, emotional, and contextual factors in each woman’s particular sphere. These findings, although limited to a specific population, suggest that healthcare professionals should consider vocalization as an individualized support tool, taking cultural differences into account. Full article

Cardiovascular disease disproportionately affects women in the United States. CVD outcomes are closely tied to a multitude of factors including lifestyle habits and socioeconomic status which create a complex interweb of determinants of health that place certain age and racial groups at higher risk over others. Such inequities highlight the need for targeted prevention strategies to address the unique risks faced by different populations. In this study, a state-wide analysis examining the mortality rates among women aged 35 years or older in Florida from 2018 to 2023 was done in order to identify high risk groups to better inform evidence-based public heath interventions that are tailored to the population’s needs. Mortality rates were extracted from the CDC Wonder Database. Age-adjusted and crude mortality rates, per 100,000 women, were calculated and stratified by ten-year age groups, Hispanic origin, race, and major CVD subtypes based on various ICD-10 codes. From the ICD-10 113 Cause List, “The Diseases of the Heart” were the cause of the majority of the deaths; however, “Other Forms of Chronic Ischemic Heart Diseases” was the leading subtype. Crude rates for the “Ischemic Heart Diseases” decreased 110.9 per 100,000 women in 2018 to 101.5 per 100,000 women in 2023. Yet, the most common cause of CVD-related mortality remains ischemic heart disease. Across the study period, non-Hispanic women experienced more than twice the crude mortality rate of Hispanic women. Racial breakdowns showed that White women had the highest CVD mortality, followed by Black women, who had elevated rates of heart failure and heart attacks in comparison to other minority groups. Asian women had the lowest rates across all cardiovascular subtypes. These findings underscore the persistent age and racial differences in cardiovascular outcomes emphasize the urgent need for culturally informed, community-specific preventative interventions to improve cardiovascular care and reduce mortality within high-risk populations. Full article

Postpartum psychosis (PPP) is a rare but high-risk psychiatric emergency, with an estimated incidence of 1–2 in 1000 births. This study focuses on describing the characteristics of episodes occurring within the first postpartum year, specifically examining clinical, etiopathogenic, and prognostic differences between immediate- or early-onset PPP (≤15 days postpartum) and delayed-onset PPP (onset after several weeks). Data were collected from ten patients diagnosed with PPP during the first postpartum year, and a retrospective descriptive analysis was conducted. Five patients experienced immediate or early decompensation and five experienced delayed onset. None of the variables analyzed showed a significant association with the timing of decompensation (p > 0.05). The majority of deliveries were vaginal (n = 8), and most patients were primiparous (n = 9). The most frequent subsequent diagnosis was schizophrenia or a psychotic spectrum disorder (n = 6). The type of partner showed a non-significant trend (p = 0.15), which may warrant further investigation. Notably, the role of partner type deserves closer examination, as it may act as a protective factor against the development of mental disorders and could inform targeted support strategies within health care systems. The lack of descriptions of time to onset periods (staging) in PPP samples could be a gap in the literature. Full article

This study examines the relationship between quality of life, self-esteem, and anxiety in Slovak women of reproductive age diagnosed with polycystic ovary syndrome (PCOS). The research was carried out with a non-experimental correlation survey design, and the data was obtained using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), the Generalized Anxiety Disorder 7-item scale (GAD-7), the Rosenberg Self-Esteem Scale (RSES), and the Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ). The research sample consisted of 244 women aged from 18 to 52 years with a confirmed PCOS diagnosis. The results revealed that lower health-related quality of life scores among women with PCOS were associated with lower self-esteem and higher levels of anxiety. Furthermore, higher general quality of life in the domains of Physical health, Psychological Health, Social relationships, and Environment were associated with higher self-esteem and lower anxiety among women with PCOS. The results also show the effect of emotional problems as a symptom of PCOS for anxiety, self-esteem, and general quality of life, especially in the areas of physical and psychological health. New insights in this area may contribute to the improvement of women’s awareness of PCOS and its consequences and emphasise the need for support of both physical and mental health. Full article

