Women, Volume 5, Issue 3 (September 2025) – 11 articles

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

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

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

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

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

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

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

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

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

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

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