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Objetivo: Determinar las características clínicas-epidemiológicas y factores de riesgo maternos relacionados con macrosomía fetal en un Hospital del Ministerio de Salud durante el periodo del 2016 al 2022. Material y métodos: El diseño fue de tipo no experimental, transversal, comparativo. Se contaron con 182 registros clínicos de recién nacidos y sus respectivas madres. Se recolectó la información mediante el análisis documental y revisión de base de datos electrónica. El análisis ajustado se evaluó mediante regresión logística. Resultados: Los resultados mostraron que la mayoría tuvo menos o igual a 41 semanas de gestación (98.90%), sexo femenino (59.89%) y parto vaginal (77.47%). Entre los factores de riesgo maternos se encontró que eran nulíparas (55.49%), tenían sobrepeso pregestacional (46.15%), no tuvieron una ganancia de peso adecuado (50.55%), no presentaron obesidad al término (54.95%). Se concluye que la talla del recién nacido (ORa:1.27, p:0.001), la talla de la madre (ORa:1.10, p:0.001), la ganancia de peso adecuado (ORa:1.62, p:0.045), la obesidad (ORa:2.26, p:0.012) se relacionaron con la macrosomía. Conclusión: La talla del recién nacido, de la madre, la ganancia de peso adecuado y la obesidad se relacionan con la macrosomía.

Objetivos: Determinar la asociación entre los factores de la atención materna y las complicaciones obstétricas del periparto y post parto. Material y métodos: Estudio cuantitativo, analítico, retrospectivo y transversal, basado en datos de la ENDES 2022. Resultados: Se analizó una muestra de 6 158 madres, el 22.2 % tuvieron complicaciones obstétricas. Las más frecuentes fueron fiebre postparto (12%) y sangrado periparto (9.9%). Los factores de la atención materna asociados con incremento de complicaciones del periparto fueron; violencia familiar (PRa=1.6; IC95%1.16-2.20; p=0.004), DM2 (PRa=4.11; IC95%1.85-9.10; p=0.001) y recibir ferroterapia (PRa=9.76; IC95%:1.88-50.64; p=0.007), por el contrario, un control prenatal brindado por personal calificado (PRa=0.29; IC95% 0.13 - 0.65; p=0.003) disminuirán estas probabilidades. Por otro lado, HTA (PRa=2.3; IC95%:1.10-4.82; p=0.027), DM2 (PRa=4), Anemia (PRa=2.11), violencia emocional (PRa= 2.22) aumentan la posibilidad de complicaciones mientras que el Control de Hb (PRa= 0.52; IC95%:0.31-2.76; p=0.014), atención posparto temprano (PRa=0.19) por personal calificado (PRa=0.66) disminuye la prevalencia de complicaciones post parto. Conclusiones: Factores de la atención materna asociados significativamente a complicaciones obstétricas del posparto y periparto fueron características del Control prenatal, las acciones de intervención y preventivo-promocionales, además de factores de riesgo como HTA, DM2, anemia y violencia familiar.

Objetivo: El presente estudio aborda la necesidad e importancia de la consejería en ecografía obstétrica como parte integral del proceso de atención prenatal desde la perspectiva de obstetras especializados. Material y métodos: Mediante un diseño cualitativo con enfoque fenomenológico, se entrevistó a tres obstetras con maestría pertenecientes a la Universidad Nacional Mayor de San Marcos. Las entrevistas se realizaron entre noviembre y diciembre de 2023, utilizando una guía semiestructurada con diez preguntas abiertas para explorar tres categorías de análisis: la necesidad e importancia de la consejería, sus características y el rol del obstetra en su implementación. Resultados: Los resultados revelaron que los obstetras consideran crucial que las gestantes reciban información detallada sobre la ecografía obstétrica para facilitar decisiones informadas y empoderarlas en el cuidado de su salud y la de sus bebés. Se destacó la utilidad de la ecografía en la detección temprana de anomalías y el seguimiento del desarrollo fetal, así como en la orientación sobre la realización oportuna de estos estudios. Los participantes coincidieron en la aplicación de los cinco pasos de consejería con adaptaciones según el contexto y la necesidad de limitar la duración de la consejería para evitar saturación informativa. Además, enfatizaron la importancia de materiales audiovisuales como rotafolios y videos para complementar la información verbal. Conclusión: El estudio subraya la importancia de integrar la consejería en ecografía obstétrica como parte estándar de la atención prenatal, resaltando el papel central del obstetra como facilitador de decisiones informadas y promotor del bienestar materno-infantil.

Objetivo: Evaluar la asociación entre la depresión y la violencia intrafamiliar en gestantes atendidas en un centro de salud peruano durante el 2022. Material y métodos: Estudio de enfoque cuantitativo, observacional, analítico transversal. Se seleccionó un total de 180 gestantes adultas que acuden al Centro de Salud Nocheto, Lima (Perú). La violencia intrafamiliar se evaluó mediante el cuestionario estándar del Ministerio de la Mujer y Poblaciones Vulnerables y la depresión mediante el Inventario de depresión de Beck. El estudio cuenta con la aprobación del comité de ética de la universidad y el permiso de la jefatura del establecimiento de salud. Resultados: El 36.11% [IC95%: 29.39-43.43] de las gestantes presentó depresión, siendo 1.11% severa; así mismo, el 41.67% [IC95%: 36.64-49.05] refirió haber presentado violencia intrafamiliar. Se identificó que el presentar violencia intrafamiliar incrementa la probabilidad de presentar depresión durante el embarazo (RPa: 9.89; p

Objetivo: Analizar el engagement y rendimiento académico en estudiantes universitarios del curso Gestión en Salud durante el año 2023. Material y métodos: Investigación de diseño no experimental tipo correlacional, la población de estudio estuvo conformada por estudiantes de la Escuela Profesional de Obstetricia matriculados en el curso Gestión en Salud. El tipo de muestreo utilizado fue no probabilístico intencional. La recolección de datos se realizó mediante el cuestionario denominado “Student Engagement Questionnaire”, contiene 35 preguntas distribuidas en cinco dimensiones, con respuestas mediante una escala de Likert; tiene un coeficiente de fiabilidad entre 0,70 y 0,93. El rendimiento académico fue medido mediante el promedio final de notas según escala vigesimal. El procesamiento de datos se realizó mediante SPSS versión 22 y la prueba de Rho de Spearman. Resultados: La muestra final estuvo conformada por 64 estudiantes, edad promedio 22,7 años. La oportunidad de participar en clase obtuvo un valor promedio 4,22. Sentirse capaz de aportar información y diferentes ideas para resolver problemas un valor 4,03 y la ayuda de profesor para responder preguntas fue 4,08. La dimensión relaciones profesor-estudiantes y docencia presentaron un valor promedio 3,85 y 3,6 respectivamente. Con respecto al rendimiento académico: 35,94% tuvo un rendimiento de 14. El coeficiente de determinación entre engagement y rendimiento académico no presentó relación significativa (p=0,02). Conclusión: Los estudiantes tienen mejor compromiso en las dimensiones trabajo en equipo y la relación profesor-estudiantes. El engagement no influye en el rendimiento académico de los estudiantes.