Non-syndromic Orofacial clefts (NSOFCs) are among the most common congenital anomalies globally, yet evidence on maternal dietary and nutritional risk factors in sub-Saharan Africa is limited. A matched case–control study with 103 mothers of children with non-syndromic OFCs and 103 control mothers of unaffected children was conducted to assess dietary patterns, food security, and supplement use. Dietary intake was assessed using a food frequency questionnaire, and patterns were identified through principal component analysis. Household food security was measured using the USDA 18-item scale, and periconceptional multivitamin and folic acid use were recorded. Logistic regression models examined the associations. Three major dietary patterns emerged: Sweet and Energy-Dense, Staple Plant-Based, and Animal Protein–Vegetable. Higher adherence to Sweet and Energy-Dense (Highest tertile, T3: OR = 22.27; 95% CI: 8.71–56.91, p < 0.001) and Staple Plant-Based (T3: OR = 4.07; 95% CI: 1.70–9.73, p = 0.002) was associated with increased OFC odds, while the Animal Protein–Vegetable pattern suggested a borderline protective association (T3: OR = 0.44; 95% CI: 0.19–1.03, p = 0.048). Severe food insecurity was more common among case-mothers (49.5%) than controls (39.8%). Periconceptional use of multivitamins and folic acid was low (<15%) in both groups. These findings highlight the importance of improving maternal diet quality and addressing food insecurity in resource-limited settings. Full article

Background: Higher socioeconomic status (SES) is generally associated with lower engagement in health-risk behaviors, in part due to increased access to health information, preventive resources, and supportive environments. However, emerging evidence suggests that this protective pattern may not extend uniformly to all forms of substance use, including adolescent e-cigarette use, and may vary by gender. For instance, some studies have found higher rates of e-cigarette use among adolescents from higher SES backgrounds. Aim: This study examined whether the associations between family SES and tobacco use differ between girls and boys. We also explored whether these associations vary by age group. Methods: A cross-sectional survey was conducted among students (age 14–20) attending public high schools in Baltimore City. Family SES was assessed using three indicators: parental education, parental employment, and household income. Tobacco use was measured using self-reported past use of e-cigarettes and conventional cigarettes. Demographic covariates included age, sex, race/ethnicity, and household composition. Separate logistic regression models were estimated for each tobacco use outcome, adjusting for covariates. To examine subgroup differences, analyses were stratified by gender and age. Results: Higher parental education was associated with lower odds of e-cigarette use, but no SES indicators were significantly associated with conventional cigarette use. Subgroup analyses showed that the protective association of parental education against e-cigarette use was evident among girls but not boys and among older but not younger adolescents. Conclusions: These findings differ from previous studies that reported a positive association between SES and adolescent e-cigarette use. In this predominantly low-income, urban sample, higher parental education appeared to be protective for girls but not for boys. These results suggest that SES influences on tobacco use may be context- and subgroup-specific. Further research is needed to better understand how sociodemographic and contextual factors shape adolescent tobacco use behaviors. Full article

The goal of this study was to identify factors associated with pain sensitivity, procedural discomfort, and referral for surgical hysteroscopy, aiming to improve office hysteroscopy success rates. This was an observational prospective cross-sectional study that analyzed data from women who underwent outpatient hysteroscopy between October 2022 and October 2023. Epidemiological, clinical, and procedural data were collected from medical records. Pain levels were assessed using a visual analog scale (VAS), categorized as acceptable (0–6) or severe (7–10). Statistical analyses were performed to explore associations between patient characteristics and pain levels, with p-values < 0.05 considered significant. This study evaluated 1662 women. The mean age was 54.0 (±12.4) years, and 59.1% were postmenopausal. Nulliparity, menopause, lower body mass index (BMI), and fewer vaginal deliveries were associated with higher pain levels (p < 0.05). Cervical stenosis significantly increased procedural pain: 20.8% and 27.6% of patients with stenosis resolved during the procedure, respectively, reported severe pain. In the multivariate logistic regression analysis, protective factors against severe pain included having ≥2 vaginal deliveries (OR 0.53, 95% CI 0.39–0.72), patent internal (OR 0.53, 95% CI 0.38–0.75) and external cervical orifices (OR 0.47, 95% CI 0.30–0.72), presence of myomas (OR 0.53, 95% CI 0.34–0.83), and biopsy performance (OR 0.55, 95% CI 0.41–0.74). Severe pain, uterine lesions, and stenosis were the main reasons for surgical referral. Lower BMI, nulliparity, menopause, and cervical stenosis were significant predictors of increased pain during outpatient hysteroscopy. These findings may help identify patients at higher risk for procedural discomfort and support strategies to improve success of office hysteroscopy. Full article

