Women, Volume 5, Issue 4 (December 2025) – 15 articles

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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

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

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

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

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