Objetivo: Establecer los factores asociados al embarazo reincidente en adolescentes atendidas en un hospital público del Perú, 2021-2022. Materiales y Métodos: Estudio de enfoque cuantitativo, observacional, analítico transversal. Se obtuvo información de las historias clínicas de todas las gestantes adolescentes (N=252) atendidas en un hospital público de atención médica general. Se evaluaron factores sociodemográficos, familiares y gineco-obstétricos de las adolescentes. El estudio fue aprobado por el comité de ética hospitalario y la asociación se determinó mediante la prueba de Regresión de Poisson. Resultados: El 16.67% de las gestantes presentó embarazo recurrente durante el 2021 y 2022, siendo 20.67% y 10.78%, respectivamente. Se identificó que estar casada (p

Introducción: La displasia craneofrontonasal (DCFN), es un trastorno malformativo poco frecuente que afecta fundamentalmente los ojos, la nariz y la frente. De todos ellos, el hipertelorismo es el componente principal e invariable. Ocurre esporádicamente en la mayoría de los casos. En la literatura se han informado sólo unos pocos casos diagnosticados antes del nacimiento. Objetivo: Describir un caso diagnosticado prenatalmente de displasia craneofrontonasal ligada al cromosoma X. Presentación de caso: Gestante de 21 años con evaluación inicial de riesgo genético incrementado de enfermedad hereditaria por antecedente personal y familiar de DCFN. Con 24 semanas de embarazo se realiza ecografía en el Centro Provincial de Genética Médica de Mayabeque- Cuba, consulta de confirmaciones que describió anomalías faciales en feto femenino con hipertelorismo, puente nasal amplio y boca entreabierta mantenida durante todo el estudio. No se reportaron hendiduras faciales ni otros defectos asociados. Se ofreció asesoramiento genético. Atendiendo a los antecedentes obtenidos, la valoración del árbol genealógico confeccionado y los hallazgos ecográficos reportados se concluyó que podía corresponder con un feto afectado por DCFN. La pareja solicitó la terminación voluntaria del embarazo. La necropsia fetal confirmó el diagnóstico de DCFN. Conclusiones: Para realizar el diagnóstico prenatal de DCFN, el fenotipado ecográfico fetal, el análisis de la historia familiar y de los hallazgos anatomopatológicos son la clave de un asesoramiento genético personalizado que permita a la pareja la opción reproductiva que considere más apropiada.

Objetivo: Establecer los determinantes estructurales e intermedio que mejor explican el desenlace de sífilis congénita. Material y métodos: Estudio observacional descriptivo con intención analítica y enfoque en determinantes sociales de la salud, realizado en una cohorte de gestantes confirmadas con sífilis gestacional, afiliadas activas a una aseguradora en el Valle del Cauca entre 2015 y 2020, se realizaron análisis exploratorios por frecuencias absolutas y relativas, análisis bivariados con tablas de contingencia empleando la prueba de chi cuadrado y análisis multivariado de regresión logística. Resultados: Se encontró mayor volumen de casos de SG en mujeres residentes de la zona urbana, del régimen subsidiado, de estrato socioeconómico uno o dos y de grupos poblacionales vulnerables como desplazadas, en condición carcelaria y residente en los municipios de Cali y el distrito de Buenaventura. Conclusiones: los determinantes estructurales e intermedios que incrementan la probabilidad de desenlace de SC fueron las gestantes del régimen subsidiado, área rural, de etnias indígena y ROM (gitanos), de estrato socioeconómico 2, con diagnóstico tardío, que no asistieron a los controles prenatales, sin pruebas de tamizaje, sin tratamiento propio ni de contactos, residentes en municipios alejados de la capital y con mayor tasa de mortalidad infantil.

Objetivo: Describir las malformaciones del sistema nervioso asociadas a embriopatía diabética en madres sin adecuado control glicémico en Latinoamérica. Material y métodos: Se realizó una revisión minuciosa de publicaciones en reconocidas bases de datos en línea en español y en inglés. Los buscadores utilizados incluyeron MEDLINE, PubMed, Scielo, BVS, HINARI, EBSCO, Google Scholar. Se encontraron artículos de tipo descriptivo, observacional, retrospectivo, guías de práctica clínica, revisión sistemática, casos y controles, y metaanálisis. Resultados: Mediante la revisión sistematizada de artículos, se obtuvo que las malformaciones del sistema nervioso central secundarias a la embriopatía diabética guardan una relacion estrecha con diversos factores de riesgo de la mujer latinoamericana. Conclusiones: Se encontró asociación entre las características epidemiológicas multifactoriales de la mujer latinoamericana y el desarrollo de malformaciones del sistema nervioso central secundarias a embriopatia diabetica, resultantes de multiples procesos fisiopatológicos desencadenados por la hipeglicemia materna.

El topiramato es un agente farmacológico antiepiléptico de nueva generación, empleado para el tratamiento de crisis parciales y tónico-clónicas primarias en adultos y niños, en monoterapia o en combinación con otros fármacos, y como profilaxis de la migraña en adultos, así como para el alcoholismo, la obesidad, y el trastorno bipolar entre otros. En los últimos años, han sido publicados numerosos casos de malformaciones congénitas y retraso de crecimiento intrauterino en neonatos de madres expuestas a este fármaco durante la gestación. Se presenta el caso de un feto con agenesia de ambos miembros superiores en una madre expuesta a topiramato durante el primer trimestre, sin otros factores asociados ni otro posible agente causal detectado.