The purpose of this scoping review is to identify major social determinants of health and barriers affecting access to mental health services in pregnant and postpartum women in the United States. It will also examine the scope of existing evidence-based interventions and dissemination and implementation strategies that were developed and implemented to increase accessibility to mental health treatment in high-risk pregnant and postpartum women. The Arksey and O’Malley Framework guided the review process, along with the Joanna Briggs Institute (JBI) recommendations for the extraction, analysis, and presentation of results in scoping reviews. Additionally, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR) was used as a reference checklist. A total of 21 studies were used for analysis that were published between 2015 and 2025. An examination of social determinants of health (SDOH) influencing factors of mental health determined that those related to neighborhood and built environment had the highest rates. Using the socioecological model, individual barriers exhibited the highest frequency, with the most common themes to these barriers across all studies being language barriers, cultural barriers, and stigma-related challenges, followed by financial and childcare challenges and transportation challenges. Major findings included important evidence that therapeutic relationships with pregnant women who are depressed can be developed and that telehealth interventions improved access for women living in rural areas. Recommendations from this review will inform evidence-based interventions to address the gap in accessibility and affordability of mental health services in US pregnant and postpartum women residing in underserved communities. Full article

Cultural and religious norms significantly influence reproductive decisions, including prenatal testing and pregnancy termination. We conducted a cross-sectional study among Muslim women living in mixed Jewish-Arab cities compared to those in predominantly Arab cities in Israel. Data for all co-variates were obtained through participants’ self-reports by an online questionnaire of 36 items for adequate content validity between July 2022 and June 2023. In total, 1081 Israeli Muslim women aged 18–49 years were enrolled. Religious affiliation has been shown to influence individuals’ attitudes toward abortion, with members of religious communities often holding more restrictive or negative views on the subject. Muslim women residing in mixed Jewish-Arab cities demonstrate significantly higher uptake of both non-invasive and invasive prenatal testing, as well as pregnancy terminations following abnormal diagnoses, compared to those in predominantly Arab cities (p < 0.001), which indicates that proximity to Jewish communities, greater availability of health services, and exposure to more permissive social norms in mixed cities may reduce religious and cultural barriers, thereby facilitating more informed reproductive decisions. Older women (≥35) in mixed cities had a higher tendency to birth a child with abnormalities in the past than Arab cities (80.9% vs. 70.0%, respectively), However, women who lived in mixed cities underwent more non-invasive (87.2% vs. 64.8%, respectively), invasive prenatal tests (85.1% vs. 69.7%, respectively), and pregnancy termination (88.3% vs. 64.1%, respectively) than those in Arab cities, p < 0.001. Our findings indicate the importance of gaining a deeper understanding of the relations between religious convictions, cultural standards, and medical practices that should contribute to reducing the prevalence of genetic disorders with their associated adverse impact on families, communities, and healthcare systems. Full article

Objective: To assess gestational diabetes mellitus (GDM) awareness among women in the Northern Borders Province of Saudi Arabia and identify factors associated with knowledge levels. Methods: A cross-sectional study was conducted among 461 women using a structured, validated online questionnaire assessing demographics, medical history, and knowledge of GDM’s effects on maternal and neonatal outcomes. Associations between demographic factors and GDM awareness were analyzed using chi-square tests. Results: Most participants (98.5%) were Saudi nationals, with a mean age of 34.5 ± 10.0 years; 82.6% had university-level education. Overall, 42.3% demonstrated fair awareness of GDM, 34.3% had good awareness, and 23.4% had poor awareness. Knowledge of GDM’s maternal complications varied: 70% recognized the risk of emergency cesarean section, but only 8.2% were aware of increased preeclampsia risk. For neonatal outcomes, 58.4% identified high birth weight as a risk, while only 31.9% recognized the risk of congenital anomalies. Higher awareness was significantly associated with education level (p = 0.02), pregnancy status (p = 0.001), trimester (p = 0.002), and family history of relevant conditions (p = 0.04). Conclusion: Although many women showed fair-to-good awareness of GDM, notable gaps remain, especially regarding specific complications. Targeted educational interventions, particularly for less-educated and non-pregnant women, are recommended to improve GDM awareness and pregnancy outcomes. Full article

