Women doi: 10.3390/women6030062

Authors: Natasa Zenic Tatjana Jezdimirovic Stojanovic Dora Maric Maja Pajek Damir Sekulic

Older women often face barriers to sustained participation in physical activity (PA) while understanding the acute psychological effects of exercise may support their long-term adherence in PA. The aim of this study was to examine acute changes in mood following a single exercise session and the moderating role of previous exercise experience in +60-year-old women from southern Croatia. Participants were women (73.3 ± 5.71 years of age) involved in an outdoor community-based exercise program. They were classified into an experienced group (EG; n = 42) and a nonexperienced group (NEG; n = 21). Mood state was evaluated by the Brunel Mood Scale (BRUMS) before (pre-) and after exercise (post-measurement). Acute mood changes were analyzed by two-way repeated-measures ANOVA with Time (pre- vs. post-measurement) and Group (EG vs. NEG) as the main effects and Time × Group interaction. By exploratory correlation analyses, we examined changes in the associations among mood dimensions separately for the EG and NEG. Favorable changes were evidenced in depression (F test = 4.32, p < 0.05), anger (F test = 9.54, p < 0.01), and confusion (F test = 14.25, p < 0.001), and the total mood disturbance score (TMD) (F test = 6.41), with significant interaction effects evidenced for tension, vigor, fatigue, and TMD. Exploratory analyses suggested differences in the correlations between mood dimensions according to exercise experience, supporting the conclusion on the differential influence of exercise in the EG and NEG. Community-based exercise induced favorable acute mood responses in older women, but these responses were influenced by previous exercise experience, with more pronounced favorable effects observed in the EG. When exercise programs for older women are designed with consideration of exercise history may enhance positive exercise experiences and support sustained participation.

Women doi: 10.3390/women6030060

Authors: Refilwe N. Phaswana-Mafuya Edith Phalane Nompumelelo Zungu Alfred Musekiwa Lebogang M. Ramalepe Peter S. Nyasulu Ruvimbo Nhandara Justin Dansou Kayla Bagg Olive Shisana

The health sector needs to provide a comprehensive evidence-based response to survivors of gender-based violence (GBV). Violence against women and girls (VAWG) and GBV are one of the most prevalent forms of violence and has sexual reproductive health and rights (SRHR) impacts. This paper determines the prevalence and diversity of responses to GBV, VAWG, and SRH, and describes the interventions and associated health outcomes in the 31 Commonwealth and other selected African countries. A narrative synthesis described the diversity of interventions for GBV, VAWG, and SRHR. A meta-analysis of eligible randomised controlled trials (RCTs) was conducted to evaluate the efficacy of interventions aimed at enhancing SRHR knowledge and attitudes among adolescents, couples, and partners. We included 60 studies on GBV, VAWG and SRHR interventions. Nine studies were included in the meta-analysis. A range of education-based interventions for SRHR were implemented resulting in improved SRHR knowledge and attitudes among adolescents, couples, and partners (OR 2.47, 95% CI: 1.51–4.03). When compared with cluster RCTs (OR 2.28, 95% CI: 1.49–4.80), RCTs provided moderate evidence of improving SRHR knowledge and attitudes (OR 1.78, 95% CI: 1.14–2.77). Home-based visits, education-based interventions, one-way or two-way SMS with health education messages, and youth-friendly health services (YFHS) may all be essential for enhancing SRHR knowledge and attitudes among partners, couples, and adolescents.

Women doi: 10.3390/women6030061

Authors: Lucas Banda Mathildah Mpata Mokgatle Olanrewaju Oladimeji

Psychological distress disproportionately affects women in South Africa, especially those living with or impacted by HIV. Stigma, structural barriers, and gaps in service provision limit access to appropriate care. This qualitative study explored the experiences of women participating in the Lyric Analysis Peer Support Intervention (LAPSI), focusing on implementation feasibility, usability, motivators for participation, and perceived benefits. Semi-structured interviews were conducted with 29 South African women from two sites (Mthatha and Tshwane). Data analysis utilized reflexive thematic analysis based on Braun and Clarke’s framework, revealing three interrelated themes: (1) feasibility of and barriers to engagement; (2) usability of LAPSI; and (3) motivators for engagement and perceived benefits. Participants reported ongoing barriers to mental health support, such as stigma, fear of negative judgment, and transport issues. However, they noted that LAPSI helped alleviate these challenges by creating psychologically safe peer spaces, building trust through shared experiences, and using culturally relevant song lyrics to encourage emotional expression among diverse literacy levels. Overall, the findings suggest that LAPSI could serve as a music-informed psychosocial intervention, with potential for future evaluation and integration into community-based and HIV-related services to address psychological distress among South African women.

Women doi: 10.3390/women6030059

Authors: Makayla J. Graham Brittany C. Slatton

Black neurodiverse women with postsecondary education occupy an underexamined intersection of race, gender, and neurodiversity, yet little research has examined their access to affirming community support. This survey study (N = 53) examines community access and mental health among Black neurodiverse women with postsecondary education. Findings reveal a 54.7 percentage-point gap between how many participants rated community support as important (96.2%) and how many had found it (41.5%). Participants also reported high rates of anxiety (90.6%), depression (79.2%), and masking (77.4%). Using qualitative reflexive thematic analysis, the following four themes were developed, defined, and named: (1) living at the intersection of race, gender, and neurodiversity; (2) structural barriers to access; (3) finding and building community; and (4) community as emotional validation and intersectional recognition. Framed through Black Feminist Disability Theory and intersectionality, these findings position access to affirming community as a structural health need and a health equity issue. Implications are drawn for campus mental health services, community organizations, and future research.

Women doi: 10.3390/women6030058

Authors: Jale Minibas-Poussard

Endometriosis is a chronic and often debilitating condition whose symptoms extend beyond pelvic pain to include fatigue, gastrointestinal and urinary complaints, menstrual irregularities, and reduced work capacity. These symptoms are typically framed within medical or occupational health discourse, yet little attention has been paid to how they are socially interpreted within workplace relationships. Drawing on the workplace bullying literature alongside qualitative research on the lived experience of endometriosis, this conceptual review proposes that endometriosis-related symptoms are minimized through two interconnected mechanisms: symptom fragmentation, in which the disease’s varied and cyclical presentations are perceived as unrelated complaints rather than expressions of one chronic illness, and identity pathologization, in which the resulting pattern of absence and reduced capacity is reattributed to the worker’s character rather than her condition. The review further situates these mechanisms within the broader literature on women-to-women workplace bullying and examines how humor may function as a socially deniable vehicle for mistreatment. Three anonymized vignettes drawn from clinical practice illustrate each mechanism in isolation and in combination, tracing the self-reinforcing loop through which fragmentation and pathologization sustain one another over time. Practical implications are offered for occupational health practice, managerial training, anti-bullying policy, and clinical care. The aim is not to psychologize endometriosis, but to contextualize suffering that currently falls between medical, organizational, and psychological frameworks—and to prevent the gradual transformation of illness into stigma and of symptoms into moral judgment.

Women doi: 10.3390/women6030057

Authors: Guner Cicek Dilara Candan Francesca Greco Francesco Murfone Vincenzo Prigitano Maria Grazia Tarsitano Gian Pietro Emerenziani

This study examined the effects of an eight-week core strengthening exercise program on menstrual pain, menstrual symptoms, and quality of life in sedentary female university students with self-reported primary dysmenorrhea. Sixty female students (age: 21.8 ± 3.4 years) were randomly assigned to a core strengthening exercise group (EG; n = 30) or a control group (CG; n = 30). Pain intensity was assessed using the Numerical Rating Scale (NRS) at baseline (T1), after four weeks (T2) and after eight weeks of intervention (T3). Menstrual symptoms and quality of life were evaluated using the Menstrual Symptom Questionnaire (MSQ) and the WHO Quality of Life–BREF (WHOQOL-BREF), respectively. NRS scores in the EG were significantly lower at T2 and T3 compared with T1 (p < 0.01). The EG showed significant reductions in negative symptoms, pain, management, and total MSQ scores, whereas management and total MSQ scores increased in the CG (p < 0.01). Significant improvements were observed in all WHOQOL domains (physical, psychological, social relationships, and environment) in the EG (p < 0.01). An eight-week core strengthening exercise program may help reduce menstrual pain and symptoms and improve quality of life in female university students with self-reported primary dysmenorrhea.

Women doi: 10.3390/women6030056

Authors: Estela Contelles-Marco Paula Sánchez-Palomares Rosa María Gómez-Sánchez Elena Chover-Sierra Noelia Navas-Echazarreta Pablo del Pozo-Herce Michal Czapla Raúl Juárez-Vela Antonio Martínez-Sabater Raquel María Martínez-Pascual

Background: Pregnancy is a period of major brain adaptation, involving structural and functional changes that help women adjust to motherhood and support caregiving. Objective: To review current evidence on neuroplasticity during pregnancy and the postpartum period, focusing on brain changes, their biological basis, and their relevance for maternal mental health and nursing care. Methods: A systematic review with narrative synthesis was conducted in accordance with the PRISMA 2020 statement. The protocol was prospectively registered in PROSPERO (CRD420261376422). Searches were performed in PubMed, BVS, IBECS, CINAHL, and the Cochrane Library for studies published between 2016 and 2026 in English or Spanish. Results: Of the 1722 records initially identified, 15 studies were included in the narrative synthesis after screening and quality assessment using the CASP checklists and SANRA scale. The evidence showed that pregnancy is associated with changes in grey and white matter, as well as in brain connectivity, particularly in regions involved in social cognition, emotional regulation, and maternal behavior. These changes, largely driven by hormonal fluctuations, may persist after childbirth and are associated with greater maternal sensitivity, stronger mother–infant bonding, and more effective caregiving. However, they may also increase vulnerability to perinatal mental health disorders. Conclusions: Pregnancy represents a critical period of neuroplasticity. A better understanding of these changes may improve perinatal care, support maternal mental health, and guide nursing interventions during the transition to motherhood.

Women doi: 10.3390/women6030055

Authors: Suhagi Kadakia Aloka L. Patel Leslie M. Harris Mary C. Dyrland Caitlin Anday Sara E. Barajas Jane Oh Tricia J. Johnson

Mothers of preterm infants (PT; <37 weeks gestational age) face economic barriers to mother’s own milk (MOM) provision, including lack of paid maternity leave and unpaid workload that may prevent sustained MOM provision. The objective of this study was to understand how mothers of PT infants navigate decisions about MOM provision and paid and unpaid work. Semi-structured interviews were conducted with mothers of PT infants between 5 days and 10 weeks postpartum. Interviews included questions about responsibilities in the home, pre-delivery work experience and plans to provide MOM, and postpartum work experience and MOM provision. Data were analyzed using reflexive thematic analysis, following Braun and Clarke’s method. This study included 18 mothers, who were predominantly non-White (79%) and covered by Medicaid (72%) with infants born at a median gestational age of 32 weeks. Three themes emerged: (1) unexpected prenatal events create postpartum job uncertainty; (2) breastfeeding intentions are often derailed after PT delivery; and (3) the unpredictable reality of having a PT infant shifts maternal priorities and obligations related to paid and unpaid workload. PT delivery creates emotional and financial stress and uncertainty for new mothers. Although federal and employment-based paid leave may alleviate some financial stress for mothers employed prior to delivery in the United States, mothers who leave the workforce before delivery will not benefit from these policies. Policies are needed to support all mothers of PT infants in facilitating long-duration MOM provision, independent of employment status.

Women doi: 10.3390/women6030054

Authors: Mohamad Zakour Khadari Hadzliana Zainal Nur Aizati Athirah Daud Abubakar Sha’aban Mohamad Saleem Anis

Gestational hypertension (GH) imposes physiological and psychosocial burdens that reduce maternal well-being. Health literacy (HL) and health-related quality of life (HRQoL) are important factors influencing self-care and perceived health. This study compared HL and HRQoL between pregnant women with and without GH during the second and third trimesters of pregnancy and examined the relationship between them. A prospective longitudinal comparative study was conducted involving 378 pregnant women. HL and HRQoL were assessed during the second and third trimesters using the 12-item Health Literacy Scale (HLS-12) and the 36-Item Short Form Health Survey (SF-36), respectively. Women with GH had lower median HRQoL and HL scores in the second and third trimesters (p < 0.05). Within the GH group, HRQoL declined from 80 (65–90) to 55 (40–65) in the physical functioning domain, with similar reductions in role limitation and general health domains. The percentage of women with low or moderate HRQoL increased markedly in the GH group (p < 0.001). HL differed significantly between groups; women with GH were more frequently classified as having inadequate or problematic HL (p < 0.001). Compared to normotensive women, pregnant women with GH have lower HL and HRQoL during the second and third trimesters. The two variables were moderately correlated. There is a further need to assess HL and HRQoL in women with high-risk pregnancies and to implement effective strategies to improve the affected domains.

Women doi: 10.3390/women6030053

Authors: Thembelani Khumalo Daniel Doh Sabastain Gunda Sipho Sibanda

This systematic review explores the multifaceted factors influencing African Australian migrant women’s decisions to remain in family violence relationships. It critically examines how existing service frameworks marginalise women who stay and advocates for culturally safe, trauma-informed, and harm-reduction programs. The study calls for a significant policy and practice shift to recognise diverse survival strategies beyond conventional notions of “leaving”. Guided by a critical realist ontological approach, the review employs thematic analysis of qualitative data to illuminate the complex interplay of social, cultural, legal, and economic factors shaping women’s choices. Findings reveal that current service models, predominantly based on a “leave to be safe” paradigm, fail to address intersecting barriers faced by African Australian migrant women. These include precarious visa status, language barriers, and fear of child removal, which compel many to remain in violent environments. The study highlights the unique challenges posed by insecure migration status, which intensifies family violence and impedes help-seeking behaviours. This review identifies significant structural and intersectional barriers, critical policy gaps and proposes re-envisioning support pathways to better serve women who, for structural and personal reasons, cannot or choose not to leave abusive relationships. It underscores the need for culturally safe, harm-reduction strategies and systemic reforms to dismantle structural inequalities embedded in immigration and family violence responses.