Abstract Background Midlife is a time of increased responsibilities for women who have multiple roles including taking care of children, caring for elderly parents, managing households, and working outside the home. With little time for themselves, women additionally experience stressful life events (SLEs). The purpose of this study was to describe the longitudinal patterns of SLEs of women during midlife and to identify predictors of the SLE longitudinal patterns using baseline data of socio-economic factors and demographic characteristics. Methods Women who were part of the Seattle Midlife Women’s Health Study (SMWHS), a longitudinal study spanning more than 23 years, who had SLEs measured at baseline and at years 2, 7, and 10 were included in these analyses (N = 380 women at baseline). The Life Event Scale (LES), a 70-item scale based on a yes/no response and a Likert-based scoring system with 0 (no effect) to 4 (large effect), was used to determine the total and impact scores of midlife women. The LES was adapted to midlife women from the Norbeck Scale for younger, pregnant women. Analytic strategies consisted of a group-based trajectory model (GBTM) to examine subgroups of women with similar exposure to SLEs using socio-economic factors (gross family income, education, race/ethnicity, employment), demographic variables (age, marital status, being a parent), and menopausal transition stage to differentiate trajectories over time. Results Approximately 86% of women had medium high exposure to undesirable SLEs with a slight decrease (65.5%), or a sharp decrease (20.1%), over 10 years. The majority (approximately 64%) had moderate, sustained impact ratings, while approximately 35% had impact ratings that decreased over time. Most women (approximately 88%) reported desirable life events, which were sustained over the ten years, and which may help to balance or offset the high ratings of undesirable stressful life events. The rated impact of these desirable events decreased slightly over time for 65% of the sample. Socio-economic factors, demographic variables, and menopausal transition stages were not significant predictors of any of the four GBTMs. Conclusion Midlife women experience SLEs throughout the menopausal transition. Most of these midlife women had had a large amount of sustained stress over 10 years although all trajectories decreased to some extent over time. Since the menopausal transition stages were not significant predictors of the ratings of SLEs, a more complex set of factors, including social as well as biological, may explain the ratings of the women over the course of this ten-year observational study.

Abstract Background Menopause is a natural period in women’s life and can be affected by several factors. The aim of this study was to identify the associated factors for age of natural menopause and among women with early and premature menopause based on a cohort study in Iran. Methods This population-based study was conducted on 894 post menopause women between 35 and 70 years old who participated in the Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort Study, a part of Prospective Epidemiological Research Studies in Iran (PERSIAN) from March 2016 to February 2019. All women completed a standard self-reported questionnaire. Data were analyzed using chi-square test, independent t test, and ANOVA as well as a multivariable linear regression model. Results The mean age at natural menopause was 48.31 ± 6.34 years. After adjusting other variables, gravida, history of cardiac disease, socioeconomic status and residence status were predictive of age at menopause (P

Abstract Background Loss in ovarian function during mid-life results in adverse changes in the cardiovascular profile of women. The association between CVD risk factors and menopause differ cross-culturally since several modifiable factors play significant roles in explaining CVD mortality in addition to differences in endogenous estrogen. Very few of the studies from the Indian subcontinent have been concerned with the menopause-specific CVD risk factors, particularly among the tribal groups. Thus, we intended to study the variations in body fat pattern and CVD risk factors between Hindu caste and Lodha tribal postmenopausal women and how these risk factors were associated with differential socio-economic, reproductive and menstrual characteristics and lifestyle variables. The Lodha tribal populations is considered a Particularly Vulnerable Group (PVTG) in this country. Methods This cross-sectional study was conducted among the Bengali Hindu caste and Lodha tribal populations of the State of West Bengal, India covering three districts namely Howrah, Jhargram and East Midnapure. A total of 197 postmenopausal participants were recruited for this study (urban caste 69, rural caste 65 and rural Lodha 63). Data on blood glucose and total cholesterol levels, blood pressure, muscle mass, body fat distribution and sociodemographic, reproductive and menstrual history and lifestyle variables were collected following standard protocols. Analysis of variance (ANOVA) was applied to compare blood glucose, total cholesterol and blood pressure levels and body fat measures across the three populations. Stepwise multiple linear regression analysis was performed to find out the factors associated with CVD risk factors. The data were analyzed with the Statistical Package for Social Science version 20.0(IBM corporation, 2011). Results This cross-sectional comparison of women at midlife, though exploratory in nature showed significant differences in body fat pattern and CVD risk factors between caste and tribal groups owing to socioeconomic disparities and, differences in reproductive characteristics and lifestyle factors. Conclusion The caste and tribal populations differed significantly in body fat pattern and CVD risk factors and in the factors associated with CVD risk suggesting interplay between menopause and modifiable factors in explaining CVD risk factors during mid-life.

Abstract Background The number of never-married women is increasing worldwide. According to a recent census (2016) this trend is also apparent in Iran. The aim of the present study was to investigate how never-married Iranian women cope with their single status. Methods The present study was qualitative in nature. Purposeful sampling with maximum variation was used to select 18 never-married women aged over 35. Data were analyzed on the basis of conventional content analysis and inductive reasoning. Results One hundred fifty-four codes, nine subcategories, three categories, and one theme were extracted. The three categories were: (1) responding to sexual needs (sub-categories: having sex; masturbation; sexual abstinence); (2) responding to emotional needs (sub-categories: getting used to being alone; living with family; closer relationship with good friends); (3) lifestyle changes (subcategories: accepting God's destiny; striving for beauty and health; becoming absorbed in work and education). Conclusions Results showed that never-married women aged over 35 tried to adapt to sexual and emotional needs and lifestyle changes as proxies of singleness in various ways. It appears that these women adopted several strategies to cope with the lack of a spouse, children, or family life, these normally being developmental tasks characteristic of early adulthood.

Abstract In July 2022, the United States Supreme Court issued a decision in Dobbs v. Jackson Women’s Health Organization that overturned Roe v. Wade, the Supreme Court decision that legalized access to abortion in the United States. The overturning of Roe v. Wade means women’s ability to choose to have an abortion or continue a pregnancy is no longer protected by the constitution of the Unites States (Rohan, Editorial: Overturning Roe v. Wade: What are the implications for perinatal nurses?, 2021). Consequently, each state can now independently decide the legality of abortion. The purpose of this commentary is to discuss potential consequences of the overturning of Roe v. Wade for women’s health, particularly midlife women’s health, in the United States. The consequences discussed include unintended pregnancy, access to the full array of reproductive health services including abortion, impact on the reproductive health of poor women and women of color, and the impact on midlife women in their caregiving roles.

