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Objective: To describe the challenges in recruitment of a national sample of young Australian women for a study of their physical and psychological wellbeing., Methods: Women, aged 18 to 39 years, were invited by email to complete an online questionnaire and, if not using systemic hormones, pregnant or breast feeding, to provide a blood sample., Results: A total of 94,546 email invitations were sent. Follow-up of 1,000 randomly selected non-responders by text message recruited 15 additional women. Direct telephoning resulted in another 516 completed questionnaires from a further 3,614 randomly selected non-responders. In all, 6,986 women completed the questionnaire and blood samples were provided by 761 (20.6%) of 3,689 eligible participants. The study sample is similar to women within the target age range captured by the Australian Census for their state of residence in terms of age distribution, education, relationship status, employment and occupation., Conclusions: Recruitment, by predominantly electronic means, has achieved a large, representative study sample of young women recruited from the eastern states of Australia. Implications for public health: Recruitment of a representative study sample can be achieved in the absence of a high response rate., (© 2019 The Authors.)

Objective: The aim of this study was to document the age-specific prevalence of fecal incontinence (FI), as well as its relationship to childbirth and urinary incontinence (UI), in a community-based sample of Australian women., Methods: A total of 444 women aged 26 to 82 years, originally recruited from a community-based research database, completed a self-administered study questionnaire. Prevalence of FI was assessed using the Pelvic Floor Distress Inventory, and UI and its subtypes were determined using the Questionnaire for Urinary Incontinence Diagnosis. Univariate (Pearson's χ tests) and multivariate logistic regression analyses were used to assess the relationship between FI type and UI adjusting for age and body mass index (BMI)., Results: Data were analyzed for 442 women. The overall prevalence of any FI was 20.7% (95% CI, 16.9%-24.5%). Loose FI was reported by 91 of 442 women, yielding a prevalence of 20.7% (95% CI, 16.9%-24.5%). Well-formed FI was reported by 20 of 442 women, yielding a prevalence of 4.5% (95% CI, 2.6%-6.4%). All the women with well-formed FI also reported problems of loose FI. The prevalence of FI increased with age up to 75 years for both types of FI. FI was not related to parity (P = 0.9). The highest proportion of any FI (24.4%) occurred in women with a parity of four or greater; however, 20.3% of nulliparous women reported FI. Within parous women, there was no significant association found between FI and history of self-reported instrumental delivery (P = 0.4). About two thirds of the women with loose and well-formed FI also reported coexisting UI. Loose FI was significantly associated with any UI (odds ratio, 2.8; 95% CI, 1.7-4.8) after adjusting for age and BMI (P < 0.001). Well-formed FI was not significantly associated with any UI after adjusting for age and BMI., Conclusions: FI is a common condition affecting one in five adult women in the community. In our study, women with loose FI, but not well-formed FI, were more likely to have UI independent of their age and BMI. Being parous was not associated with an increased risk of any FI.

Objective: The aim of this article was to describe a pragmatic approach to the menopausal status classification of clinical research study participants that allows for women who have gynecological circumstances that mask their natural menstrual pattern., Design: We demonstrate the application of an algorithm for the Health and Wellbeing After Breast Cancer study based on self-reported menstrual cycle pattern, gynecological history, presence or absence of vasomotor symptoms, and systemic hormone use to classify women with newly diagnosed breast cancer as premenopausal, perimenopausal, or postmenopausal for research purposes., Results: Within 12 months of their breast cancer diagnosis, 1,684 participants, mean +/- SD age 57.4 +/- 11.9 years, completed a comprehensive women's health questionnaire. Menopausal status in 71.8% of the women was classified by reported bilateral oophorectomy, age, greater than 12 months of amenorrhea, or regular menstrual cycles and absence of symptoms. Status in the remainder was classified by progression through the decision tree., Conclusions: The Health and Wellbeing After Breast Cancer study menopausal classification algorithm is a useful tool for research involving female participants that allows for the classification of women who have had a hysterectomy and/or use systemic hormonal contraception or hormone therapy.