Women doi: 10.3390/women6030052

Authors: Alessandro Messina Safae El Motarajji Camilla Chimenti Francesca Valloreo Bianca Masturzo Livio Leo

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.

Women doi: 10.3390/women6030051

Authors: Basilio Pecorino Giorgio Arcarese Benito Chiofalo Paolo Scollo Giuseppe Scibilia

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.

Women doi: 10.3390/women6030050

Authors: Nerina Fabbro Alberto Onorato Valentina Bassi Roberto Cannataro

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.

Women doi: 10.3390/women6030049

Authors: Donatella Caserta Fernando Ficarola Francesco Branda Andrea Giannini Aris Raad Besharat Angela Musella

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.

Women doi: 10.3390/women6030048

Authors: María del Carmen Velasco-Carrasco Ana Cordellat-Marzal Alicia Sales Carolina Pinazo-Clapés Sacramento Pinazo-Hernandis Cristina Blasco-Lafarga

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.

Women doi: 10.3390/women6030047

Authors: Cibeles Serna-Menor Ivan Herrera-Peco María Aránzazu Sánchez-Calabuig Aranzazu Aparicio Alexis Serna-Menor Raquel Moreno-Sánchez Gema Mata-González Juan Pablo Hervás-Pérez

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.

Women doi: 10.3390/women6030046

Authors: Melisa Zelina Téllez-Villagómez Francisco Javier Olivas-Aguirre Marcelino Téllez-Amezcua Karina de Jesús Díaz-López María Guadalupe Delgadillo-Ramos Francisco José Amaro-Gahete Marco Antonio Hernández-Lepe

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.

Women doi: 10.3390/women6030045

Authors: Fabiana Chyczij Ana Caramelo Pedro Morgado Sara Diogo Gonçalves

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.

Women doi: 10.3390/women6030044

Authors: Luis Moral-Moreno

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.

Women doi: 10.3390/women6030043

Authors: Alan Roberto Hatanaka Antonio Braga Evelyn Traina Larissa Keren de Azevedo Teixeira Carolina Longo Pedro Teixeira Castro Heron Werner Gustavo Yano Callado Edward Araujo Júnior

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.

Women doi: 10.3390/women6030042

Authors: Hasina Amanzai Souraya Sidani Shrishti Kumar Sumyya Rahman Sepali Guruge Enza Gucciardi Charlotte T. Lee Karan Ralhan Anika Joshi

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.

Women doi: 10.3390/women6020041

Authors: Bogdan Dumitriu Alina Dumitriu Flavius George Socol Ioana Denisa Socol Ileana Enatescu Cosmin Rosca Adrian Gluhovschi

When women choose a contraceptive method, the decision depends not only on what they prefer but also on the quality of the information they encounter online and on how confident they feel about using a method. We examined how exposure to inaccurate online contraceptive information (“digital misinformation”) and uncertainty about contraceptive decisions (“decisional conflict”) related to mental health and quality of life in women with and without a history of abortion. This was a cross-sectional study of 134 women aged 18–42 years attending obstetrics–gynecology or family-planning services at one Romanian tertiary center. Women were grouped as having no prior abortion (n = 41), one prior abortion (n = 53), or repeat abortion (n = 40). We measured a study-specific digital misinformation index, an access barrier index, contraceptive self-efficacy, reproductive autonomy, depression (PHQ-9), anxiety (GAD-7), well-being (WHO-5), quality of life (WHOQOL-BREF), and current use of highly effective contraception. We compared groups and used regression, mediation, and exploratory profiling. Women with repeat abortion reported the most online misinformation (10.0 ± 2.0), the most decisional conflict (43.9 ± 9.3), the lowest quality of life (61.3 ± 5.6), and the lowest use of highly effective contraception (45.0%). More misinformation and more access barriers were each associated with greater decisional conflict, while higher self-efficacy was associated with less. In this cross-sectional sample, online misinformation and decisional uncertainty were associated with reproductive vulnerability more closely than abortion count alone. Findings are associational and require prospective confirmation.

Women doi: 10.3390/women6020040

Authors: Luz M. Gallo-Galán José L. Gallo-Vallejo Juan Mozas-Moreno

Pregnancy-related low back pain (LBP) is a highly prevalent condition with substantial consequences. However, its relationship with objective perinatal outcomes has been scarcely investigated. The aim of this study was to analyze the association between the presence and intensity of pregnancy-related LBP with delivery and perinatal outcomes. An analysis of a prospective cohort was performed including 147 physically active (PA) pregnant women, defined as those meeting the World Health Organization recommendations for PA (≥600 MET·min/week), assessed using the short version of the International PA Questionnaire. Participants were classified according to the presence (64.6%) or absence of LBP during pregnancy. Umbilical artery pH was significantly lower in neonates born to women with LBP compared with those without LBP (7.24 ± 0.10 vs. 7.29 ± 0.06; p < 0.001). Within the LBP group, higher pain intensity was moderately and inversely correlated with umbilical artery pH (Spearman ρ = −0.42, p = 0.037) and remained independently associated with lower umbilical artery pH values in multivariable linear regression analysis after adjustment for relevant maternal characteristics and PA. Apgar scores were globally normal, with no clinically relevant differences between groups. No significant differences were observed in other delivery and perinatal outcomes. These findings suggest an association between pregnancy-related LBP and subtle changes in fetal acid-base status at birth but should be interpreted cautiously from a clinical perspective.

Women doi: 10.3390/women6020039

Authors: Gulzar Shah Caroline Andrew Kingsley Kalu Elizabeth Ayangunna Bushra Shah

Intimate partner violence (IPV) against women is recognized as a public health and human rights issue globally. Nigeria continues to experience a substantial burden of IPV. This study analyzed patterns and multilevel factors associated with violence against women in Nigeria, including emotional, physical, and sexual violence. This study analyzed data from 5458 women aged 15 to 49 years who participated in the 2024 Nigeria Demographic and Health Survey (NDHS). We computed multivariable binary logistic regression and Firth logistic regression (for relatively rare events). Women whose partners consumed alcohol had higher odds of experiencing emotional violence (AOR = 2.97), less severe physical violence (AOR = 3.11), severe physical violence (AOR = 3.22), and sexual violence (AOR = 2.07). Partner controlling behaviors, including restricting contact with family or friends, was also consistently linked to elevated IPV risk. Women living with a partner had higher odds of severe physical and sexual violence. Higher education and greater household wealth were associated with lower IPV outcomes. Our study provides practice-relevant evidence and policy implications, including the need for integrated prevention strategies that address behavioral risk factors, strengthen early screening for controlling behaviors, and promote women’s socioeconomic empowerment.

Women doi: 10.3390/women6020038

Authors: Naoko Hikita Otgontogoo Oidovsuren Megumi Haruna Ariunaa Yura

This prospective observational study investigated secondhand smoke (SHS) exposure levels across gestational stages and identified longitudinal associated factors among pregnant women in Darkhan-Uul Province, Mongolia. Participants recruited between October 2019 and September 2020 answered a self-administered questionnaire and provided spot urine samples at each trimester. SHS exposure was assessed via urinary cotinine (UC) levels, and generalized estimating equations were used to identify associated factors. The final sample included 526 participants. UC levels ≥ 5 ng/mL were observed in 40.1%, 32.0%, and 29.0% of participants in the first, second, and third trimesters, respectively. Compared to the first trimester, the risk of SHS exposure was significantly lower in the second (adjusted odds ratio [AOR]: 0.70; 95% confidence interval [CI]: 0.54–0.91) and third trimesters (AOR: 0.59; 95% CI: 0.45–0.77). Additionally, compared to smoke-free households, those permitting smoking in designated areas (AOR: 1.70; 95% CI: 1.28–2.26) or having no restrictions (AOR: 2.54; 95% CI: 1.29–4.96) showed higher odds of exposure. These results highlight the importance of household smoking restrictions and should be disseminated among pregnant women, their families, and healthcare providers to reduce risk of SHS exposure.

Women doi: 10.3390/women6020037

Authors: Carla Rodríguez-Santiago Héctor González-de la Torre Candelaria de la Merced Díaz-González Sergio Mies-Padilla Claudio-Alberto Rodríguez-Suárez

This study aimed to evaluate the effectiveness of counseling and educational interventions delivered during pregnancy and early motherhood in promoting maternal health knowledge, self-care behaviors, and related health outcomes among adolescent and young women. A systematic review of randomized controlled trials and quasi-experimental studies published in English or Spanish was conducted using Medline, Web of Science, Scopus, Cinahl, and the Cochrane Library. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools, and risk of bias was evaluated using the Risk-of-Bias 2 and ROBINS-I tools. Data were synthesized narratively and in tables. When comparable outcomes were reported, preliminary meta-analyses were performed using standardized mean differences with random-effects models. The certainty of evidence was assessed using the GRADE approach. Seven studies (n = 7) involving 776 participants were included. Interventions consisted of counseling or educational programs delivered through face-to-face sessions, group activities, or digital resources. Overall, the interventions were associated with improvements in pregnancy-related knowledge, self-care behaviors, psychological outcomes, and maternal health practices and attitudes; however, the certainty of evidence was low to very low and a high risk of bias was identified across studies. Meta-analysis suggested a possible beneficial effect favoring the intervention for pregnancy-related health knowledge (SMD = 1.90; 95% CI: −0.02 to 3.83) and self-care behaviors (SMD = 2.39; 95% CI: 0.29 to 4.49), although substantial heterogeneity was observed. Counseling and educational interventions during pregnancy may contribute to improvements in pregnancy-related health knowledge and self-care among pregnant adolescents and young women; however, the current evidence is limited and of low certainty. Further well-designed studies conducted in diverse settings are needed to confirm these findings and strengthen the evidence base.

Women doi: 10.3390/women6020036

Authors: Jie Lin Xiaoyan Lin Zongkai Li Samuel Chacha Duolao Wang Shaonong Dang

Maternal hemorrhage (MH) remains a leading preventable cause of maternal health, yet global disparities on its burden remain poorly quantified. Using the Global Burden of Disease 2021 data, we analyzed global, regional, and national trends in age-standardized maternal mortality ratio (ASR_MMR) attributed to MH from 1990 to 2021. We applied Joinpoint regression, age–period–cohort modeling, inequality indices and frontier analysis. This descriptive–analytical ecological study is based on modeled secondary data. Globally, the proportion of ASR_MMR attributed to MH declined from 33.31% in 1990 to 24.52% in 2021 (relative reduction: 24.24%). ASR_MMR attributed to MH consistently declined, with an estimated annual percentage change (EAPC) of −3.17 (95% UI: −3.42, −2.91). In 2021, Central and West Africa countries reported ASR_MMR attributed to MH exceeding 300 per 100,000 live births, while the Caribbean experienced a temporary increase. ASR_MMR attributed to MH was strongly inversely correlated with the socio-demographic index (SDI). Absolute inequality (slope index of inequality) narrowed by 49.4%, while relative inequality (concentration index) increased by approximately 27.5%. Countries with the largest negative deviations from the frontier included Somalia, the Central African Republic, Chad, Nigeria, and Afghanistan. While substantial global progress has been made, socioeconomic inequities continue to drive persistent disparities in MMR attributed to MH. Policies must not only address average reductions but also the widening relative gap between advantaged and disadvantaged populations.

Women doi: 10.3390/women6020035

Authors: Gabriella Dasilva Alana Starr Alexandra Campson Kayla Ernst Diana Lobaina Vama Jhumkhawala Mindy Brooke Frishman Lea Sacca

Period poverty, defined as difficulty affording menstrual products, is increasingly recognized as a basic needs issue among students in the United States. However, evidence on the prevalence and awareness of this phenomenon among both undergraduate and graduate populations remains limited. Therefore, the aim of this descriptive cross-sectional study is to describe period poverty experiences and awareness levels among menstruating college students at a public university in South Florida. An online survey was administered to menstruating undergraduate and graduate students (n = 151). Period poverty was assessed using a past-year affordability question, while awareness of period poverty was measured descriptively through seven items derived from a previous study on period poverty in U.S. college students. Overall, 13.9% of respondents reported past-year period poverty. Awareness of period poverty was limited, despite high support for policies providing free menstrual products. Only 16.67% perceived period poverty to be highly prevalent in developed countries, and only 8% believed that it existed in their local area. Three fourths (75.00%) of the sample strongly supported policies to provide free menstrual products. Finally, over half of the respondents felt “not at all embarrassed” (55.07%) towards buying menstrual products, while just over one fourth reported being “fairly embarrassed” (28.26%). The discrepancy between the number of students experiencing period poverty and the levels of awareness of the issue shows a clear need for evidence-based educational interventions and menstrual resources on college campuses to improve overall menstrual well-being.