Endometriosis is a benign and often underdiagnosed condition that affects women of reproductive age, typically between 18 and 45 years. It can cause infertility and pain, including radicular pain and low back pain (LBP). The aim of this case report is to emphasize the importance of making a differential diagnosis when facing LBP and radicular symptoms. We report the case of a 17-year-old female patient, R.A., presented with a significant LBP (NPRS 8/10) radiating from her lumbar spine to her right buttock and occasionally to both legs, accompanied by weakness. She revealed exacerbation of pain during menstruation, despite being under hormonal contraceptive treatment. After three physiotherapy sessions that included education, manual therapy and exercise, the patient’s pain persisted so her physiotherapist recommended an evaluation in the emergency department, where standard radiography did not reveal any significant findings. Physiotherapy continued until the fifth session, when the patient agreed to undergo evaluation at a specialized endometriosis centre. Further investigations revealed endometriotic tissue on the uterosacral ligament, leading to hormonal therapy adjustment, with which pain gradually decreased to a manageable level (NPRS 2/10). This case report highlights the importance of an early differential diagnosis in patients with LBP, as endometriosis can present not only in older women but also in younger patients, including those already on oral contraceptives. Therefore, to mitigate the risk of pattern recognition bias, clinicians must maintain a high index of suspicion for endometriosis, even in atypical or unlikely clinical presentations. Full article

Postmenopausal osteoporosis is estrogen-dependent and results in an imbalance between bone formation and resorption. The approved therapy is intended to reduce the risk and consequences of fractures, but still has a number of contraindications and associated adverse effects. Recently, oxytocin has been shown to have an anabolic effect on bone tissue, increasing the production of osteoblasts and inhibiting the activity of osteoclasts. Thus, this study aimed to examine the potential of oxytocin as a biomarker and therapeutic agent for postmenopausal osteoporosis. A PubMed search yielded 16 articles upon analysis of the inclusion and exclusion criteria. The results showed that, compared to women in the same age group without bone loss, those diagnosed with osteoporosis exhibited lower blood oxytocin levels, possibly related to a greater tendency towards fractures. The administration of oxytocin could be a promising strategy to enhance bone quality and, consequently, to reduce the incidence of fragility fractures; however, no human studies have been conducted regarding its use as a possible treatment. Thus, it is essential to increase the number of clinical trials in women with ovarian dysfunction and bone loss, in which oxytocin could become a viable therapeutic alternative. Full article

Maternal mental illness significantly impacts caregiving, influencing both mothers and their children. This narrative review examines the challenges faced by mothers with conditions such as depression, anxiety, bipolar disorder, and schizophrenia, which often disrupt caregiving routines, emotional stability, and social integration. These difficulties can hinder secure attachments and contribute to adverse developmental outcomes in children, including heightened risks of anxiety, depression, behavioral issues, and cognitive impairments. Children of mothers with mental illnesses are 1.8 times more likely to develop emotional or behavioral problems and face a 2.7 times higher risk of suicidal ideation during adolescence. Intergenerational transmission of mental illness is also prevalent, with affected children showing a 2.5 times greater likelihood of developing mental illnesses in adulthood. Effective interventions include cognitive behavioral therapy (CBT), family-based approaches, and community programs integrating parenting education and mental health resources. These strategies have demonstrated improvements in maternal well-being and child resilience. The review highlights the need for comprehensive policies addressing maternal mental health, early intervention for children, and culturally sensitive support systems to break cycles of intergenerational mental illness. Future research should prioritize evaluating long-term intervention effectiveness and exploring innovative tools like digital mental illnesses solutions to support affected families. Full article