Background: Whereas symptomatic endometriosis may affect work performance, the impact of endometriosis in the general community is not known. Aims: The associations between endometriosis and each of sick leave and work ability, were investigated in a large sample of non‐healthcare seeking women. Materials and Methods: This community‐based, cross‐sectional study recruited 6986 women, aged 18–39 years, from three eastern states of Australia between 11 November 2016 and 21 July 2017. Women were identified as having endometriosis if they had undergone a pelvic ultrasound and reported a diagnosis of endometriosis. Working women completed the Work Ability Index. Results: Participants were predominantly of European ancestry (73.1%) and 46.8% were overweight or had obesity. The prevalence of endometriosis was 5.4% (95%CI 4.9–6.0%) with the highest prevalence of 7.7% (95%CI 6.5 to 9.1%) for women aged 35–39 years. Among the 4618 working women, those with endometriosis had significantly more sick days from work (33.6% reported ≥10 days vs 13.5%, overall χ2P < 0.001). Endometriosis was associated with a greater likelihood of poor to moderate work ability, after adjusting for age, body mass index, ethnicity, relationship status, student status, insecure housing, being a carer for another person, parity, ever use of assisted reproductive technologies, and depressed mood (odds ratio 1.90, 95%CI 1.40–2.58, P < 0.001). Conclusions: This study provides new evidence that the negative impact of endometriosis on work attendance and work ability is not limited to women with prevalent symptoms and severe disease, but appears to encompass women across a broader spectrum of this condition in the community. [ABSTRACT FROM AUTHOR]

Background: Although serum ferritin is considered a reliable indicator of iron stores, there are few data documenting the prevalence of low ferritin in representative samples of young women. Aims: To estimate the prevalence of low ferritin and to identify factors associated with low ferritin in young Australian women. Methods: Women, aged 18–39 years, living in the eastern states of Australia were recruited by email to a cross‐sectional, online questionnaire‐based study between November 2016 and July 2017. Participants not pregnant, breast feeding, taking hormonal contraception, using assisted reproduction or postmenopausal were invited to provide a blood sample. Results: Of the 3689 invited participants, 761 (23.1%) provided a sample and 736 women, mean (SD) age 31.7 (±5.6) years, were included in the analyses. The overall prevalence of serum ferritin <30 μg/L was 34.8% (95% confidence interval (CI) 31.4–38.3%), with 41.4% (35.1–48.0%) in NSW, 31.5% (26.4–37.1%) in Victoria and 32.6% (26.8–39.0%) in Queensland. Serum ferritin <30 μg/L was positively associated with the reporting of >2 days of heavy menstrual bleeding (adjusted odds ratio (AOR) 1.73, 95% CI 1.15–2.59), living in New South Wales (AOR 1.57, 95% CI 1.07–2.30), not working outside home (AOR 1.58, 95% CI 1.01–2.49), and inversely associated with never experiencing heavy menses (AOR 0.46, 95% CI 0.23–0.93) and obesity (AOR 0.32, 95% CI 0.21–0.50). Conclusions: This study demonstrates that serum ferritin below 30 μg/L is common amongst young Australian women. Healthcare professionals should note the association between low ferritin and heavy bleeding. [ABSTRACT FROM AUTHOR]

Background: In Australia many hormonal contraceptives are not Pharmaceutical Benefits Scheme (PBS) supported, hence the use of different formulations have not been quantified. Objectives: To document the use of hormonal contraceptives and factors associated with their use. Materials and methods: Cross‐sectional, online questionnaire‐based study of 6986 Australian women, aged 18–39 years, recruited by email invitation from two large, representative databases. Main outcome measures were the prevalence of use of hormonal contraceptives and associated socio‐demographic characteristics. Results: Of the 6600 potential hormone contraceptive users, 43.2% were current users. Most (63.6%) reported using a combined oral contraceptive (COC) of which 30.9% were non‐PBS‐supported anti‐androgenic progestin‐containing COCs. Use of long‐acting reversible contraceptives (LARC) or an injectable contraceptive was reported by 26.8%. Education beyond secondary school, being Australian born, rural residency, normal body mass index, age <25 years and nulliparity were significantly associated with hormonal contraceptive use. Women who reported polycystic ovary syndrome or acne were more likely to be taking a third or fourth generation COC (P < 0.0001) and endometriosis was significantly associated with intrauterine system (IUS) use. Third or fourth generation COC use was reported by 12.1% of obese, current smokers. Conclusion: An estimated one‐third of Australian women aged 18–39 are taking a non‐PBS‐supported anti‐androgenic progestin COC, highlighting inequity in access to COC options. That hormonal contraceptive use is higher in rural areas is a novel finding and the proportion of LARC or injectable use suggests that uptake in Australia is higher than previously reported. [ABSTRACT FROM AUTHOR]