Women doi: 10.3390/women6020034

Authors: Edoardo Mocini Alessia Maiolo Valerio Riccardo Aquila Maria Eugenia Caligiuri Francesca Greco Gian Pietro Emerenziani Emanuele Tinelli Umberto Sabatini Elisa Giannetta Maria Grazia Tarsitano

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition frequently associated with psychiatric comorbidity, including disordered eating. Adult women remain under-recognized and underrepresented in ADHD research, and emerging evidence suggests that symptom expression may be shaped by gendered social factors, ovarian hormone fluctuations, and metabolic health. In this manuscript, we provide a gender-focused theoretical overview of the literature linking ADHD to binge eating symptoms in adult women, with attention to underdiagnosis, menstrual cycle-related symptom variability, and obesity-related metabolic risk, and empirically test the association between a self-reported ADHD diagnosis and binge eating symptoms in an online cross-sectional sample of adult women. Women reporting an ADHD diagnosis (n = 140) were compared with a random subsample of n = 140 women without ADHD drawn from the same survey; comparability between groups on age, education, and employment was formally verified; and binge eating symptoms were assessed with the Binge Eating Scale (BES) as a continuous outcome and as an ordered three-category variable. Women reporting an ADHD diagnosis showed significantly higher BES scores than controls (rank-biserial r = 0.28, 95% CI 0.15–0.41), and a higher proportion of severe binge eating symptomatology (BES ≥ 27; 22.1% vs. 11.4%; OR = 2.20, 95% CI 1.14–4.25) than controls. The association remained significant in a sensitivity analysis adjusting for age and BMI. Taken together, our findings support the need for routine, gender-sensitive screening for binge eating symptoms in women with ADHD, as well as ADHD screening in women presenting with binge eating and obesity.

Women doi: 10.3390/women6020033

Authors: Benecia Jackson Padmashree Rida Nikita Jinna

The United States faces a worsening maternal mortality crisis that starkly contrasts with trends in other high-income nations. Maternal mortality rates (MMRs) have more than doubled over the past two decades, rising from 9.65 deaths per 100,000 live births in 1999–2002 to 23.6 in 2018–2021, with approximately 700 deaths annually. Black and American Indian/Alaska Native women experience maternal mortality rates two to three times higher than their White counterparts, reflecting persistent structural inequities rather than biological differences. This narrative review synthesizes current evidence on the underlying drivers of racial inequities in maternal mortality and evaluates evidence-based interventions and policy strategies to address these disparities. A comprehensive literature review between 2000 and 2025 was conducted using databases including PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies examining clinical, social, and structural determinants of maternal health outcomes, as well as evidence-based interventions and maternal health policy. Targeted searches of policy reports and grey literature were also performed to identify relevant policy initiatives and system-level interventions. Key contributors to disparities include underlying health conditions, postpartum mental health inequities, provider shortages, and limited access to postpartum care, with pregnancy-associated breast cancer (PABC) representing a less common but clinically significant risk factor that warrants further investigation in the context of racial inequities. Structural racism and socioeconomic disparities further exacerbate inequities through differential access to care, treatment bias, and barriers to healthcare utilization. System-level challenges, including workforce shortages, maternity care deserts, and the absence of federally mandated paid maternity leave, disproportionately impact marginalized populations. Although policy initiatives such as Medicaid postpartum coverage extensions, the Maternal Health Momnibus Act, and Maternal Mortality Review Committees represent important progress, they remain insufficient without broader structural reform. Evidence-based interventions, including midwife- and doula-led care, community-based peer support, and culturally tailored mental health programs, demonstrate measurable improvements in maternal outcomes. Outcomes of this review highlight the need for a comprehensive, equity-centered approach to reducing maternal mortality disparities, emphasizing structural reform, expanded access to care, strengthened data systems, and community-driven solutions.

Women doi: 10.3390/women6020031

Authors: María Ruiz-García Irene Martínez-García Andrea Herreros-Solano Silvana Patiño-Cardona Elena Moreno-Charco Laura Martínez-Cabrera Adrián González-Sánchez Carlos Pascual-Morena

Systemic inflammation plays a key role in the pathophysiology of pre-eclampsia (PE) and gestational diabetes mellitus (GDM). Recently, the Systemic Immune Inflammation (SII) and Systemic Inflammation Response Index (SIRI) indices have emerged as potential risk predictors, but current evidence shows mixed results. The aim of this meta-analysis was to assess the association between elevated SII/SIRI levels and the development of both complications. In accordance with the PRISMA guidelines, a search was conducted in PubMed, Scopus and Web of Science (up to February 2026). Observational studies linking the SII and SIRI indices to PE and GDM were included. Methodological quality (NHLBI tools) and evidence (GRADE) were assessed, and a random-effects meta-analysis was applied to synthesise the measures of association. Thirteen studies involving more than 150,000 pregnant women were included. The meta-analyses demonstrated that elevated levels of SII and SIRI are associated with an increased risk of GDM by 28% (OR = 1.28; 95% CI: 1.16–1.42) and 27% (OR = 1.27; 95% CI: 1.11–1.48) respectively, albeit with considerable heterogeneity. They also increase the risk of PE by 16% (OR = 1.16; 95% CI: 1.08–1.24) and 21% (OR = 1.21; 95% CI: 1.05–1.40), without significant heterogeneity. Although the quality of the studies was good, the strength of the evidence was low for GDM and very low for PE. Therefore, while these indices show potential as early biomarkers, these findings should be considered suggestive and require further validation and standardisation across diverse populations.

Women doi: 10.3390/women6020032

Authors: Mădălina Daniela Meoded Mariana Tănase Mihai Covaci Claudia Mehedințu Aida Petca Ciprian Cirimbei

Emerging evidence suggests that psychological trauma, chronic stress, and unresolved emotional conflict may influence cancer-related processes through neuroendocrine and immunological pathways. However, the clinical relevance of trauma-related psychological profiles in oncology remains insufficiently defined, particularly in women with breast and gynecological cancers. This exploratory observational study included 135 women with breast, cervical, ovarian, and endometrial cancers undergoing multimodal oncological treatment. Psychological assessments were performed using validated instruments, including the PTSD Checklist (PCL), Hamilton Anxiety and Depression Scales (HAM-A, HAM-D), the Adult Attachment Scale (AAS), and a Lazarus-based checklist of stressful life events to assess cumulative stress exposure. Descriptive and exploratory analyses were conducted to identify clinically relevant patterns. A high prevalence of anxiety, depressive symptoms, and trauma-related distress was observed. Insecure attachment patterns were frequent and associated with increased psychological burden. Many patients reported moderate-to-high cumulative stress exposure, suggesting broader vulnerability profiles characterized by emotional dysregulation. These findings support a biopsychosocial model in which trauma, attachment insecurity, and cumulative stress are associated with psychological vulnerability in oncology. Although causal relationships cannot be established, these factors may influence coping and adaptation to disease. Integrating trauma-informed psychological assessment into oncology care may enhance patient-centered management.

Women doi: 10.3390/women6020030

Authors: Belén Olmedilla-Caballero Mavi Alcántara Rosa M. Patro-Hernández Jesús J. García-Jiménez

Gender-based violence constitutes a major public health and social concern, with particularly complex implications in structurally vulnerable contexts such as rural settings. However, empirical evidence regarding the specific profile and risk perception of women experiencing gender-based violence in small municipalities remains limited. The aim of this study was to analyze the sociodemographic characteristics of women victims of gender-based violence residing in small rural municipalities and to examine their associations with mental health indicators and perceived risk of future violence. The sample comprised 30 women receiving support at a Specialized Care Centre for Victims of Gender-Based Violence (CAVI) serving three small municipalities in the Vega Media region (Region of Murcia, Spain). Standardized measures of depression, anxiety, and stress were administered, together with an assessment of perceived risk. The findings suggest a specific sociodemographic profile characterized by moderate levels of depression, anxiety, and stress symptoms and generally low perceived risk. Women without children reported higher levels of psychological distress and perceived risk than those with children, although these differences should be interpreted with caution given the sample size. Overall, these findings provide preliminary insights into the characteristics and risk perception of women experiencing gender-based violence in rural settings and highlight the need for context-sensitive prevention and intervention strategies.

Women doi: 10.3390/women6020029

Authors: Daniela Eugenia Popescu Ioana Roșca Alina Turenschi Andreea Teodora Constantin Alexandru Dinulescu Alexandru-Cosmin Palcău Ciprian Andrei Coroleuca Elena Poenaru Leonard Năstase

Motherhood is a profoundly transformative stage, associated with both emotional fulfillment and psychological and physical vulnerability. The aim of this study was to assess the perceptions, difficulties and resources needed by mothers in the experience of motherhood. We conducted an exploratory cross-sectional observational study, based on an online questionnaire administered to 172 mothers. We analyzed socio-demographic data, experiences related to pregnancy and childbirth, perceived level of support, emotional difficulties, and resources considered useful in the role of motherhood. Most participants were women aged 30 to 45, with university or postgraduate education, married and with one or more children. Although motherhood was predominantly described in positive terms such as “fulfillment”, “love” and “joy”, a significant percentage of mothers reported increased fatigue, lack of personal time and emotional difficulties. The resources considered essential for maternal balance were family support, personal time, emotional support and access to clear and empathetic medical information. In conclusion motherhood is perceived as a complex experience, in which fulfillment frequently coexists with emotional overload and vulnerability. This exploratory study highlights the complex emotional and psychosocial dimensions of motherhood among Romanian women. The findings suggest the need for accessible emotional and social support resources. A comprehensive approach addressing both emotional and practical needs may contribute to improved maternal well-being.

Women doi: 10.3390/women6020028

Authors: Álvaro Huerta Ojeda Emilio Jofré-Saldía Sergio Galdames Maliqueo Guillermo Barahona-Fuentes Regina de Villa Garduño Carlos Jorquera-Aguilera Paola Ruiz-Araya María-Mercedes Yeomans-Cabrera Maximiliano Bravo Yapur

The Latin American Development Group for Maturity (GDLAM) protocol has been widely used to assess functional autonomy (FA) in community-dwelling older adults. However, to date, no percentile-based rating scale has been established for older Chilean women living in the community. The aim was to create a percentile-based rating scale for the GDLAM protocol in community-dwelling older Chilean women. 347 older women volunteered for this study. The sample was divided into five groups by age ranges (G1: 60.0–64.9 years, G2: 65.0–69.9 years, G3: 70.0–74.9 years, G4: 75.0–79.9 years, and G5: ≥80.0 years). The research had an observational, cross-sectional design with a descriptive strategy. The GDLAM protocol included (a) Putting on and taking off a T-shirt (PTS), (b) Standing up from the sitting position (SSP), (c) Standing up from the prone position (SPP), (d) Walking 10 m (W10 m), and (e) Sit-ting and getting up from the chair and moving around the house (SCMA), all assessed in seconds (s), while the General Index of Autonomy (GI) was calculated in points (p). The percentile-based classification was developed with the following thresholds: percentile ≤ 0.15: “Very Good,” percentile 0.16–0.49: “Good,” percentile 0.50–084: “Regular,” and percentile ≥ 0.85: “Poor.” After creating the percentile-based ranking scale for the five age ranges, it was observed that the older the age, the lower the FA, as represented by the five tests and the GI. The percentile-based ranking scale presented in this research will enable us to accurately assess and interpret the FA of older and community-dwelling women in Chile. However, the study is limited to women and cannot be generalized to older adults in general.

Women doi: 10.3390/women6020027

Authors: Mayra Alejandra Mafla-España Javier García Sánchez Lucía Ortega-Pérez de Villar Guillermo Casero-García María Dolores Torregrosa Omar Cauli

The protective effect of physical activity on breast cancer recurrence may be mediated changes in by sex hormone levels. In this study, we examined the association between habitual physical activity and estrogen and androgen plasma levels in postmenopausal women with localised breast cancer. We conducted a cross-sectional study among 47 postmenopausal women who were breast cancer survivors with estrogen receptor-positive tumours (enrolled at the Medical Oncology Department of University Hospital Dr. Peset, Valencia, Spain). Habitual physical activity was assessed using the International Physical Activity Questionnaire (IPAQ), and a weighted estimate of total physical activity per week (MET∙min∙wk−1) was calculated. Total plasma levels of estrone, 17β-estradiol, progesterone, androstenedione, testosterone, and dehydroepiandrosterone-sulphate (DHEA-sulphate) were measured. Bivariate analyses by the Spearman correlation test were done between physical activity and each hormone concentration. Multivariate analyses (linear regression) using concentration of each hormone as the dependent variable and physical activity, age, marital status, BMI, Charlson Comorbidity Index, tumour stage, previous radiotherapy, or previous chemotherapy as predictor variables. Estrone concentration was positively and significantly correlated with BMI (ρ = 0.332, p = 0.022), but no other correlations were found between BMI and the other hormone concentrations, nor were concentrations of any hormone associated with age or Charlson Comorbidity Index (p > 0.05 in all cases). Physical activity was significantly and inversely correlated with estrone concentration (ρ = −0.308; p = 0.035). Linear regression analysis confirmed a statistically significant association between estrone concentration and BMI and physical activity, after adjusting for all potential confounders (for BMI: standardised β coefficient = 0.407; non-standardised β coefficient = 1.054; t = 2.898; p = 0.006; 95% CI for non-standardised beta: 0.318- to 1.790; for physical activity: standardised β coefficient = −0.300; non-standardised β coefficient = −0.005; t = −2.135; p = 0.039; 95% CI for non-standardised beta: −0.010- to 0.000). The relationship between estrone concentration and physical activity may be further explored as a biomarker for evaluating the protective effect of physical activity against breast cancer recurrence in women receiving anti-estrogen therapies.