Women’s greater vulnerability to intrusive memories following trauma may be partially explained by the influence of ovarian hormones on memory consolidation processes. Contributing to accumulating research examining the influence of ovarian hormones on the development of intrusive memories, we hypothesized that cyclical fluctuations in estradiol and progesterone, not merely absolute levels, contribute to this risk. We further hypothesized that hormonal contraceptives, which effectively eliminate fluctuations and keep ovarian hormones at chronic low levels, can convey protective effects against memory intrusions following analogue trauma exposure. We examined the development of memory intrusions following trauma film stressor exposure among men (n = 27), hormonal contraceptive (HC) users (n = 41), and naturally cycling (NC) women in the early follicular (EF; n = 24), late follicular (n = 20), ovulatory window (n = 14), and luteal phases (n = 21) for 5 days to assess whether low ovarian hormone levels convey a protective effect for women. Contrary to hypotheses, this study found no support for this prospect; rather, exposure to stressors during the window around ovulation increased the risk for more frequent intrusive memories. Enhanced stress responsivity may have particular effects on ovulation, promoting evolutionary fitness. Full article

Depression and anxiety are the most prevalent mental health concerns among college students. In addition to the typical college stressors, Hispanic students may experience minority status stress associated with their membership in a socially stigmatized ethnic and cultural group. Ethnic minority status stress has been positively associated with psychological distress. Therefore, this study examined, among Hispanic college students, (a) gender differences in the associations of ethnic minority status stress and social support to depression and anxiety symptoms, (b) if social support buffered the association of minority stress with depression and anxiety symptoms, and (c) if the social support moderation effect differed by gender. The results indicated that the negative association of social support to depression symptoms was stronger for women than men and that social support buffered the association of ethnic minority status stress to depression symptoms only for women. The negative association of minority status stress to depression symptoms was statistically significant only for women who reported lower levels of social support. No gender or social support moderation effects were observed in relation to anxiety symptoms for women or men. The results highlight the importance of social support in ameliorating the potential impact of ethnic minority status stress on psychological distress among Hispanic college women. Full article

Sleep disturbances frequently affect postmenopausal women, yet the evidence supporting the use of aromatherapy as a therapeutic intervention remains inconclusive. This systematic review and meta-analysis evaluated the efficacy of aromatherapy in improving sleep quality in postmenopausal women by analyzing data from randomized controlled trials (RCTs). Three RCTs comprising a total of 301 participants were included. Eligible studies compared aromatherapy with control conditions and reported sleep-related outcomes. The pooled analysis revealed no statistically significant difference in global Pittsburgh Sleep Quality Index (PSQI) scores between the aromatherapy and control groups (mean difference, −2.66; 95% CI −6.49 to 1.17; p = 0.17), with high heterogeneity (I² = 98%). However, subgroup analyses demonstrated significant improvements in sleep latency (mean difference, −0.98; 95% CI −1.75 to −0.21; p = 0.01) and daytime drowsiness (mean difference, −0.79; 95% CI −1.30 to −0.28; p = 0.002). These findings suggest that aromatherapy may provide targeted benefits for certain aspects of sleep, particularly sleep latency and daytime dysfunction. Further high-quality RCTs with larger sample sizes, standardized aromatherapy protocols, and long-term follow-up are necessary to validate these outcomes and establish evidence-based clinical guidelines for the use of aromatherapy in managing sleep disturbances among postmenopausal women. Full article

Vestibulodynia is vulvodynia localized to the vulvar vestibule and is a chronic disease defined as vulvar pain of at least three months’ duration, without a defined cause, that severely affects women’s health and quality of life with limited treatment options. We collected stool and vaginal samples from 30 women affected by vestibulodynia and 27 healthy women. Bacterial gut and vaginal microbiomes were characterized by amplicon sequencing, and compositional and functional differences between the control and the patient groups were assessed. No differences in vaginal or fecal alpha and beta diversity were found, but vaginal microbiota of patients was found to be associated with Lactobacillus iners. Moreover, the relative abundance of L. iners negatively correlated with the relative abundance of L. crispatus, and positive correlations between commensals and pathobionts were found in the vestibulodynia vaginal microbiota but not in the healthy controls. The bacterial functions and contributors were defined in the study groups for the fecal and vaginal microbiota. Our results portrayed the vaginal microbiome of patients with vestibulodynia as potentially not as efficient at living in an anaerobic environment as the healthy microbiome is and too inclined to acidify this environment, exposing it to the risk of developing other ailments. Full article