Background: Little is known of the prevalence and severity of menstrual dysfunction, climacteric symptoms, pelvic floor disorders, sexual problems, and psychological wellbeing after lung transplantation in women. Materials and Methods: Adult female lung transplant recipients, attending the Alfred Hospital Lung Transplant Service in Melbourne, Australia participated in a women's health, cross-sectional questionnaire-based study. Results: The 123 of 149 potential participants were recruited between September 2014 and July 2015. Their median age was 53.5 years, and 44 were premenopausal, 3 perimenopausal, and 76 postmenopausal. Moderate–severe menstrual and premenstrual symptoms were common, and 43% of partnered premenopausal women were not using contraception. Vasomotor symptoms (VMS) were common in postmenopausal women <55 years (80.0%), and the use of menopausal hormone therapy was low (8.9%). The estimated prevalence of low sexual desire associated with distress was 24.4%. Low wellbeing was significantly and independently associated with being aged 50 ≤ 60 years, moderate–severe VMS, impaired forced expiratory volume in 1 second, and psychotropic medication use. Conclusions: Our findings demonstrate that premenopausal lung transplant recipients need to be asked about bothersome menstrual symptoms, and contraceptive compliance needs regular review. Transplant recipients at midlife have substantially lower wellbeing than women of other ages and this needs attention, including assessment and management of menopausal symptoms. [ABSTRACT FROM AUTHOR]

Objectives: It has been hypothesised that vasomotor symptoms (VMS), the hallmark of menopause, may affect women's workplace performance. The aim of this study was to investigate the association between VMS and self-reported work ability, taking into account socio-demographic characteristics. Study design/Main Outcome measures: A national cross-sectional survey of women, aged 40-65 years, was conducted between October 2013 and March 2014. Participants provided socio-demographic and lifestyle factors and completed the Menopause Specific Quality of Life Questionnaire (MENQOL) and the Work Ability Index (WAI).Results: Of 2020 women who comprised the study sample, 1274 were in paid employment and 1263 completed the WAI. The WAI score was good-excellent for 81.5% of women and poor-moderate for 18.5%. After adjustment for socio-demographic characteristics, having any VMS was associated with greater likelihood of poor-moderate work ability [odds ratio (OR)=2.45, 95% CI 1.69-3.54]. Poorer work ability was significantly and independently associated with being un-partnered, obese or overweight, smoking, being carer and having insecure housing finance, but not with age.Conclusions: Overall, most women functioned well at work. We observed an association suggesting a relationship not only between menopausal VMS and personal wellbeing, but also between VMS and self-assessed work ability. Although 4 in 5 women functioned well at work, recognition of the association with VMS may improve wellbeing and work performance of working women at midlife. [ABSTRACT FROM AUTHOR]

The editorialists discuss recommendations from the Women's Preventive Services Initiative on screening for urinary incontinence in women and advise caution regarding widespread screening on the basis of limited, indirect evidence. [ABSTRACT FROM AUTHOR]

Objectives The extent to which menopause influences wellbeing is unclear. We investigated the association between moderate-severely bothersome vasomotor symptoms (VMS) and psychological general wellbeing in women, aged 40–65 years, taking into account socio-demographic and lifestyle factors. Study design/Main outcome measures This was a cross-sectional survey of 2020 Australian women, aged 40–65 years, recruited from the community between July 2013 and March 2014. Wellbeing was assessed by the Psychological and General Wellbeing questionnaire (PGWB) and VMS by the Menopause-specific Quality of Life Questionnaire. Results Moderate-severely bothersome VMS had a strong significant negative association with psychological general wellbeing [regression coefficient ( β ) = −8.17, 95% confidence interval (CI) −10.90 to −5.45]. Socio-demographic factors associated with lower wellbeing included being un-partnered ( β = −2.80, 95% CI −4.74 to −0.86), obese ( β = −5.46, 95% CI −7.24 to −3.68) and a smoker ( β = −3.47, 95% CI −6.10 to −0.84). Older age ( β = 0.29, 95% CI 0.06–0.42) and participation in paid and/or volunteer work ( β = 2.72, 95% CI 0.61–4.82) were positively associated with wellbeing. For those with insecure housing, being a carer was associated with better wellbeing. Conclusions Moderate-severely bothersome VMS are significantly and independently negatively associated with psychological general wellbeing in women at midlife. This is an important consideration when assessing psychological wellbeing in women during this life phase. [ABSTRACT FROM AUTHOR]