Abstract Background Hysterectomy, particularly when conducted in women younger than 45 years, has been associated with increased risk of non-communicable diseases. In India, research indicates that hysterectomy is a common procedure for women, but there have been no studies on its long-term effects. We examined patterns of hysterectomy amongst women in India and associations with their health and well-being in later life. Methods This analysis utilised the first wave of the Longitudinal Study on Aging in India, a nationally representative study of adults that included a module on health and well-being. We analysed data on 35,083 women ≥45 years in India. We estimated prevalence of hysterectomy and performed multivariable logistic regression to identify associated risk factors and to examine the association between hysterectomy status and eight self-reported chronic conditions, hospitalisation and mobility. Results The prevalence of hysterectomy among women >=45 years was 11.4 (95% CI: 10.3, 12.6), with higher odds among urban women (aOR: 1.39; 1.17,1.64) and higher economic status (highest compared to lowest quintile: aOR: 1.95; 1.44, 2.63). Hysterectomy history was associated with four chronic conditions: hypertension (aOR: 1.51; 95% CI: 1.28, 1.79), high cholesterol (aOR: 1.43; 1.04, 1.97), diabetes (aOR: 1.69; 1.28, 2.24), and bone/joint disease (aOR: 1.54; 1.20, 1.97) and higher odds of any hospitalisation in the past year (aOR: 1.69; 1.36, 2.09). Conclusions In India, evidence suggests that hysterectomy is associated with major chronic conditions. The assessment for hysterectomy as a treatment option for gynaecological morbidity should consider potential health consequences in later life.

Abstract High recidivism rates indicate that current forms of imprisonment may be an ineffective response to problems that mainly burden those ensconced in poverty and marginalization. Homelessness, unemployment, racial disparities, drug use, and mental illness, disappear from public view when the afflicted individuals are relegated to a life behind bars. Women are the fastest growing prison population and most incarcerated women are from Black and Latinx groups. Structural racism encompasses the many ways in which society fosters racial discrimination through mutually reinforcing unfair systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. In turn, this behavior reinforces discriminatory beliefs, values, and distribution of resources. Structural racism pervades every aspect of society, including the carceral system, from policing to prosecutorial decisions, pretrial release processes, sentencing, correctional discipline, and even reentry. Women constitute a minority within the carceral system, and as a result, their unique health care needs, especially during the midlife period, are inadequately addressed and often overlooked. There is also a general lack of gender sensitivity and special considerations in existing jail and prison policies and practices. This commentary highlights the impact of structural racism on the arrests and incarceration of women, and discusses their special health and wellness needs, with emphasis on midlife women. It also illuminates the need to address structural racism and its ripple effects within the carceral system.

Abstract Background Connectedness and attachment are vital parts of humanity. Loneliness, a state of distress in reaction to perceived detachment and isolation, is reported by over one-third of U.S. adults and is associated with numerous physical and mental health consequences. What contributes to loneliness, especially in women and minority populations, is poorly understood, but this population is also at greater risk for abuse and trauma. Our study aimed to further understand loneliness in urban midlife women and to explore the relationship that may exist with trauma(s). Methods To identify primacies for mental health care, female midlife participants (N=50) of a long-standing urban community-based cohort focused on health improvement completed a one-time audiotaped interview with both quantitative assessments and a qualitative interview. Loneliness was assessed by the UCLA 3-item Loneliness Scale. Using semi-structured interviews, open-ended questions facilitated a discussion regarding mental health needs and experiences. Interview transcripts were coded and analyzed following a grounded theory methodology. Themes around loneliness and trauma emerged. The transcripts were coded using the same methodology and coders as the individual interviews. Twenty women participated in two optional focus groups. Results Participants had a mean age of 50, with the majority identifying as Black/African American (N=37) and unemployed (N=33). Three themes emerged regarding perceived causes of loneliness: trauma, the burden of responsibilities for others, and secondary to unhealthy relationships. Loneliness associated with trauma will be explored here; other themes are beyond the scope of this paper and will be discussed in subsequent analyses. Quantitative results suggest that physical abuse (loneliness scores 5.4 vs. 4.0, p=0.003), as well as emotional abuse and neglect (loneliness scores 5.6 vs. 4.4, p=0.01), were associated with greater loneliness. Conclusion In urban midlife low-income women, lifetime physical abuse and emotional abuse/neglect are associated with increased feelings of loneliness. Qualitative data provide insight into how participants viewed their traumatic histories, ways in which the trauma has ongoing influence, and how they experience loneliness. Though further investigation is needed, trauma-informed approaches should be considered in both primary care and mental health settings with a focus on mitigating loneliness and providing appropriate support and trauma treatment.

Abstract Purpose Recent studies have suggested that higher postmenopausal follicle stimulating hormone (FSH) may be associated with lower risk of diabetes. However, relatively little is known about postmenopausal FSH levels, including the level of variation between women and whether reproductive factors are associated with this variation. Methods We assessed the relationship of multiple reproductive factors with FSH levels among 588 postmenopausal women in the Kuopio Ischaemic Heart Disease Risk Factor Study. Participants were aged 53 to 73 years and not using hormone therapy at study enrollment (1998–2001) when reproductive factors were assessed and FSH was measured. Results After adjustment for age, menopause timing, sex steroid levels, adiposity and behavioral factors, we observed numbers of pregnancies and age at first birth were each inversely associated with FSH levels. For example, women with ≥ 3 births and an age at first birth ≥ 25 years had mean FSH levels that were 7.8 IU/L lower than those of women with 1–2 births and an age at first birth ≤ 24 years (P = 0.003). Number of miscarriages was inversely associated with FSH levels (-2.7 IU/L per miscarriage; P = 0.02). Women reporting 4 or more years of past hormone therapy use had significantly higher mean FSH levels than women who had never used hormone therapy (P for trend = 0.006). Conclusion Multiple reproductive factors were associated with postmenopausal FSH, independent of estradiol, adiposity and other confounders. These findings warrant replication and further exploration of potential underlying mechanism.

Abstract Background Vitamin D is vital for skeletal integrity as well as optimal muscle work. High incidence and prevalence of vitamin D deficiency as well as pelvic organ prolapse are found in postmenopausal women, thus raising the question of whether the entities could be related. Methods We compared 50 postmenopausal women aged 50 to 75 years with pelvic organ prolapse (POP) with 48 women of same age without POP. The clinical assessment of the disorder was performed using the Pelvic Organ Prolapse Quantification system (POP-Q). An anamnestic questionnaire was filled out by the participants on their anthropometric data, life habits, reproductive history, previous and actual diseases. A blood sample was collected for determination of 25-OH-vitamin D as well as calcium and phosphorus concentrations. Results The group with POP and the control group were comparable in body mass index, physical activity, life habits and general health, but differed significantly in parity (being higher in POP) and vitamin D blood level concentrations, being lower in POP patients. A significantly higher prevalence of vitamin D deficiency (25-OH-vitamin D