Women doi: 10.3390/women6020026

Authors: Samantha Arias-Covarrubias Perla E. Hernández-Marcelo Evelyn Regalado-Rentería David S. Díaz-Ortegón Eduardo Castaño-Tostado José A. Enciso-Moreno David G. García-Gutiérrez Iza F. Pérez-Ramírez

Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder associated with adverse maternal and fetal outcomes. However, current diagnostic strategies have a limited capacity to identify women at risk early in pregnancy. In this longitudinal prospective pilot study, 200 pregnant Mexican women were recruited at 11–14 weeks and underwent follow-up throughout pregnancy. Of these, 34 women (19 with GDM and 15 with normal glucose tolerance [NGT]) completed follow-up and were included in the final analyses. Most withdrawals were due to logistical constraints, although the reduced final sample size should be considered when interpreting generalizability. Nine serum proteins (ADIPOQ, AFM, FABP4, IGFBP-5, PAPP-A, PAPP-A2, RBP4, RETN, SHBG) were measured simultaneously using an antibody array and subsequently validated by ELISA. FABP4 showed the greatest increase in the first trimester (4.9-fold, p = 0.0105) and the highest apparent discriminative performance (AUC = 0.91), which declined in the second and third trimesters. Exploratory, hypothesis-generating multivariable analyses suggested a stronger association when FABP4 was combined with gravidity and serum triglycerides (AUC up to 0.97). Overall, FABP4 emerged as a promising candidate biomarker for early GDM detection in Mexican women; however, these findings are preliminary and require validation in larger, independent cohorts to support early risk stratification.

Women doi: 10.3390/women6020025

Authors: Rebecca G. Renegar Heidi E. Stolz

The purpose of this study was to examine relationships between infant feeding and parenting self-efficacy. Mothers (N = 121) receiving home visiting reported on PSE and infant feeding at two times (e.g., longitudinally). Mothers were exclusively formula feeding (46.7%), exclusively breastfeeding (19.8%) or combining breastfeeding and formula (33.1%). Infant feeding was regressed on parenting self-efficacy and relevant demographics using logistic regression. Mothers with higher parenting self-efficacy were more likely to be exclusively formula feeding or combination feeding at Time 1. Continued breastfeeding was not predicted by self-efficacy but rather by working status and earlier supplementation. Results suggest higher parenting self-efficacy associated with formula feeding suggests social reinforcement or feelings of success around the enactment of or choice in infant feeding method. Lower parenting self-efficacy associated with initial breastfeeding suggests unsuccessful enactment (i.e., breastfeeding challenges) or negative social reinforcement. More research is needed to understand infant feeding norms and practices in relationship to parenting self-efficacy to best promote breastfeeding intervention and support maternal mental health. Practitioners should work to extend exclusive breastfeeding through supportive positive reinforcement, while limiting formula supplementation. The importance of parental leave for longer breastfeeding duration should be considered when establishing leave policies.

Women doi: 10.3390/women6020024

Authors: André Schneider Luciano Bernardes Leite José E. Teixeira Pedro Forte Tiago M. Barbosa António M. Monteiro

High-intensity interval training (HIIT) has emerged as a time-efficient exercise strategy with potential benefits for older adults. However, evidence regarding its effects on functional fitness, body composition, and quality of life in older women remains limited. This randomized controlled trial included community-dwelling older women allocated to a HIIT group or a control group. The intervention consisted of a 65-week HIIT program (3 sessions/week), while the control group maintained usual activities. Functional fitness was assessed using standardized field-based tests, body composition was evaluated by bioelectrical impedance analysis, and quality of life was measured using the WHOQOL-BREF questionnaire. Pre- and post-intervention assessments were performed under standardized conditions. Data were analyzed using mixed ANOVA models, with significance set at p < 0.05. Compared with the control group, the HIIT group significantly improved aerobic capacity (2MST: +25.4 vs. −19.6 repetitions; p < 0.001), lower-limb strength (30s CST: +4.8 vs. −2.6 repetitions; p < 0.001), and mobility (TUG: −0.3 vs. +0.4 s; p < 0.001). Body composition improved with reductions in body fat percentage (−1.8% vs. +1.9%; p < 0.001) and visceral fat index (−0.6 vs. +0.3; p < 0.001), alongside increased total body water (+2.3% vs. −1.8%; p < 0.001). Quality of life improved significantly in physical, psychological, and environmental domains (p < 0.001). HIIT was associated with improvements in functional fitness, body composition, and quality of life, with no major adverse events reported. These findings support the use of HIIT as a practical intervention to enhance health and functional independence in aging populations.

Women doi: 10.3390/women6020023

Authors: Gustavo Santos Débora Santos Reginaldo Mafetoni Clara Sanfelice Janize Maia Karina Zihlmann Ricardo Mouta Cindy Lima Patrícia Parenti Joaquim Neto Wágnar Nascimento Telma Araújo Cesar Reis Carolliny Ichikawa Júlia das Neves Carvalho Ana da Fonseca Dias Maria Bettencourt Maria Guerra

Respiratory Syncytial Virus infection is a significant cause of morbidity and mortality in infants. Maternal vaccination with the bivalent vaccine Abrysvo® in the third trimester (24–36 weeks) is an effective strategy to prevent severe respiratory illnesses in newborns. However, the introduction of this new technology faces structural obstacles that amplify inequalities. This rapid literature review sought to map and synthesize evidence on inequalities and inequities in adherence and accessibility to maternal vaccination among Black pregnant women. A rapid literature review was conducted using a mixed-methods approach (narrative synthesis and thematic analysis), following guidelines adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook. The research question was structured using the acronym Population/Problem, Exposure, Comparison, and Outcome, focusing on Black pregnant women, maternal vaccination, comparison with other groups, and barriers/determinants. The search was conducted in databases such as PubMed (via Medical Literature Analysis and Retrieval System Online), Scopus and Literatura Latino-Americana e do Caribe em Ciências da Saúde, covering studies published between 2022 and 2025 that presented disaggregated analysis by race. The analysis and interpretation of the findings were guided by Critical Race Theory. The analysis of the twelve included studies (mainly from the United States, the United Kingdom, and Brazil) revealed systematic and robust disparities. Black pregnant women had lower vaccination coverage and were less likely to receive timely recommendations compared to White pregnant women. The barriers identified include: institutional distrust (resulting from structural racism), poor access to prenatal care, inadequate communication, and socioeconomic factors. Inequities are structural and multifactorial phenomena. To ensure that the benefits of the vaccine are distributed equitably, strategies such as anti-racist training for healthcare teams, active vaccination outreach, and continuous monitoring of data disaggregated by race are essential.

Women doi: 10.3390/women6010022

Authors: Ana Leticia Becerra-Gálvez Erick Alberto Medina Jiménez Alejandro Pérez-Ortiz América Genevra Franco Moreno Sandra Angélica Anguiano Serrano César Augusto de León Ricardi Gabriela Ordaz Villegas

During the COVID-19 pandemic, women have had to face different psychosocial problems. For this reason, psychoeducational interventions based on web-based resources have been developed to address their mental health. This study aimed to evaluate the pilot of a psycho-emotional support web platform based on elements of cognitive-behavioural therapy in Mexican women during the COVID-19 pandemic. Through a pre-experimental design with pre-test and post-test evaluations, 73 women between 18 and 68 years old (M = 43.42 years, SD = 12.40) had access to this platform for one month, which contained four thematic modules (stress, anxiety, depression and violence). They also received two complementary three-hour synchronous sessions. All participants reported similar levels of emotional symptoms (p > 0.05), as well as perceiving violence exerted by their partners (p > 0.05). The web platform and its psychoeducational content turned out to be quality informative resources; however, no statistically significant changes were observed in the psychological variables in question. Web platforms and emotional support applications should be developed according to the needs and characteristics of the population for which they are designed; this will promote greater satisfaction and reduce therapeutic abandonment.

Women doi: 10.3390/women6010021

Authors: Emily E. Pulsipher Mikaela J. Dufur

Social capital has been well established to have beneficial effects on a variety of behavioral, developmental, and health outcomes across the life course. In particular, social capital has been proven to be a protective factor benefiting health, particularly among young people. However, we know little about whether or how social capital might provide a protective effect against a very specific mental health challenge of young and mid-adult life: experiencing postpartum depression. Using linear regression models and restricted-use data from the National Study of Adolescent to Adult Health (five waves conducted beginning in 1995 when respondents were in grades 7–12 and following them into adulthood) on women who gave birth during early adulthood, and controlling for a variety of demographic factors (such as race, parental and partner social capital, SES), we aim to understand potential associations between social capital derived from families and romantic partners and postpartum depression symptomology. Our findings suggest the need for approaches that help pregnant women build and maintain key social connections and resources with fathers and partners.

Women doi: 10.3390/women6010020

Authors: Francisca Expósito M. Dolores Sánchez-Hernández Marta Badenes-Sastre Ana M. Beltrán-Morillas Laura Villanueva-Moya

Sexual harassment remains a widespread issue in higher education, with serious consequences, especially for women within the university setting. In this research, we explored the mediating role of psychological distress in the link between sexual harassment and coping strategies among women in higher education. In total, 637 women from the university community participated in this study, of whom 100 were victims of sexual harassment at their university. In Study 1, sexual harassment was found to predict higher levels of anxiety and depression, which were in turn associated with greater use of coping strategies focused on self-criticism, wishful thinking, and social withdrawal. In Study 2, sexual harassment predicted increased negative affect, which was subsequently associated with a stronger reliance on rumination. Taken together, the findings could suggest that the psychological distress women experience due to sexual harassment may determine their coping strategies. These results underscore the importance of adopting institutional measures that not only address the psychological impact of sexual harassment but also promote more adaptive coping strategies to reduce its long-term impact on women in higher education.

Women doi: 10.3390/women6010019

Authors: Adnin Zaman Aaron Lazorwitz Myla Strawderman Hong Hong Liu Sarah A. Tydings Susan W. Groth Victoria A. Catenacci Elizabeth A. Thomas

Combined oral contraceptive pills (COCPs) are commonly used by reproductive-aged women with overweight or obesity, but their metabolic effects remain understudied. This pilot study examined the feasibility of recruiting and retaining women with overweight or obesity initiating COCPs and evaluated changes in body weight, body composition, energy intake (EI), eating behaviors, and cardiometabolic markers. Premenopausal women aged 18–40 years with a body mass index between 25 and 45 kg/m2 initiating COCPs (n = 10) or using nonhormonal contraception (NHC; n = 10) were followed for six months. Outcome measures included body weight, body composition, EI, eating behavior questionnaires, ecological momentary assessment of appetite and satiety, and fasting laboratory measures. There were no between-group differences in changes in weight, EI, or appetite. Binge-eating severity decreased in COCP users and increased in NHC users, though the within-group change in COCP users was not statistically significant. Exploratory analyses demonstrated increases in hemoglobin A1c and triglycerides among COCP users compared to NHC users, while bioavailable testosterone decreased in COCP users only. This study demonstrates high retention and feasibility among women with overweight/obesity undergoing intensive dietary and metabolic monitoring. Although weight outcomes were similar between groups, these preliminary findings identify potential metabolic signals warranting confirmation in adequately powered studies.

Women doi: 10.3390/women6010018

Authors: Yolanda Terán-Figueroa Darío Gaytán-Hernández Omar Parra-Rodríguez Carlos Daniel Coronado-Ruis Sandra Olimpia Gutiérrez-Enríquez Efraín Gaytán-Jiménez

This study analyzes the evolution and spatial distribution of cervical cancer mortality. Furthermore, it develops a dynamic simulation model for estimating the evolution of the disease up to 2040. This manuscript details an ecological and retrospective study that analyzed official mortality, morbidity, and population data from the 58 municipalities that constitute the state of San Luis Potosi. We used Moran’s index, linear correlation, structural equation modeling, Excel predictions, and Vensim PLE x64 simulation software to conduct this study. The evolution of deaths from cervical cancer shows a downward trend; mortality follows a clustered distribution pattern, and it is not random. The structural model showed standardized regression coefficients of 0.68 between syphilis cases and cervical cancer cases, with a coefficient of 0.35 for deaths; candidiasis cases with cervical cancer at a coefficient of 0.25 and with deaths from the same disease at a coefficient of 0.46. The coefficients of determination for cervical cancer cases and deaths were 0.74 and 0.91, respectively. This shows that these co-infections—syphilis and candidiasis—are a risk factor for cervical cancer mortality. The estimated mortality rates per 100,000 inhabitants for 2025, 2030, 2035, and 2040 were 5.5, 5.1, 4.8, and 4.4, respectively. The prediction indicates an increase in the number of CC cases and deaths from this cause.

Women doi: 10.3390/women6010017

Authors: Fabiola Raffone Serena Testa Concetta Iaccarino Miriam Olivola Tommaso Barlattani Domenico De Berardis Francesca Pacitti Vassilis Martiadis

Eating disorders (EDs) disproportionately affect women and are associated with substantial morbidity, chronicity, and mortality. While established psychological models focus on the content of maladaptive cognitions related to body weight, shape, and eating behaviors, growing evidence suggests that additional process-level mechanisms contribute to symptom persistence and treatment resistance. Metacognitive models emphasize how individuals relate to their thoughts, emotions, and internal experiences, highlighting maladaptive beliefs about thinking and the resulting cognitive–attentional patterns (e.g., repetitive negative thinking, self-focused attention, and inflexible attentional control) as potential maintaining factors across psychopathology. This narrative review synthesizes the theoretical and empirical literature on metacognitive dysfunction in EDs, with a focus on mechanisms that may be particularly relevant for women. We integrate epidemiological data and gender-sensitive frameworks, and review evidence on metacognitive beliefs and cognitive–attentional syndrome (CAS)-related processes across anorexia nervosa, bulimia nervosa, and binge-eating disorder. Overall, studies indicate that dysfunctional beliefs about the uncontrollability and danger of thoughts, alongside perseverative cognitive styles, are associated with greater ED symptom severity. We discuss diagnosis-relevant patterns as clinically useful heuristics, interactions with sociocultural and emotional vulnerability factors, and implications for assessment, treatment integration, and prevention. The evidence base is largely correlational and derived from predominantly female samples, underscoring the need for longitudinal research and studies that explicitly test sex/gender as a moderator.