Abstract Introduction Breast cancer is one of the most prevalent cancers among women in Isfahan, Iran; however, its prevention is not desirable in this city. This disease poses several health, social and economic challenges for women. To promote women's self-care in breast cancer prevention, this study aims to design, implement and evaluate a self-care program among women in Isfahan through using a community-based participatory action research method. Methods The present study is based on a community-based participatory action research approach. In this study, the participatory action research includes four general phases of organizing, action planning, action, and rethinking. These phases are summarized as follows: In the organizing phase, the needs of the participants and the action research settings are examined. This means that the current situation is identified and the views of the process owners are assessed. In the action planning phase, using the results of the first phase, some strategies are designed to promote self-care behaviors in the prevention of breast cancer among women in Isfahan. In the implementation phase, the selected strategies are implemented with the help of the process owners. Finally, in the rethinking phase, the results of the implementation of the strategies are monitored and evaluated. This cycle continues until the intended results are achieved. Discussion Changing the role of individuals from a passive status to an aware and active status in the care process requires motivation, responsibility, and active participation of individuals in the disease control process. Moreover, many cultural and social factors affect the active participation of Iranian women. Therefore, individuals can be involved in promoting their health using a community-based participatory action research approach.

Abstract Background Many women experience various symptoms during the period of menopausal transition, including complaints of reduced cognitive functioning. However, these complaints are not necessarily recognized as core menopausal symptoms. In this study, we sought to characterize subjective complaints of reduced cognitive functioning by analyzing cross-sectional data from the Japan Nurses’ Health Study (JNHS). Methods The JNHS 4-year follow-up questionnaire containing a 21-item climacteric symptom checklist, which included a question about “poor memory or forgetfulness”, was mailed between 2005 and 2011 to all JNHS participants, regardless of their age at the time of the survey. We estimated the prevalence of slight and severe complaints in 5-year age-groups. We used principal component analysis to explore the underlying factors among the 21 symptoms during the menopausal transition period in women aged 45–54 years at the time of the survey. We also examined risk factors for complaints using multivariable modified Poisson regression analysis. Results In total, 12,507 women responded to the 4-year survey. The mean age at the time of the 4-year survey was 46.5 years (range 27–82). “Poor memory or forgetfulness” showed a peak prevalence of 81.7% (severe 27.9%; slight 53.8%) at 50–54 years, and gradually decreased after 55 years. Principal component analysis indicated that “poor memory or forgetfulness” belonged to somatic symptoms and was close to psychological symptoms in women aged 45–54 years. In women aged 45–54 years, the complaint was also significantly associated with hot flashes and sweats. Multivariable modified Poisson regression analysis showed that menopausal status (uncertain and postmenopausal), less sleep (sleep of

Abstract More than 10% of American adults experience some level of daily pain, and nearly 40 million (17.6%) experience episodes of severe pain annually. Women are particularly impacted by both episodic and chronic pain with higher prevalence and a greater level of pain-related disability compared to men. Midlife is a critical period for women during which the frequency of pain complaints begins to increase. Although pain is known to be influenced and controlled by sex hormones, it has not been widely recognized as a symptom of the menopausal transition outside of the menopause research community. The recent thematic series in this journal has specifically highlighted pain related conditions including rheumatoid arthritis, migraine and abdominal pain for which the significance among midlife women is not typically recognized. The studies presented in this thematic series present a small fraction of relevant, understudied questions regarding pain and its impact on women in midlife. Addressing the gaps in knowledge will require longitudinal studies that consider the emergence of pain symptomatology in relation to midlife trajectories of other symptoms and health determinants, as well as further study of new and emerging therapies.

Abstract Background The COVID-19 pandemic presented challenges that disproportionately impacted women. Household roles typically performed by women (such as resource acquisition and caretaking) became more difficult due to financial strain, fear of infection, and limited childcare options among other concerns. This research draws from an on-going study of hot flashes and brown adipose tissue to examine the health-related effects of the COVID-19 pandemic among 162 women aged 45–55 living in western Massachusetts. Methods We compared women who participated in the study pre- and early pandemic with women who participated mid-pandemic and later-pandemic (when vaccines became widely available). We collected self-reported symptom frequencies (e.g., aches/stiffness in joints, irritability), and assessments of stress, depression, and physical activity through questionnaires as well as measures of adiposity (BMI and percent body fat). Additionally, we asked open-ended questions about how the pandemic influenced women’s health and experience of menopause. Comparisons across pre-/early, mid-, and later pandemic categories were carried out using ANOVA and Chi-square analyses as appropriate. The Levene test for homogeneity of variances was examined prior to each ANOVA. Open-ended questions were analyzed for yes/no responses and general themes. Results Contrary to our hypothesis that women would suffer negative health-related consequences during the COVID-19 pandemic, we found no significant differences in women’s health-related measures or physical activity across the pandemic. However, our analysis of open-ended responses revealed a bi-modal distribution of answers that sheds light on our unexpected findings. While some women reported higher levels of stress and anxiety and lower levels of physical activity, other women reported benefitting from the remote life that the pandemic imposed and described having more time to spend on physical activity or in quality time with their families. Conclusions In this cross-sectional comparison of women during the pre-/early, mid-, and later-pandemic, we found no significant differences across means in multiple health-related variables. However, open-ended questions revealed that while some women suffered health-related effects during the pandemic, others experienced conditions that improved their health and well-being. The differential results of this study highlight a need for more nuanced and intersectional research on risk, vulnerabilities, and coping among mid-life women.

Background and Purpose: Gender inequity in academic medicine persists despite efforts to the contrary. Even with increasing representation of women physicians in academic medicine, leadership positions and promotion to tenure are still not representative. This study describes the experiences of women physicians at various stages of their careers, uncovering current challenges and potential areas for improvement toward gender equity. Methods: Three focus groups were conducted (n?=?28) as part of a national professional development conference: Growth, Resilience, Inspiration, and Tenacity (GRIT) for Women in Medicine: GRIT. We thematically analyzed participant responses to assess perspectives on the impact of experiences, barriers to professional growth, opportunities for improvement, and definitions of success. Results: The major issues the participants faced included subthemes of (1) systemic barriers to success, (2) implicit biases, (3) self-advocacy, and (4) burnout and stress. Solutions for issues that were discussed included (1) fostering supportive communities, (2) encouraging personal and professional development, and (3) the need for system-wide policy changes. We found that most women needed or benefited from the fostering of communities and desired opportunities for developing professional skills. Participants felt institutional transparency for grievances determined the level of support and confidence in reporting instances of mistreatment. Participants tended to define success according to (1) personal success and (2) leaving a legacy. Conclusions/Implications: Despite policy advancements and a social evolution away from discrimination against women, women in medicine continue to experience inequities across career stages. Potential solutions include fostering supportive communities, encouraging personal and professional development, and system-wide policy changes.

Abstract This paper reviews differences in the experience of the menopause transition and midlife health outcomes between Black and White women who participated in the Study of Women’s Health Across the Nation (SWAN), a 25-year, longitudinal, multi-racial/ethnic cohort study. We identify health disparities, i.e., instances in which Black women’s outcomes are less favorable than those of White women, and consider whether structural racism may underlie these disparities. Although SWAN did not explicitly assess structural racism, Black women in SWAN grew up during the Jim Crow era in the United States, during which time racism was legally sanctioned. We consider how we might gain insight into structural racism by examining proxy exposures such as socioeconomic characteristics, reports of everyday discrimination, and a range of life stressors, which likely reflect the longstanding, pervasive and persistent inequities that have roots in systemic racism in the US. Thus, this paper reviews the presence, magnitude, and longitudinal patterns of racial disparities observed in SWAN in six areas of women’s health – menopause symptoms, sleep, mental health, health related quality of life, cardio-metabolic health, and physical function –and elucidates the contextual factors that are likely influencing these disparities. We review the strengths and weaknesses of SWAN’s design and approach to analysis of racial disparities and use this as a springboard to offer recommendations for future cohort studies.

Background: Historically, medical studies have excluded female participants and research data have been collected from males and generalized to females. The gender gap in medical research, alongside overarching misogyny, results in real-life disadvantages for female patients. This systematic scoping review of the literature aims to determine the extent of research into the medical research sex and gender gap and to assess the extent of misogyny, if any, in modern medical research. Methods: Initial literature searches were conducted using PubMed, Science Direct, PsychINFO and Google Scholar. Articles published between January 01, 2009, and December 31, 2019, were included. An article was deemed to display misogyny if it discussed the female aesthetic in terms of health, but did not measure health or could not be utilized to improve clinical practice. Results: Of the 17 included articles, 12 examined the gender gap in medical research and 5 demonstrated misogyny, assessing female attractiveness for alleged medical reasons. Females remain broadly under-represented in the medical literature, sex and gender are poorly reported and inadequately analyzed in research, and misogynistic perceptions continue to permeate the narrative. Conclusion: The gender gap and misogynistic studies remain present in the contemporary medical literature. Reasons and implications for practice are discussed.

Abstract “Race” and “ethnicity” are socially constructed terms, not based on biology - in contrast to biologic ancestry and genetic admixture - and are flexible, contested, and unstable concepts, often driven by power. Although individuals may self-identify with a given race and ethnic group, as multidimensional beings exposed to differential life influencing factors that contribute to disease risk, additional social determinants of health (SDOH) should be explored to understand the relationship of race or ethnicity to health. Potential health effects of structural racism, defined as “the structures, policies, practices, and norms resulting in differential access to goods, services, and opportunities of society by “race,” have been largely ignored in medical research. The Women’s Health Initiative (WHI) was expected to enroll a racially and ethnically diverse cohort of older women at 40 U.S. clinical centers between 1993 and 1998; yet, key information on the racial and ethnic make-up of the WHI cohort of 161,808 women was limited until a 2020–2021 Task Force was charged by the WHI Steering Committee to better characterize the WHI cohort and develop recommendations for WHI investigators who want to include “race” and/or “ethnicity” in papers and presentations. As the lessons learned are of relevance to most cohorts, the essence of the WHI Race and Ethnicity Language and Data Interpretation Guide is presented in this paper. Recommendations from the WHI Race and Ethnicity Language and Data Interpretation Guide include: Studies should be designed to include all populations and researchers should actively, purposefully and with cultural-relevance, commit to recruiting a diverse sample; Researchers should collect robust data on race, ethnicity and SDOH variables that may intersect with participant identities, such as immigration status, country of origin, acculturation, current residence and neighborhood, religion; Authors should use appropriate terminology, based on a participant’s self-identified “race” and “ethnicity”, and provide clear rationale, including a conceptual framework, for including race and ethnicity in the analytic plan; Researchers should employ appropriate analytical methods, including mixed-methods, to study the relationship of these sociocultural variables to health; Authors should address how representative study participants are of the population to which results might apply, such as by age, race and ethnicity.

Abstract Background Female Sexual Dysfunction (FSD) is a distressing condition linked to menopause. This study aimed to determine the prevalence and contributing factors for FSD among postmenopausal women. Methods This was a cross-sectional study. A convenience sample of postmenopausal women attending a gynecology clinic in a teaching hospital affiliated with Tehran University of Medical Sciences was enrolled into the study. The Female Sexual Function Index (FSFI) was used to assess sexual function. In addition, demographic and psychosocial information were recorded. The association between sexual function and anxiety and depression were examined to explore the data. Results In all 162 postmenopausal women were studied. We performed general linear regression analysis to assess the relationship between sexual function and anxiety while including demographic variables in the model. The results showed that the model could explain about 46% of the variance observed in sexual function (adjusted R 2 = 0.467). The analysis indicated that among independent variables, age (p

Abstract Sexual self-efficacy is essential for appropriate and desirable sexual function and sexual quality of life. This study aimed to compare sexual quality of life and sexual self-efficacy among women during reproductive-menopausal transition stages and postmenopause. This was a cross-sectional study of a sample of Iranian women. The sexual quality of life-female (SQOL-F) scale was used to measure sexual quality of life (SQOL) and sexual self-efficacy (SSE) was measured using the sexual self-efficacy questionnaire (SSEQ). Data were compared between the study groups using multiple linear regression. In all 340 women (170 in reproductive-menopausal transition stages and 170 postmenopause) were studied. The mean ages of reproductive-menopausal transition stages and postmenopausal women was 30.8 ± 6.55 and 56.3 ± 3.54 respectively (P