Women doi: 10.3390/women6010016

Authors: Patrizia Carmen Marruffi-Bonfante Manuel Rosety-Rodríguez Alberto Bable-Marruffi Javier Choquet de Isla Javier Riscart-López

Body dissatisfaction and eating disorder (ED) risk indicators can persist into later life but are less frequently assessed in routine care for older women. Among women aged 50 years and older, attendance on dietary care pathways in clinical settings may offer a pragmatic opportunity for early identification (screening) of ED risk indicators and related psychological distress, particularly during the menopausal transition. Thus, the aim of this study was to compare body dissatisfaction and ED risk indicators in older women attending dietary treatment versus those not following a dietary regimen. This cross-sectional study compared women aged ≥50 years without a prior ED diagnosis who were receiving medically supervised dietary treatment (DTG; n = 42) with peers not following any dietary regimen (NDG; n = 40) in Cádiz (Spain). Participants completed the Eating Disorder Inventory-3 Referral Form (EDI-3RF), AF-5 Self-Concept Questionnaire, List of Brief Symptoms (LBS-50), and the International Physical Activity Questionnaire (IPAQ) and underwent anthropometric assessment. Compared with those women in the NDG, those in the DTG had a higher body mass index (p = 0.002), higher drive for thinness (p < 0.001) and body dissatisfaction (p < 0.001), lower physical self-concept (p = 0.001), and higher total EDI-3RF scores (p < 0.001). Based on the EDI-3RF, 11.9% of the DTG met clinical referral criteria versus none in the NDG (p = 0.031). These findings indicate that, in this sample of women aged ≥ 50 years, women attending dietary care pathways exhibited a higher ED risk profile, higher psychopathological symptom levels, and lower physical self-concept than women not following a dietary regimen. Given the cross-sectional design, results should be interpreted as associations and may reflect pre-existing differences among women who enter dietary care; nonetheless, dietary care pathways may represent a practical opportunity to incorporate brief screening for body image concerns and ED risk indicators in older women.

Women doi: 10.3390/women6010015

Authors: Rosa M. Limiñana-Gras María Patiño-Ortega Paloma López-Hernández Carmen M. Galvez-Sánchez

Eating disorders are multifactorial mental health conditions that predominantly affect adolescent girls and young women and constitute a major public health concern due to their severe and often chronic impact on physical, psychological, and psychosocial functioning. Although existing research suggests that gender-related constructs and traditional gender roles may be associated with the development and expression of eating disorders, empirical evidence using validated measures remains limited. Accordingly, the present study examines health-related variables from a gender-sensitive perspective in a clinical sample of women diagnosed with an eating disorder. Forty women aged 14 to 50 years completed an assessment protocol including measures of gender norms, eating disorder symptoms, mental health, and self-perceived overall health. Results indicated that poorer mental health and self-perceived overall health were significantly associated with higher levels of eating disorder symptomatology. In an exploratory hierarchical regression analysis, overall conformity to traditional feminine gender norms was associated with eating disorder symptomatology after accounting for health-related variables. Exploratory analyses of individual gender norm dimensions indicated that only a small number of associations remained statistically significant after applying a false discovery rate correction. In sum, within the limitations of a modest and heterogeneous clinical sample, the findings suggest that conformity to traditional feminine gender norms is associated with less favorable health indicators and greater eating disorder symptomatology among women with EDs. These results underscore the potential value of incorporating gender-informed perspectives into future research and clinical reflection, while highlighting the need for replication in larger and longitudinally designed studies.

Women doi: 10.3390/women6010014

Authors: Adrianna Maria Kosior-Lara Jacek Wąsik Małgorzata Kuchta Dorota Ortenburger

This cross-sectional study aimed to assess the relationship between the level of physical activity and the severity of depressive symptoms in adult women, taking into account the mediating role of perceived stress and differences in this relationship across levels of depressive symptom severity. The study included 200 women aged 18–65 years. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ), depressive symptom severity was measured with the Beck Depression Inventory (BDI), and perceived stress was evaluated using a standardized stress scale. Descriptive statistics, non-parametric tests, hierarchical regression, mediation analysis with bootstrapping, and quantile regression (Q25, Q50, Q75) were applied, controlling for selected sociodemographic variables. The results showed that perceived stress was the strongest predictor of depressive symptom severity. Physical activity was not a significant independent predictor of depression after adjustment for stress; however, it demonstrated a significant indirect effect through stress reduction. Quantile regression analysis revealed that the protective effect of physical activity was more pronounced in the lower and middle quantiles of depressive symptom severity and attenuated at higher levels of severity. These findings indicate that the relationship between physical activity and depressive symptoms is predominantly indirect and conditional, supporting the integration of physical activity promotion with stress-reduction–focused interventions.

Women doi: 10.3390/women6010013

Authors: Rosita Rotella José M. Soriano Isabel Peraita-Costa Agustín Llopis-González María Morales-Suarez-Varela

This study aimed to assess maternal health profiles related to diet, pregnancy, and breastfeeding practices among 437 mothers with children under 24 months in a rural village in Madagascar, and to examine their association with maternal educational attainment using interviews and anthropometric data. Bivariate statistical analyses were performed to explore associations between maternal education level and all studied variables. Multivariate analyses were also conducted but did not yield reliable results and are therefore not presented. The findings showed that higher maternal education was strongly associated with better socioeconomic conditions; improved access to essential resources like food, clean water, and healthcare facilities; and greater dietary diversity. More educated women reported consuming a wider range of foods, reflecting better nutritional quality and potential benefits for maternal health. In contrast, education level did not significantly affect pregnancy-related care or breastfeeding practices as recommended by the WHO. This suggests that while education enhances women’s ability to access and choose nutritious diets, broader cultural or systemic factors may shape maternal care behaviors. Women with higher educational attainment had greater access to diverse and sufficient diets, which may contribute to improved maternal nutritional status. Sustainable interventions aimed at improving women’s education and nutritional literacy are needed to support informed dietary choices and improve maternal and child health outcomes.

Women doi: 10.3390/women6010012

Authors: Carmen M. Galvez-Sánchez Julio A. Camacho-Ruiz Ana M. Contreras-Merino Rosa M. Limiñana-Gras

Endometriosis is a chronic inflammatory disorder affecting about 190 million women of reproductive age worldwide. It represents a major health challenge due to its broad impact on physical, reproductive, and psychological well-being and is clinically characterized by pelvic pain, menstrual irregularities, and infertility. This narrative review synthesized current evidence on the relationship between adiposity, metabolic and inflammatory markers, and endometriosis from a biopsychosocial and intersectional perspective. A comprehensive search was conducted in PubMed, Scopus, and Web of Science for peer-reviewed studies published in English over the past decade.: Results pointed out that endometriosis significantly affects inflammatory activity within adipose tissue, especially in visceral adipose tissue. Studies also reported reduced adipocyte size and altered adipose tissue function. The endometriosis cytokine profile exhibited a pattern of systemic and tissue-specific inflammatory activation (i.e., elevated levels of interleukin-6 and monocyte chemoattractant protein-1). Sociodemographic factors (i.e., age, race/ethnicity, socioeconomic status, and educational level) also play a significant role in differences in symptomatology, disease course, and healthcare access. To sum up, endometriosis need to be considered as a multisystem condition related to metabolic, inflammatory, and psychosocial factors. It is necessary to adopt a biopsychosocial and intersectional perspective to improve diagnosis and support more equitable and personalized therapeutic approaches.

Women doi: 10.3390/women6010011

Authors: Sara Diogo Gonçalves Verónica Esteves Rita S. Matos Ana Caramelo

Aromatherapy, the therapeutic use of essential oils, is increasingly recognized as a complementary approach to women’s mental health, particularly during hormonally sensitive life stages such as menstruation, pregnancy, postpartum, and menopause. Concerns about the side effects of pharmacological treatments during these periods have driven interest in non-pharmacologic interventions. This narrative review synthesizes current clinical evidence on the efficacy of aromatherapy in alleviating psychological distress in women. A comprehensive literature review between 2000 and 2025 across PubMed, Scopus, and Web of Science databases identified 47 studies focusing on essential oils for anxiety, depression, or stress in female populations. The most substantial evidence supports the use of lavender, bergamot, rose, chamomile, clary sage, and ylang-ylang, with inhalation and massage as the most frequently studied delivery methods. Outcomes include reductions in cortisol, heart rate, and subjective stress, along with improvements in mood and emotional regulation. Aromatherapy demonstrates particular promise in postpartum and perimenopausal care. However, methodological heterogeneity and variability in oil composition limit generalizability. Despite these challenges, the evidence suggests that aromatherapy may serve as a safe, low-cost adjunct for managing mood disorders and stress in women, particularly when integrated into personalized, holistic care strategies.

Women doi: 10.3390/women6010010

Authors: Elena Fasola Ursula Mirastschijski Andeera Abu Innab Agnieszka Nalewczynska Maria Czapiga Dhouha Dridi Giorgio Reggiardo Eleonora Perrella Cosimo Oliva

Genitourinary syndrome of menopause (GSM), which includes vulvovaginal atrophy (VVA) and other bothersome genitourinary symptoms, affects over half of postmenopausal women and has a considerable impact on quality of life. This study aimed to evaluate the efficacy and safety of an injectable combination of hyaluronic acid and amino acids for treating GSM-related symptoms. In this prospective, multicenter study, 84 women aged 46–60 with moderate to severe VVA confirmed by gynecological examination received three intradermal treatments at 21-day intervals, targeting the vestibule, introitus, lower vaginal wall, and labia majora. Symptom severity was assessed using a visual analog scale (VAS), while tolerability and satisfaction were evaluated via a five-point Likert scale. Quality of life was measured using the Satisfaction With Life Scale (SWLS). Assessments were conducted at baseline, after each injection, and at 3- and 6-month follow-up visits. After three months, significant improvements were noted in vaginal dryness, itching, burning, and dyspareunia (all p < 0.001). Patient satisfaction increased from 59.0% to 80.7%, and SWLS scores rose from 4.57 ± 1.76 to 6.53 ± 1.10, reflecting enhanced quality of life. The treatment was well tolerated and demonstrated a favorable safety profile. These findings suggest that this injectable formulation may represent an effective, non-hormonal option for women with VVA, particularly those who are not candidates for hormone therapy.

Women doi: 10.3390/women6010009

Authors: Lucky Norah Katende-Kyenda

Cervical cancer remains the main etiology of high morbidity and mortality among women in developing world despite the screening plans. In South Africa, screening policies are low. Attitude, knowledge, and practices (AKP) play a pivotal role in diagnosis, prevention and screening. The review explores AKP towards cervical cancer and screening including global and regional burden, and determinants of screening uptake. Previous empirical studies identifying factors influencing adherence to screening services were identified. Studies from 2020–2025 were searched using PubMed and Google databases. Identified terms and topics were combined using Boolean Operators and PRISMA guidelines. Keywords were “attitudes”, “knowledge”, “practice”, “current cervical cancer screening”, AND “South Africa”, “global”, “regional”, “burden”, “cervical cancer”, “screening uptake determinants ” and “cervical cancer screening”, “factors influencing adherence”, and “cervical cancer screening”, “practices and pap smear tests”, “strengths”, “limitations”, “future research”, AND (“cervical cancer screening”). Key findings: many women know cervical cancer or Pap smears but lack detailed knowledge about risk factors and screening protocols, actual Pap smear uptake is low. Fear of outcome of procedure, pain, or embarrassment are primary barriers, and lack of service access. A multidisciplinary approach involving healthcare providers, government and non-governmental organizations is crucial in addressing gaps in cervical cancer screening.

Women doi: 10.3390/women6010008

Authors: Hasina Amanzai Kristina Kokorelias Belize Beltrano Emma Hannem Jessica Pinney Lily Zeng Kateryna Metersky Stephanie Nishi Angelina Stafford Juilett Saunders Hill

African American (AA) women often experience earlier onset and more severe menopause symptoms, especially vasomotor symptoms (VMSs) like hot flashes, compared to other groups. However, limited research has examined the effectiveness and acceptability of menopause treatments in this population. This scoping review synthesized evidence on pharmacological (e.g., hormone replacement therapy [HRT], SSRIs, venlafaxine, nitroglycerin) and holistic (e.g., dietary changes, physical activity [PA], supplementation) approaches for managing menopause symptoms in AA women. Using Joanna Briggs Institute and PRISMA-ScR guidelines, a scoping review was conducted, guided by the PCC framework. Four databases (CINAHL, PsycInfo, PubMed, Scopus) were searched for English-language studies (2010–2025) involving AA women aged 40–65. Eligible studies included RCTs and observational designs with ≥10% AA participants. Data were charted and synthesized descriptively. Fourteen U.S.-based studies (11–53% AA representation) were included. Pharmacological treatments—especially HRT and SSRIs—were effective for VMSs and mood symptoms. Holistic approaches showed mixed outcomes; PA and magnesium offered modest benefit, while phytoestrogens sometimes worsened memory. Race-specific results were rarely reported. Effective pharmacological options exist, but evidence tailored to AA women is lacking. Future research must ensure greater AA representation and culturally responsive approaches to menopause care.

Women doi: 10.3390/women6010007

Authors: Isabella Ferreira de Souza Janaina Pereira Dina Toreli César Eduardo Fernandes Luiz Vinicius de Alcantara Sousa Glaucia Luciano da Veiga Beatriz Alves Edimar Cristiano Pereira Fernando Luiz Affonso Fonseca

This study discusses the challenges encountered in breast cancer screening coverage in Brazil. The aim was to verify mammography coverage in Brazil. A cross-sectional study was carried out using data provided by the Ministry of Health verifying the following information: method of detection, analysis of coverage, clinical and sociodemographic variables of breast cancer. We observed significant differences in the number of mammograms performed between Brazilian regions and between levels of education, which may be determining factors for adherence to the examination, as well as differences related to the collection period analyzed. Raising awareness among the population about the importance of mammography and training health professionals are fundamental to increasing coverage. It is necessary to invest in awareness-raising strategies and in a health care network prepared to welcome women with suspicious signs and symptoms, ensuring investigation and treatment.

Women doi: 10.3390/women6010006

Authors: Kallie Nowell Deirdre Dlugonski Emily DeFranco Linda May Johanna M. Hoch

Despite the many benefits for both the mother and fetus of physical activity during pregnancy, only 12.7–37.8% of pregnant persons in the United States achieve the recommended 150 min of moderate-intensity physical activity per week. While many variables influence physical activity participation during pregnancy, social support has been associated with physical activity participation in various populations. Originally used in the study of criminology, the social support theory has been applied in recent evidence as a method of promoting physical activity and other healthy behaviors. Recent literature suggests that social support and co-participation are interpersonal facilitators of participation in physical activity. Therefore, we propose an integrated model through a combination of social support and co-participation in physical activity to increase physical activity during pregnancy: the SsCo-PAP Model. The practical advantage of this combination is that both social support and co-participation emphasize social connectedness to facilitate physical activity. We recommend that the model be utilized by clinicians to educate, encourage, and support their patients to be physically active during their pregnancy. Future research should analyze the feasibility and effectiveness of using the SsCo-PAP Model in clinical practice.

Women doi: 10.3390/women6010005

Authors: Desmond Mnisi G. Olivia Sumbane T. Maria Mothiba L. Winter Mokhwelepa

Mastectomy, while a life-saving intervention for breast cancer, often leads to profound psychological and emotional challenges for affected women. Feelings of loss altered body image, and anxiety about recurrence can significantly impact mental well-being. This study aimed to explore and describe the experiences of women after mastectomy at Mankweng Tertiary Hospital in Limpopo Province, South Africa. In this study, a qualitative phenomenological design was used. Data were collected through semi-structured in-depth interviews with women who had undergone mastectomy. Fifteen participants were purposively sampled, and thematic analysis was used to identify key patterns and meanings in their narratives. The findings revealed that the participants initially described feelings of being ‘disabled’, incomplete, and anxious about cancer recurrence or their ability to perform maternal functions such as breastfeeding. However, over time, many developed resilience and acceptance, seeing surgery as a life-saving measure and an opportunity for renewal. The adjustment of women after mastectomy is a complicated emotional transition from crisis and loss to adjustment and empowerment. The results identify the need for holistic psychosocial support that combines counseling, peer networks, and education for their family members addressing their emotional healing, body image, and social reintegration.

Women doi: 10.3390/women6010004

Authors: Rachel-Paige Casey Lindsey Borgia Elizabeth Steinbach Bassam Dahman Catherine T. Witkop Krista B. Highland James D. Mancuso Anwar E. Ahmed

To improve shared decision-making about the potential risks and benefits of hormone therapy (HT), it is crucial to understand the joint effects of menopausal age and HT use on hypertension onset. This study examines the combined and individual effects of age at menopause and HT on hypertension onset in U.S. women based on their hysterectomy and oophorectomy history. This population-based, cross-sectional study included 4776 postmenopausal women with and without hysterectomy and oophorectomy history from the 2011–2020 National Health and Nutrition Examination Survey (NHANES). Age at hypertension onset was defined as the time scale at which a respondent was diagnosed with hypertension following the menopause onset. The weighted prevalence of hypertension was 40.0% (95% CI 38.2–41.8%) overall, highest in those who had an oophorectomy with or without hysterectomy (51.6%), followed by those with hysterectomy alone (45.3%), then in those with an intact uterus and ovaries (33.7%), p < 0.0001. Among women with an intact uterus and ovaries, those who experienced menopause before age 45 and used HT had a comparable risk of hypertension (aHR = 1.34, 95% CI: 0.81–2.22) to women who experienced menopause between ages 45 and 54 and did not use HT. Conversely, women who experienced menopause before age 45 and did not use HT showed a significantly increased risk of hypertension (aHR = 1.68, 95% CI: 1.27–2.22). The findings suggest that the absence of ovaries, with or without a uterus, HT use, and age at menopause are associated with the likelihood of hypertension development. This study highlights the need for personalized management and decision-making to reduce the risk of hypertension and cardiovascular disease in peri- and postmenopausal women.

Women doi: 10.3390/women6010003

Authors: James J. Annesi Maliheh Bakhshi

Poor satisfaction with one’s body is associated with obesity and emotional eating (EmE), especially in women. To improve behavioral obesity treatments, this study aimed to identify the effects of targeting the mediators of the body satisfaction–EmE relationship to improve weight-reduction outcomes. Women with Class II obesity (body mass index [BMI] of 35–39.9 kg/m2) were randomized into 6-month treatments targeting either increased physical activity and self-regulation (TARGETED group, n = 44) or standard weight management education (STANDARD group, n = 33). Improvements over 6 months in EmE, body satisfaction, mood, eating-related self-efficacy and self-regulation, and physical activity, and in weight over 6, 12, and 24 months, were significantly greater in the TARGETED group. Mood and eating-related self-efficacy mediated the body satisfaction–EmE relationship at baseline and the group–EmE change relationship. In the consideration of the treatment targets, increased physical activity predicted reduced EmE, mediated by mood change, and increased self-regulation predicted reduced EmE, mediated by self-efficacy change. Reduced EmE predicted weight losses. This research (a) identified psychological/behavioral mediators of the body satisfaction–EmE relationship; (b) ascertained methods associated with the improvement of those variables, their correlates, and interrelations; and (c) confirmed the viability of the indicated behavioral targets on EmE within a community-based obesity treatment. Given the identified associations with short- and longer-term weight losses, treatments were effectively informed.

Women doi: 10.3390/women6010002

Authors: Letícia Calazans Queiroz Cardone Raphael Federicci Haddad Rômulo Negrini Juliana Jorge Romano Mariana Netto Otsuka Tatiani Araújo Pandim Eduardo Zlotnik

This study examined the consistency between clinical criteria, assigned priority level, and waiting time for elective hysterectomy, assessing whether higher priority translates into faster surgical access. We conducted a retrospective cohort study including 846 women who underwent the procedure between January 2018 and January 2024 at a public hospital in São Paulo, Brazil. The median waiting time was 6 months (IQR: 3–10), with wide variability ranging from 0.5 to 53 months. All components of the clinical score were associated with higher priority levels, demonstrating adequate discriminative ability to identify patients at greater clinical risk. However, assigned priority was not associated with shorter waiting times. Criteria reflecting greater clinical vulnerability, including duration of symptoms (β = +2.50 months), age (β = +1.00), and cardiovascular disease (β = +1.00), were paradoxically associated with longer waiting times, whereas anemia was the only factor associated with reduced waiting time (β = −1.00). These findings reveal a marked discrepancy between formal prioritization and actual surgical scheduling, underscoring the need for more objective and equity-oriented criteria in the management of surgical waiting lists.

Women doi: 10.3390/women6010001

Authors: Ananda Puttaiah Manjunath S. Somannavar Mrutyunjaya B. Bellad Umesh Charantimath M. S. Deepthy Jeffrey S. A. Stringer Shivaprasad S. Goudar

Adverse pregnancy outcomes (APOs) such as prematurity, low birth weight, stillbirth, and birth defects remain significant global health challenges. While many risk factors are known, APOs encompass a wide range of outcomes with diverse, sometimes poorly understood etiologies. Pregnancy-related acute kidney injury (PR-AKI) and liver injury are particularly associated with increased maternal and fetal mortality. This study investigated the association between hematological parameters, kidney and liver injury markers and adverse pregnancy outcomes. This cross-sectional study involved 714 pregnant women aged 18–40 years, conducted between August 2021 and August 2022. Maternal blood samples were collected before and after delivery to compare hematological parameters. Kidney and liver injury markers were measured using standard methods. The study analysed the association of these parameters with adverse pregnancy outcomes. The median age of participants was 24 years (Q1, Q3: 21, 26). Women with adverse pregnancy outcomes had statistically significant serum creatinine levels [0.52 mg/dL (0.45, 0.58)] compared to those without [0.50 mg/dL (0.44, 0.56)], although the difference was not clinically significant. Elevated Aspartate Transaminase (AST) levels (>90th percentile) were statistically associated with adverse pregnancy outcomes. Pairwise comparisons with Bonferroni corrections revealed significant differences in Hemoglobin (Hb), White Blood Cell (WBC), Red Blood Cell (RBC), platelet, and Packed Cell Volume (PCV) levels before and after delivery (p < 0.05) in both groups. Elevated AST levels, but not other hematological or biochemical parameters, were independently associated with adverse pregnancy outcomes, whereas creatinine differences lacked clinical impact.

Women doi: 10.3390/women5040050

Authors: Cecilia Mota-González Claudia Sánchez Jorge Carreño Claudia Yereni Jímenez-García

This systematic review aimed to identify psychosocial risk factors associated with the development of complicated perinatal grief in adult women who experienced pregnancy loss. Following PRISMA guidelines, comprehensive searches were conducted in Web of Science, PubMed, Scopus, and PsycINFO databases, covering 1990–2024. A total of 34 quantitative studies comprising 7872 participants were included, mainly using cross-sectional and longitudinal designs. Findings indicate that complicated perinatal grief is a multifactorial condition influenced by personal variables (absence of living children, history of depression or PTSD, advanced maternal age, low education and income), obstetric factors (later gestational loss, multiple pregnancies, stillbirth, or neonatal death), and psychosocial factors (low social support, relationship conflict, violence, ostracism, and limited psychological care). Negative cognitions, rumination, and maladaptive coping strategies were also linked to prolonged symptoms of depression, anxiety, and post-traumatic stress. The review concludes that complicated perinatal grief is a multidimensional phenomenon determined by psychological, social, cultural, and medical factors and highlights the need to understand perinatal loss as a profoundly significant experience that affects women’s identity, relationships, and mental health. This evidence highlights the importance of emphasizing the identified risk factors that can lead to complicated grief.

Women doi: 10.3390/women5040049

Authors: Promethi Das Deep Nitu Ghosh Catherine Gaither Tracey S. Hodges

Women in vulnerable living situations with schizophrenia face intersecting challenges, including migration-related trauma, caregiving burdens, and systemic barriers such as cultural dislocation, limited healthcare access, and stigma. These factors heighten vulnerability compared with men and contribute to delayed diagnoses, poor treatment adherence, and adverse outcomes. Advances in artificial intelligence (AI) and digital tools offer potential support, though they should be regarded as complementary rather than stand-alone solutions. This review synthesizes literature on gender-specific care for women with schizophrenia, examining clinical, social, and reproductive needs alongside the impact of migration and psychosocial adversity. Emerging models, including women-focused psychiatric units, perinatal services, and community therapeutic spaces, illustrate holistic approaches that integrate the medical, psychological, and social dimensions of care. Digital interventions, such as smartphone applications, mobile health tools, and digital participation strategies, are considered supportive extensions that offer opportunities to improve access, reduce costs, and enhance continuity of care. Despite this promise, digital tools remain under-validated for women in precarious contexts. Ethical challenges, including algorithmic bias, data privacy risks, and the exclusion of undocumented or marginalized groups, further constrain equitable implementation. This review aims to articulate conceptual linkages among gender, migration, and digital innovation in schizophrenia care, identifying thematic patterns, ethical tensions, and structural limitations in the existing literature. The synthesis provides a foundation for future hypothesis development and interdisciplinary research to advance inclusive and equity-driven mental health interventions.

Women doi: 10.3390/women5040048

Authors: Lóránt Csákány Andrea Surányi Flórián Kovács Szabolcs Várbíró Gábor Németh Attila Keresztúri Norbert Pásztor

Stress urinary incontinence (SUI) is the most common subtype of female urinary incontinence, affecting up to one in four women and markedly reducing quality of life. Its pathophysiology primarily involves impaired suburethral and paraurethral support, resulting in decreased tissue stiffness and urethral hypermobility. Conventional imaging provides anatomical detail but is limited in its ability to assess pelvic floor biomechanics. This narrative review summarizes current evidence on strain elastography (SE) as a functional imaging modality in urogynecology, with emphasis on evaluating suburethral tissue stiffness in women with SUI. A narrative review was performed using PubMed (2000–2025). Primary searches (“strain elastography” AND “female stress urinary incontinence”; “stress incontinence” AND “elastography”) yielded 19 records, of which 12 were included after screening. Owing to the limited number of SE-specific studies, the review was expanded to include shear wave elastography research, key guidelines, and biomechanical literature on pelvic floor ultrasound in adult women with SUI. SE provides a non-invasive, real-time method for assessing tissue stiffness, bridging the longstanding gap between anatomical and biomechanical evaluation. Current evidence supports SE as a feasible and promising diagnostic adjunct for the functional assessment of SUI in women.