HIGHLIGHTS 1. Ovarian tumors diagnostic value has been determined using the tools on contrast-enhanced abdominal CT Scan. 2. The tools including primary finding like mass size, septation, solid component, and additional finding such as ascites, peritoneal implants, lymph node enlargement. 3. Most tumors were ovarian malignant tumors according to their histopathological results. 4. Contrast-enhanced abdominal CT Scan of ovarian tumors evaluated by the tools gave better and more reliable diagnostic value than without using the tools. ABSTRACT Objectives: The purpose of this study was to determine the diagnostic value of contrast-enhanced abdominal CT scan in ovarian tumors in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, to provide scientific and clinical benefits. Materials and Methods: Samples were taken retrospectively by contrast-enhanced abdominal CT scan raw data in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from January 2017 to December 2018. Using inclusion and exclusion criteria, a total of 88 samples were obtained and reviewed blindly by Female Organ Division of Radiology Department, Faculty of Medicine Universitas Airlangga, and by using "tools" (primary and additional findings of modified ovarian tumors malignancy). The data were correlated with histopathological findings and analyzed by statistical tests and the results with and without "tools" were compared. Results: Samples were grouped by age, distributed with a range of 20 years and the group of 41-60 years had the highest age of ovarian tumor samples (46.6%) with 84.1% being ovarian malignant tumors according to their histopathological results. It was dominated by serous, mucinous and endometroid types with sensitivity of 93.3%, specificity of 64.3%, positive predictive value of 93.3% negative predictive value of 69.2%, and accuracy value of 89.8%. More reliable results were obtained by using “tools”. Conclusion: Contrast-enhanced abdominal CT scan of ovarian tumors in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, evaluated by “tools” still had a better and more reliable diagnostic value than without tools in determining policy steps in handling ovarian tumors with a note that more in-depth research on pitfalls is needed so it may enrich the characteristic findings in imaging.

HIGHLIGHTS 1. Pregnant women infected with COVID 19 have a higher risk of maternal fetal mortality and morbidity. 2. The available evidences show a safety profile in all type of COVID vaccines in pregnancy. 3. Vaccination in pregnant women will decrease pregnancy complications, adverse pregnancy outcomes, and maternal death risk. 4. The benefit of COVID vaccination exceeds the potential risk in pregnant women. 5. Pregnant women are strongly recommended to receive COVID vaccine. ABSTRACT COVID-19 pandemic has been lasting for years, and pregnant women encounter an increased risk of mortality and morbidity. Until now, vaccine COVID-19 has been developed and shows a promising result. Unfortunately, pregnant women are consistently excluded from receiving a new vaccine. Because pregnant women are excluded from participating in a clinical trial of vaccines related to safety issues, this exclusion cycle prevents pregnant women from receiving the vaccine that may benefit them. In this review article, the author provides evidence, data, and the reason why vaccination of pregnant women should be started in Indonesia, at least in a clinical trial, especially for health workers and women with comorbidities.

Abstract Background Reducing cervical cancer mortality and morbidity using visual inspection with acetic acid (VIA) is a primary option, particularly in resource constrained countries. Although VIA screening is a priority program in Ethiopia, there is limited scientific evidence on prevalence of VIA screening service utilization and factors influencing screening practices in the community. This study aimed to assess the magnitude of visual inspection with acetic-acid (VIA) service utilization and associated factors in an urban community among women in Hawassa city, Southern Ethiopia. Methods This community-based cross-sectional study was conducted among women aged 30–49 years old who were residents of Hawassa city. The study population (n = 419) was recruited using a multistage random sampling technique. A pretested and structured interviewer-administered questionnaire was used to obtain information on sociodemographic characteristics, reproductive and behavioral variables, awareness of cervical cancer and VIA screening, and VIA screening practices. Multivariate logistic regression models were used to determine factors associated with VIA screening service utilization. Results A total of 411 women aged 30–49 were interviewed with a response rate of 98.1%. The visual inspection with acetic-acid (VIA) screening service was utilized by 85 women (20.7%). Multivariable logistic regression analysis showed that use of VIA screening service was significantly associated with older age (adjusted odds ratio (AOR) = 4.64, 95%CI: 2.15–10.01), having a history of sexually transmitted infection (STI), (AOR = 3.90, 95%CI: 2.02–7.53), having awareness about cervical cancer and VIA screening (AOR = 3.67, 95%CI:1.68–8.04), self-perceived susceptibility (AOR = 3.52,95%CI:1.74–7.13),receiving information from health workers (AOR = 4.519, 95%CI: 1.686–12.114) and having received community health education from health extension workers (AOR = 6.251, 95%CI:2.994–13.050). Conclusion Self-reported use of VIA screening was low in the study area. Age of participants, history of STI, awareness of cervical cancer and VIA screening, self- perceived susceptibility, receiving information from health workers and community health education from health extension workers were associated with increased prevalence of VIA screening service utilization. These findings suggest that educational and clinical interventions at the community levels and in healthcare facilities should be strengthened to improve cervical cancer risk knowledge, and to encourage women to seek cervical cancer screening in approved settings to order to increase utilization of the service.

Abstract Getting old is hard, but it beats the alternative. This commentary explores some of the challenges of aging with a physical disability and the considerations taken to prevent further functional decline or injury during the aging process.

Objective: Sexual and reproductive health is an integral part of the health and well-being of adolescents. In this paper, the authors summarized the outline of the problems of sexual violence against children, with special emphasis on that against girls. The commentary was written from the point of view of general gynaecologists, sexologists, obstetrics and gynaecology nurses, clinical psychologist, and dermatologist. Mechanism: For the convenience of the readers’ better understanding, we described things in the following order; first, we explained the concept of child sexual abuse, then we discussed symptoms of sexual violence against children, and special attention was given to the issue of Sexually Transmitted Diseases (STD). Lastly, we emphasized general principles of physical diagnostics in the case of suspicion of sexual harassment of children. Findings in Brief: This work reveals the importance of holistic care of sexual assault victims. Conclusions: The cooperation of gynaecologists with dermatologists, medical examiners, paediatricians, psychologists, and dieticians is essential to interdisciplinary collaboration for children. Acquaintance by doctors with symptoms that can be a sign of sexual abuse of a child is necessary. If they appear in the form of physical injuries or STDs, they will probably be possible to diagnose only by medical service.

Artificial intelligence will change work for most people in significant and unexpected fashions in the next few decades. A change similar to that seen with the industrial revolution of the 19th century. Certain jobs will cease to exist while new employment will be created. The implication of this transformation in medicine and obstetrics and gynecology in particular needs discussion, as it stands it is anxiety-provoking. Artificial intelligence will have implications on the number of physicians needed in certain specialties, the workloads of those physicians, and the ease of accessing information. In the field of reproductive endocrinology, artificial intelligence is already being used to select embryos with the greatest potential for implantation. Who will develop that technology and the drivers for development will also be considered. Physicians, insurance companies, and other funders of health care need to be informed to anticipate and prepare for these changes. As such we will discuss anticipated changes in the near future to be initiated by artificial intelligence, we anticipate physician quality of life will improve while the demonstrated anxiety is unfounded.

Abstract Midlife women between the ages of 40 and 65 years have reported multiple challenges due to menopausal, developmental, and situational transitions from younger to older adulthood. During the midlife period, many women seek health care for gastrointestinal symptoms and irritable bowel syndrome (IBS). Multiple factors including stress, poor sleep, diet, and physical inactivity may contribute to IBS or gastrointestinal symptoms in midlife women. As such, a comprehensive assessment and treatment approach is needed for midlife women suffering gastrointestinal symptoms. This article reviews the main aspects of the menopausal transition, sex hormonal changes, abdominal and pelvic surgery, psychosocial distress, behavioral factors, and gut microbiome, as well as their relevance on IBS and gastrointestinal symptoms in midlife women. Also, management strategies for IBS in midlife women are discussed. To date, gastrointestinal symptoms during midlife years remain a critical area of women’s health. Additional research is needed to better understand the contributors to gastrointestinal symptoms in this group. Such efforts may provide a new window to refine or develop treatments of gastrointestinal symptoms for midlife women.

Abstract Palpitations are reported commonly by women around the time of menopause as skipped, missed, irregular, and/or exaggerated heartbeats or heart pounding. However, much less is known about palpitations than other menopausal symptoms such as vasomotor symptoms. The objective of this review was to integrate evidence on menopausal palpitations measures. Keyword searching was done in PubMed, CINAHL, and PsycINFO for English-language, descriptive articles containing data on menopause and palpitations and meeting other pre-specified inclusion criteria. Of 670 articles, 110 met inclusion criteria and were included in the review. Results showed that 11 different measures were used across articles, with variability within and between measures. Inconsistencies in the wording of measurement items, recall periods, and response options were observed even when standardized measures were used. Most measures were limited to assessing symptom presence and severity. Findings suggest that efforts should be undertaken to (1) standardize conceptual and operational definitions of menopausal palpitations and (2) develop a patient-friendly, conceptually clear, psychometrically sound measure of menopausal palpitations.

Abstract Background Contraceptive methods have rapidly evolved over the past several decades, but little research has explored how women interact with contraception over time. Exploring contraceptive beliefs, perceptions, and attitudes of women in midlife can reveal much about how lived experience affects contraceptive decisions and reproductive health choices. Methods Individual, semi-structured interviews were conducted with 20 women between the ages of 40 and 55 who had not reached menopause and did not have a permanent method of sterilization. Data were coded using qualitative descriptive methods. Results Three major themes were identified: 1) journey toward empowerment; 2) finding the right fit: evolution over time; and 3) anticipating a transition. Past experiences with or fear of side effects and hormones were common reasons to change or avoid certain contraceptive methods. Most participants were happy with their contraceptive method; however, those who were unhappy were more likely to vocalize fatigue at continuing to need contraception as menopause approached. Conclusion Approaching contraceptive counseling from a place that considers the journey with contraception over a reproductive life span will help identify how beliefs, perceptions, and attitudes of women affect their contraceptive practices and choices.

Abstract The Women’s Health Institute in collaboration with the Journal of Women’s Midlife Health hosted a national roundtable with Dr. Vivian Pinn via Zoom to honor her for her achievements in the areas of women’s health, wellness, and research. The panelists included Gloria A. Bachmann, MD, MMS, Sherri-Ann Burnett-Bowie, MD, MPH, and Sioban D. Harlow, PhD.

Abstract Background Prior literature on disability has centered on disability prevalence among older adults ages 65 and older, providing only limited insight to potential gender differences in disability prevalence in mid-life. Midlife is, however, a critical time to be examined, as it is typically the time in the life course when large inequalities in physical health first emerge. Methods Using the Harmonized data files provided by the Gateway to Global Aging Data, we estimate disability prevalence of nationally representative adults ages 55–65 from 23 countries (N = 79,465). We examine gender differences in two disability indicators, limitations in instrumental activities of daily living (IADLs) and activities of daily living (ADLs) in two time periods, 2004/05 and 2014/15. Results There are substantial cross-country variations in IADL and ADL disability prevalence in midlife. Within countries, we find that women have higher IADL prevalence than men in only one out of five countries. Similarly, for ADL prevalence, women have higher ADL prevalence than men in only one out of ten countries. Further, comparing disability prevalence in two time periods, we observe different country-specific time trends. Conclusions In the majority of mid and high-income countries, there is no significant gender difference in IADL and ADL prevalence, but there are few countries where women show higher prevalence of disability than men in mid-life. This finding calls for future research into what contributes to cross-country variations.

Abstract Previously, quality of life (Qol) has been defined as an individual’s evaluation of a satisfactory life as a whole (i.e. physically, mentally, psychologically, and socially). Only a few studies have examined the racial differences between QoL and risk factors associated with health, demographics, and lifestyle in midlife women. Thus, the purpose of our study was to determine racial differences in QoL in menopausal women due to lifestyle, demographic, and health related risk factors. A stratified ordinal logistic regression model was applied to self-reported questionnaire data from the Midlife Women’s Health Study (MWHS) to determine risk factors associated with QoL differences between White and Black women during the menopausal transition. In multivariable models, our results showed Black women who had 3 or 4 comorbidities were about 4 times as likely to have higher QoL compared to women who had 0 to 2 comorbidities (95% CI: 1.65,10.78). However, the number of comorbidities was not significantly associated with QoL in White women in univariate or multiple regression. Further, body mass index and income were not significant factors in QoL in Black women but were in White women. Overall, our results illustrate that differences in health, demographic, and lifestyle factors are associated with QoL during menopause. Also, we suggest that future studies evaluate stratified models between racial groups to determine race-specific risk factors related to quality of life.

Objective: To identify and describe the certainty of evidence of gynecology and obstetrics systematic reviews (SRs) using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Method: Database searches of SRs using GRADE, published between 1 January 2016 to 31 December 2020, in the 10 “gynecology and obstetrics” journals with the highest impact factor, according to the Journal Citation Report 2019. Selected studies included those SRs using the GRADE approach, used to determine the certainty of evidence. Results: Out of 952 SRs, ninety-six SRs of randomized control trials (RCTs) and/or nonrandomized studies (NRSs) used GRADE. Sixty-seven SRs (7.04%) rated the certainty of evidence for specific outcomes. In total, we identified 946 certainty of evidence outcome ratings (n = 614 RCT ratings), ranging from very-low (42.28%) to low (28.44%), moderate (17.65%), and high (11.63%). High and very low certainty of evidence ratings accounted for 2.16% and 71.60% in the SRs of NRSs, respectively, compared with 16.78% and 26.55% in the SRs of RCTs. In the SRs of RCTs and NRSs, certainty of evidence was mainly downgraded due to imprecision and bias risks. Conclusions: More attention needs to be paid to strengthening GRADE acceptance and building knowledge of GRADE methods in gynecology and obstetrics evidence synthesis.