Women doi: 10.3390/women5040047

Authors: Jordan Tewhaiti-Smith Mark Gannott Alex Semprini Deborah Bush Augustus Anderson Allie Eathorne Neil Johnson Jane E. Girling Michael East Joy Marriott Ruth Fisher Mike Armour

Endometriosis and chronic pelvic pain (CPP) impose substantial economic burden in New Zealand, yet no national cost-of-illness (COI) model currently exists. This study provides the first nationwide estimate using a modified World-Endometriosis-Research-Foundation (WERF) EndoCost protocol incorporating direct healthcare, productivity, and carer costs. An attribution correction model was applied to account for diagnostic overlap, assigning 43.4% of CPP cases to endometriosis. Attribution-adjusted annual per capita costs were INT 97,497 (NZD 174,130) for endometriosis and INT 33,262 (NZD 59,406) for CPP. Macroeconomic costs ranged from INT 12.7B to 17.7B (NZD 22.6B–31.7B) per annum, depending on prevalence. Productivity losses were the primary cost driver, accounting for 65% of endometriosis and 75% of CPP cost. The unattributed lifetime burden was INT 1.96M (NZD 3.50M) per person for endometriosis and INT 1.54M (NZD 2.74M) per person with CPP. This reflects total economic burden over a 34.5-year working lifespan, adjusted for labor-force participation. Diagnostic delays and health system inefficiencies such as poor healthcare access and suboptimal symptom management are likely to be the most significant modifiable contributor to this burden. Addressing this will require investment in healthcare provision and symptom management alongside equitable access to fertility care.

Women doi: 10.3390/women5040046

Authors: Keiko Aizawa Mihoko Fujii Yuki Yonekura

Use of assisted reproductive technology (ART) to bear children has in recent years become widespread in Japan. While midwives are required to understand the experiences of individual women and provide ongoing support for them, implementing respectful care that meets the needs of women using ART remains challenging. This study therefore aimed to explore the specific care components expected of midwives for women with twin pregnancies after ART. A cross-sectional questionnaire survey was conducted through Google Forms on 273 women with twin pregnancies, of whom 85 had conceived twins through ART. Women were recruited through national multiple birth support groups and midwifery centers providing postnatal care. Data were collected from July 2021 to December 2022, and care expectations were rated on a 5-point Likert scale. Factor analysis was performed to identify care components, and reliability was evaluated using Cronbach’s alpha. Among the participants, 41.2% were between 36 and 40 years of age. Seven primary care factors were identified: comprehensive parenting support for twins, addressing concerns regarding the sudden death of twins, interdisciplinary medical collaboration, connecting women with twin pregnancies, understanding post-delivery physical pain, providing continuity before and after delivery, and supporting the development and well-being of the twins. The findings emphasize the importance of understanding individual ART histories and providing tailored care to respond appropriately to women’s needs during pregnancy, childbirth, and the postpartum period. The identified components provide an empirical foundation for integrating these perspectives into routine midwifery care and educational programs for women with ART-conceived twin pregnancies.

Women doi: 10.3390/women5040045

Authors: Konstantina Adamidou Panagiota Tragantzopoulou

Positive Body Image (PBI) has been conceptualized as a multidimensional construct encompassing acceptance, functionality appreciation, and self-care, yet little is known about the lived processes through which women move from self-criticism to reconciliation with their bodies. This study aimed to explore how women experience, construct, and sustain PBI in their everyday lives, and to identify the psychological and contextual factors that facilitate its development. Semi-structured interviews were conducted with ten women in Greece (ages 18–62) of diverse body sizes, educational backgrounds, and life circumstances, which were then analyzed using interpretative phenomenological analysis. Participants were recruited through convenience sampling and interviewed online between July and August 2025. Findings revealed three superordinate themes—(1) Catalysts of Realism and Self-Care, (2) From Rejection to Reconciliation, and (3) My Own Positive Body Image—comprising nine subthemes that together illustrated a developmental process of body acceptance and meaning-making. Findings revealed a trajectory from self-rejection to reconciliation, marked by shifts from external appearance to holistic embodiment, and from self-criticism to compassion, functionality appreciation, and intrinsic motivation. Participants described mindful self-care practices—particularly exercise and healthy eating—as acts of self-nurturing, supported by psychotherapy, positive social relationships, and turning points such as illness, aging, or personal maturation. These catalysts facilitated a reorientation of body image away from societal ideals and toward health, resilience, and existential meaning. The study contributes to understanding how women develop sustainable forms of PBI, highlighting the importance of self-compassion, supportive contexts, and body functionality. These insights have implications for interventions aiming to promote wellbeing, resilience, and healthier relationships with the body across the lifespan.

Women doi: 10.3390/women5040044

Authors: Carol Nash

Personalized medicine regarding the biopsychosocial model can extend to females considering fertility choices through online one-on-one interactions. This finding is relevant, as recent publications suggest that online one-on-one interventions might help them in this regard. An examination of one online one-on-one intervention considers its conceptual appropriateness. The investigation is through a narrative historical analysis of a previous online group meeting, personalized to help researchers reduce their burnout. The finding is that, with an adaptation of the group process to the individual’s schedule, some participants became overwhelmed by being responsible for their schedule. By using a modification of the same process—one that does not depend on them determining their participation schedule—females can respond to writing prompts that reveal their values, from the most objective to those that are increasingly subjective. However, notably, those who are clear about their values would likely experience the least difficulty in assuming responsibility for their participation. In this regard, methodological examples of possible prompts for the modified process are offered. Through the appropriate personalization of an online, one-on-one process, the future aim in testing this process is to improve the likelihood of success in helping females clarify their values for making fertility-related decisions.

Women doi: 10.3390/women5040043

Authors: Ximena Solis-Gómez Mónica Alethia Cureño-Díaz Maximiliano Olguín-Montiel Adriana Jiménez Erika Gómez-Zamora Ahidée Guadalupe Leyva-Lopez Yaneth Citlalli Orbe-Orihuela Miguel Trujillo-Martínez Ricardo Castrejón-Salgado José Ángel Hernández-Mariano

Early menarche has been recognized as an early-life marker of metabolic vulnerability, yet its link to gestational diabetes mellitus (GDM) remains unclear. We investigated this association in a retrospective case–control study of 71 cases and 355 controls from a tertiary hospital in Mexico City. Age at menarche was evaluated both in categories and using restricted cubic splines to capture potential non-linear trends. Mediation analysis explored the contribution of pregestational body mass index (BMI) to the relationship between variables. Women who experienced menarche before age 12 had more than twice the odds of developing GDM compared with those whose menarche occurred between 12 and 15 years (adjusted OR = 2.51, 95% CI 1.40–4.50). In contrast, late menarche showed a minor, non-significant increase in risk. The spline models revealed a subtle U-shaped pattern, suggesting that both very early and delayed pubertal timing may carry metabolic disadvantages. The mediation analysis showed that pregestational BMI accounted for only a minor share of this association. Overall, the findings indicate that early pubertal onset may influence glucose regulation during pregnancy through pathways beyond adiposity, highlighting early menarche as a valuable marker for identifying women at higher risk of GDM.

Women doi: 10.3390/women5040042

Authors: Pietro Ferraro Carlotta Amantea Marco Rissone Gianluca Ceccarelli Giuseppe Saffioti

Musculoskeletal disorders (MSDs) are a major occupational health concern, especially for women in physically demanding jobs. Despite efforts to standardize risk assessment in occupational medicine, the lack of homogeneous criteria limits the comparability and applicability of the findings, particularly concerning gender-specific risks. A systematic review was conducted across PubMed, Scopus, and Web of Science, following PRISMA guidelines. The review included primary studies in English or Italian that applied standardized criteria to assess MSDs among working women. The search strategy was built using the PICO framework, focusing on uniform assessment methods for MSDs in occupational contexts. Out of 416 initially retrieved records, 5 studies met the inclusion criteria. These studies, conducted in North America, Europe, and Asia, applied diverse yet standardized tools such as the ISO 2631, INRS/Saltsa guidelines, ergonomic assessments, and functional capacity evaluations. Female representation ranged from 12% to over 80%, highlighting the underrepresentation of women in some studies. All studies incorporated criteria to ensure population or exposure homogeneity. Although standardized methods are increasingly being used in MSD research, only a few studies integrate a gender-sensitive approach. This review underscores the need for personalized occupational health models that consider sex and gender differences, promoting equitable and effective fit-to-work assessments.

Women doi: 10.3390/women5040041

Authors: Carlos Navarro-Martínez Diego Hernán Villarejo-García Rafael Carvajal-Espinosa Germán Cánovas-Ambit Boryi A. Becerra-Patiño José Pino-Ortega

Breast cancer (BC), despite its high survival rate, can cause significant functional sequelae in the scapulohumeral joint after surgery. This study evaluated angular velocity during a lateral reach test, comparing the operated arm with the non-operated arm as a possible indicator of functional asymmetry. This study employed an observational, comparative, cross-sectional design. Twenty-two women voluntarily participated in the study. The anthropometric characteristics were as follows: mean age, 55.95 ± 6.34 years; height, 1.63 ± 0.06 m; body weight, 65.37 ± 11.10 kg; and BMI, 24.73 ± 3.60 kg/m2. The participants, who were survivors of breast cancer and had undergone surgery on only one arm, regularly performed physical activity in the Department of Exercise, Education, and Cancer at the University of Murcia, BC. A lateral opening test was performed, measuring the angular velocity in both arms during 15 repetitions using the WIMU PRO™ inertial device. Results showed no significant main effects for arm (p = 0.369) or surgery side (p = 0.587) but a significant interaction (F = 29.44, p = 0.001), with lower velocity in the operated arm both for right-side surgery (right: 100.4 ± 31.1 vs. left: 111.7 ± 32.0 °/s) and left-side surgery (left: 92.1 ± 22.3 vs. right: 100.2 ± 20.2 °/s). Effect sizes were small to moderate (Hedges’ g = 0.35–0.36). This difference may suggest the presence of postoperative functional asymmetries, which may inform future research on therapeutic exercise approaches, though direct clinical applications cannot yet be established. These preliminary findings highlight the feasibility of using inertial devices to assess postoperative functional asymmetry in breast cancer survivors.

Women doi: 10.3390/women5040040

Authors: Georgios Laskaris Ioanna Spyropoulou Melika Mehriar Biljana Popeska Larisa Bianca Elena Petrescu-Damale Snezana Jovanova Mitkovska Misko Djidrov

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.

Women doi: 10.3390/women5040039

Authors: Courage Mlambo

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.

Women doi: 10.3390/women5040038

Authors: Isabel Rute Pereira Margarida Sim-Sim Maria Otília Zangão

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.

Women doi: 10.3390/women5040037

Authors: Avanthi Puvvala Atharva Rohatgi Diana Lobaina Megha Srivastav Vama Jhumkhawala Sahar Kaleem Lea Sacca

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.

Women doi: 10.3390/women5040036

Authors: Júlia Olivé-Mas Eva Aguilar Meritxell Tost Laia Martí Cristina Giménez Cristina Lesmes Ana Moreno-Baró Mariona Aparicio Mireia Agut Irina Olasz Jesus Cobo

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.

Women doi: 10.3390/women5030035

Authors: Marta Górna Natália Čamarová Zuzana Rojková Patrícia Slebodová

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.

Women doi: 10.3390/women5030034

Authors: Samuel Atta Tonyemevor Mary Amoako Lord Jephthah Joojo Gowans Alexander Kwarteng Collins Afriyie Appiah Solomon Obiri-Yeboah Daniel Kwesi Sabbah Peter Donkor

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.

Women doi: 10.3390/women5030033

Authors: Payam Sheikhattari Rifath Ara Alam Barsha Chidubem Egboluche Shervin Assari

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.

Women doi: 10.3390/women5030032

Authors: Rafaela Tiemi Iwamoto Vicentin Raphael Federicci Haddad Julia Stamato de Figueiredo Eric Katsuyama Gustavo Yano Callado Edward Araujo Júnior Débora Davalos de Albuquerque Maranhão

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.

Women doi: 10.3390/women5030031

Authors: Kayla Ernst Gabriella Dasilva Megha Srivastav Alexandra Campson Pedro Soto Avanthi Puvvala Elisheva Knopf Diana Lobaina Goodness Okwaraji Jennifer Mendonca Mindy Brooke Frishman Michelle Keba Knecht Lea Sacca

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.

Women doi: 10.3390/women5030030

Authors: Mahdi Tarabeih Aliza Amiel Wasef Na’amnih

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.

Women doi: 10.3390/women5030029

Authors: Hind N. Alenezi Fayez K. Alanazi Alhanouf Bin Muhanna Shadi Mohammed Ali Softa Baraah AbuAlsel Hanaa E. Bayomy Safya E. Esmaeel Manal S. Fawzy

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.

Women doi: 10.3390/women5030028

Authors: Miryam Vergara Daniele Ceron Gloria Giglioni Gabriella Di Crescenzo Elisa Burani

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.

Women doi: 10.3390/women5030027

Authors: Tiago Franca Joana Fonseca Ferreira Melissa Mariana Elisa Cairrao

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.

Women doi: 10.3390/women5030026

Authors: Rosa Ayesa-Arriola Claudia Parás Alexandre Díaz-Pons

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.

Women doi: 10.3390/women5030025

Authors: Kelly A. Daly Alika Tsytsurina Danielle M. Mitnick Amy D. Marshall

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.

Women doi: 10.3390/women5030024

Authors: Luiza Martins Robert H. McPherson Weihua Fan Norma Olvera Consuelo Arbona

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.

Women doi: 10.3390/women5030023

Authors: Choltira Tangkeeratichai Charnsiri Segsarnviriya Kittibhum Kawinchotpaisan Pansak Sugkraroek Mart Maiprasert

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.

Women doi: 10.3390/women5030022

Authors: Elisa Viciani Barbara Santacroce Antonella Padella Alena Velichevskaya Andrea Marcante Laura Di Rito Matteo Soverini Alessandra Graziottin Filippo Murina Andrea Castagnetti

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.

Women doi: 10.3390/women5020021

Authors: John P. Bartkowski Katherine Klee Xiaohe Xu Jacinda B. Roach Shakeizia (Kezi) Jones

Intersectionality, especially with a race–class–gender focus, has been used to study many facets of women’s experiences. However, this framework has been underutilized in the study of breastfeeding prevalence. Our study is the first of its kind to use intersectionality to illuminate breastfeeding network prevalence disparities with empirical data. We use insights from this theory to examine breastfeeding patterns reported by women living on the Mississippi Gulf Coast. Mississippi makes an excellent site for such an examination, given its history of racial discrimination, entrenched poverty, and strikingly low rates of breastfeeding, particularly for African American women. We identify a series of factors that influence racial disparities in lactation network prevalence, that is, breastfeeding among friends and family of the women we surveyed. Our investigation relies on survey data drawn from a random sample of adult women who are representative of the Mississippi Gulf Coast population supplemented by a non-random oversample of African American women in this predominantly rural tri-county area. Results from the first wave of the CDC-funded 2019 Mississippi REACH Social Climate Survey reveal that Black-White differentials in breastfeeding network prevalence are significantly reduced for African American women who report (1) higher income levels and (2) more robust community support for breastfeeding. We conclude that breastfeeding is subject to two key structural factors: economic standing and community context. An appreciation of these intersecting influences on breastfeeding and long-term efforts to alter them could bring about greater breastfeeding parity among African American and White women in Mississippi and perhaps elsewhere. We end by identifying the practical implications of our findings and promising directions for future research.

Women doi: 10.3390/women5020020

Authors: Maria Elisa Martini Albrecht Milena Giuberti Bathomarco Gustavo Yano Callado Nathalie Jeanne Bravo-Valenzuela Edward Araujo Júnior

This case report describes a fetus diagnosed with complete atrioventricular block (CAVB) associated with positive maternal anti-Ro and anti-La antibodies, referred to our fetal cardiology unit at 25 weeks of gestation. The diagnosis of systemic lupus erythematosus (SLE) was established during the investigation of the fetal condition. Oral dexamethasone was initiated and well tolerated, with no adverse effects reported throughout the remainder of the pregnancy. The fetal heart rate (HR) remained above 50 bpm, and, therefore, no beta-sympathomimetic agents were administered. Due to progressive reduction in myocardial contractility and the appearance of early signs of endocardial fibroelastosis, intravenous immunoglobulin (IVIG) therapy was initiated. The patient was hospitalized for the infusion, which was well tolerated without complications, and a second IVIG cycle was administered four weeks later. Significant improvement in ventricular contractility and reduction in fibroelastosis were observed. As reported in the literature, no chronotropic effect was noted, and fetal HR remained stable after treatment. Weekly monitoring of cardiovascular profile score and fetal HR was maintained, with the score consistently remaining at 8 throughout gestation, supporting continued outpatient management. Delivery occurred at 36 weeks and 3 days due to spontaneous preterm labor. A male neonate weighing 3025 g was delivered with Apgar scores of 8 and 9, and an initial heart rate of 84 bpm. Neonatal electrocardiography confirmed persistent CAVB, and the newborn was monitored in the neonatal intensive care unit. At follow-up, the infant remains clinically stable and has not required permanent pacemaker implantation.

Women doi: 10.3390/women5020019

Authors: Subeksha Shrestha Preeti Patel Sentirenla Longchar Aiswarya Francis Xavier

Gender-based violence (GBV) is a profound and pervasive societal issue, disproportionately affecting women across diverse settings, including homes, workplaces, and public spaces. Despite its prevalence, significant challenges impede research on GBV, particularly regarding data collection, analysis, and ethical handling. This study investigates the complexities inherent in GBV research, focusing on the obstacles posed by under-reporting, ethical considerations, data quality, and the need for cross-comparative standards. Using a combination of police records, web scraping, news reports, and survey data from USAID’s Demographic and Health Surveys (DHS), our study examines strategies to work with sensitive GBV datasets, while maintaining data integrity. Our study advocates for improved demographic surveying and data integration methodologies that can enhance data accuracy and comparability. The findings suggest that while technological advancements, particularly generative AI and machine learning approaches, offer promising avenues for automating survey processes, reducing costs, and enhancing data collection efficiency, they present the limitations of secondary datasets, a lack of data disaggregation, and discrepancies in data coding systems, which highlight the necessity of refining global data standards.

Women doi: 10.3390/women5020018

Authors: Julia Argentina Rodríguez-Pastor Antonio Jesús Molina-Fernández

Female Genital Mutilation (FGM) remains a deeply entrenched cultural practice affecting millions of women and girls worldwide, with particularly high prevalence in Sierra Leone. Despite international efforts to eradicate FGM due to its severe consequences, it persists as a social norm, often reinforced by traditional institutions such as the Bondo society. This paper explores the historical, cultural, and social dimensions of FGM in Sierra Leone, examining the role of the Bondo society in perpetuating the practice and its implications for women’s rights and health. This study analyzes the existing literature to understand both the resilience of FGM as a practice and the challenges faced by intervention programs. A total of eight peer-reviewed studies were included in the final synthesis. The findings highlight the complex intersection of tradition, gender identity, and societal expectations, which sustain FGM despite legal and advocacy efforts. The paper further discusses potential strategies for mitigating FGM, including community-based awareness programs, legal reforms, and engagement with cultural gatekeepers to promote alternative rites of passage. The study concludes that while progress is being made, a culturally sensitive, grassroots approach is essential for the long-term eradication of FGM in Sierra Leone.

Women doi: 10.3390/women5020017

Authors: Ángel Denche-Zamorano Damián Pereira-Payo Javier De Los Ríos-Calonge Pablo Tomás-Carús Daniel Collado-Mateo José Carmelo Adsuar

Fibromyalgia is a condition that primarily affects women and compromises the quality of life (QoL), life satisfaction (SWL), mental health and cognitive function of sufferers. This study aimed to analyze the effects of a physical activity program based on Virtual Square Step Exercise on the above conditions in women with FM. A 12-week randomized controlled trial was designed with 61 women with FM assigned to a control group (CTL) and an experimental group (VSEE). The VSSE group performed VSSE sessions three times a week for 12 weeks, while the CTL continued with their usual treatment. The applicability and safety of the program was tested in this population. In addition, the participants’ QoL, SWL, mental health status, and cognitive function were assessed before and after the intervention program using different questionnaires and tests. VSEE was found to be applicable (with adherence greater than 85%) and safe (with no accidents, injuries, or health-compromising incidents) in women with FM. The VSEE showed a significant reduction in self-perceived depressive symptoms compared to the control group (p < 0.05). In contrast, no significant changes in QoL, SWL, mental health and cognitive function were observed in the VSEE compared to the CTL (p > 0.05). Therefore, even though our VSEE-based intervention was found to be applicable and safe in women with FM, it did not produce significant changes in improving QoL, SWL, mental health, and cognitive function in our sample. The small sample size and post-pandemic context may have affected the findings. More research with a larger sample size is needed to confirm the effects and applicability of VSEE in women with FM.

Women doi: 10.3390/women5020016

Authors: Francisco José Barbas Rodrigues Patrícia Coelho Sónia Mateus João Metello Miguel Castelo-Branco

Urinary tract infections (UTIs) are among the most prevalent infectious diseases in older women, especially those over 65 years of age. Physiological changes related to aging, comorbidities, and frequent use of medical devices such as urinary catheters increase susceptibility. Increasing antimicrobial resistance further complicates treatment strategies. This study aims to describe the epidemiological profile of UTI in women over 65 years of age, focusing on the characterization of etiological agents, observed antimicrobial resistance patterns, and commonly reported risk factors. We conducted a retrospective analysis of microbiological and clinical data from elderly women diagnosed with UTIs. Bacterial isolates were identified and antimicrobial susceptibility profiles were evaluated over a specified period. A statistical analysis was performed to determine the prevalence of different pathogens and antibiotic resistance trends. Escherichia coli was the predominant uropathogen, consistent across different clinical scenarios and patient conditions. The four most common bacterial strains—E. coli, Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecalis—aligned with global epidemiological data. In Escherichia coli a significant increase in resistance to nitrofurantoin was observed, possibly indicating excessive empirical use, while resistance to other antibiotics, such as amoxicillin/clavulanic acid and ertapenem, remained stable or decreased. Institutional antibiotic stewardship programs likely contributed to this trend. The study highlights E. coli as the main etiological agent in elderly women with UTIs. The observed resistance patterns emphasize the need for localized antimicrobial surveillance and personalized therapeutic approaches. Continuous microbiological monitoring and rational use of antibiotics are crucial to optimize treatment outcomes and control the development of resistance.

Women doi: 10.3390/women5020015

Authors: Akemi Sawai Takashi Shida

The sleep–wake rhythm, regulated by the suprachiasmatic nucleus (SCN) and peripheral clocks, is influenced by light, nutrition, stress, and exercise. Recent findings suggest that estrogen receptors in the SCN may link ovarian hormone regulation to circadian rhythms, highlighting the need to consider hormonal fluctuations throughout the menstrual cycle when examining the effects of exercise on the sleep–wake rhythm in females. Therefore, we conducted a scoping review to compile existing studies involving human participants, aiming to provide a foundation for research focused on the specific physiological phenomena in females. Based on 228 literature sources, only 6 met the inclusion criteria. Despite variations in the exercise type, intensity, and duration, transient exercise demonstrated a significant impact on the expression of the clock genes BMAL1, PER2, and CRY1, suggesting their susceptibility to such activities. This review highlights the absence of studies examining the effects of exercise on clock gene expression in females, particularly in relation to menstrual cycles and ovarian hormone fluctuations, emphasizing the need for future investigations that incorporate these factors.

Women doi: 10.3390/women5020014

Authors: Alina Cernasev Karissa Cliff Hayleigh Hallam Emily Nagel Alex Johnson Tracy M. Hagemann

Background: The introduction of the human papilloma virus (HPV) vaccine has allowed for incredible strides in the reduction in HPV-related cancers. Despite widespread availability and a recent age group expansion for the vaccine, uptake remains low. Particularly, concerning disparities exist in the state of Tennessee and among minority women. This study aimed to identify key influences of decision-making to receive the HPV vaccine in minority women living in Tennessee. Methods: This study used a prospective, observational, qualitative methods approach. Minority women residing in Tennessee were recruited through flyers posted in various community-based locations around the state. Narrative interviews of participants were conducted until thematic saturation was achieved. Interviewing occurred telephonically, with questions focused on participant perceptions of HPV and its vaccine. Verbatim transcripts were created via external software, and then inductively coded by three researchers. These codes were grouped into categories based on similarities, which facilitated the emergence of themes. Results: A total of 21 participants were interviewed between July and October 2024. Thematic analysis revealed two themes: (1) Awareness of HPV: Determining if the Vaccine is Right for Me; and (2) Intrinsic Motivators for HPV Vaccine adoption: “Like going to the salon and getting your hair half-done”. While some participants had an accurate understanding of HPV, its health consequences, and had received the vaccine, most were unvaccinated and had little understanding of the benefits of this preventative method. Those who received the HPV vaccination were influenced by proactive healthcare workers who provided in-depth education about its benefits. Those who did not elect to receive the vaccine described how its lack of mandate and seldom informational opportunities impacted their decision. Conclusions: Overall, minority women in Tennessee could benefit from improved access to information regarding HPV and its vaccine, as well as direct provider influence and counseling on receiving the vaccine to avoid detrimental health consequences.

Women doi: 10.3390/women5020013

Authors: Mentxu Natividad María Emilia Chávez Ariadna Balagué Jennipher Paola Paolini Pep Picó Raquel Hernández Nerea Dalmau Elisa Rial Mireia Salvador Eduard Izquierdo Laura Vergara Ricardo León Marta Armero José Antonio Monreal Alexandre González-Rodríguez

Women with schizophrenia have distinct health and social needs compared to men. The Mutua Terrassa Functional Unit for Women with Schizophrenia has designed a new intervention called the Community Therapeutic Space (CTS), which is based on individual and group interventions focused on physical and mental health, and social factors. We carried out a narrative review focusing on green and blue spaces, climate change, light, digitalization and health, and gynecological screening in women with schizophrenia, to propose content for seven topics of the CTS. The personalized space offers individual appointments with mental health professionals with particular attention to pharmacological and social issues. The health space focuses mainly on groups of healthy habits, and links women to community activities. The interaction space focuses mainly on social connections, and the connection with nature. The content of these three spaces has been divided into seven colors: green and blue corners (related to green and blue spaces), red corner (climate change), yellow corner (light and health), white corner (mainly focused on mindfulness), black corner (digitalization in healthcare), and purple corner (related to gynecological screening). In the future, peer-to-peer and volunteer programs may help our healthcare unit to ensure and maintain the positive effects of these interventions.