Objective Whether moderate to severe obesity (body mass index (BMI) ≥ 30 to <40 kg/m 2 ) contributes to breast cancer recurrence and mortality remains uncertain. Subjects and methods 1199 women, recruited within 12 months of their diagnosis of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−) invasive breast cancer completed an enrolment questionnaire and an annual follow-up questionnaire every 12 months for another 5 years. The impact of obesity on time to either local or distant recurrence or new breast cancer, or death due to breast cancer was determined by Cox regression. Women in the most extreme categories of BMI (<18.5 and ≥40) were excluded from the analysis. Results Of the 1155 included women, mean age, 58.4 ± 11.6 years, 53.8% had Stage 1 disease and 88.9% received oral adjuvant endocrine therapy (OAET) within 2 years of diagnosis. The likelihood of an event was significantly associated with moderate to severe obesity (HR = 1.71, 95%CI, 1.12–2.62, p = 0.014), disease beyond Stage 1 (HR = 2.87, 95% CI 1.73–4.75, p < 0.001), OAET (HR = 0.26, 95%CI 0.14–0.46, p < 0.001), mastectomy (HR = 3.28, 95%CI 1.98–5.44, p < 0.001) and radiotherapy (HR = 2.12, 95%CI 1.24–3.63, p = 0.006). For Stage 1 disease, only moderate to severe obesity (HR 3.23, 95%CI 1.48–7.03, p = 0.003) and OAET use (HR 0.41, 95%CI 0.17–0.98, p = 0.046) were significantly associated with an event. Conclusion Moderate to severe obesity is associated with a poorer invasive breast cancer prognosis; this is also true for women with Stage 1 disease, and is independent of age and treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the level of understanding in women with newly diagnosed invasive breast cancer of the key clinical features of their disease that are important determinants in treatment decision making. Methods: The 1684 women aged between 26 and 88 years at diagnosis enrolled in a 5-year cohort study were asked by questionnaire about their estrogen receptor (ER) and progesterone receptor (PR) status and about their past or current treatment with adjuvant endocrine therapy. Information was linked with their ER and PR status determined from the histopathology report. Logistic regression analysis was used to explore the relationship between age and education status and the likelihood of being able to correctly report hormone receptor status, as well as the relationship between the likelihood of receiving adjuvant endocrine therapy and knowledge of hormone receptor status in women who were ER or PR positive. Results: Not being able to correctly report hormone receptor status was associated with being older and having a lower level of education. Of women who were ER positive or PR positive or both and were at least 40 weeks from diagnosis, having received some form of endocrine therapy was significantly associated with self-identification as being ER or PR positive (OR = 1.82, 95% CI 1.24-2.68, p = 0.002), even when age was taken into account. Conclusions: That self-knowledge of hormone receptor status was independently associated with likelihood of receiving endocrine therapy suggests that the methods of helping women understand the nature of their breast cancer are worthy of review. [ABSTRACT FROM AUTHOR]

Abstract: Background: The study was conducted to perform a direct comparison of the satisfaction of intrauterine device (IUD) users and Implanon users after 6 months. Study design: Women were recruited to this study in the contraception clinics of Southern Health and Family Planning Victoria. Each woman completed a questionnaire at the time of starting her contraception with either an IUD or Implanon. Women were sent a follow-up questionnaire after 6 months to assess their satisfaction with their chosen method of contraception. Results: A total of 439 participants were recruited for this non randomized cohort study; 211 choosing an IUD and 228 choosing to use Implanon. The main reason patients in both groups chose their contraceptive method was recommendation by the doctor. Follow-up was achieved in over 84% in both groups. More than 50% of women in both groups reported at least one side effect. The most commonly reported side effect in both groups was abnormal bleeding and this was also the most common reason for having the contraceptive device removed. The IUD users reported a higher rate of satisfaction with their chosen method of contraception, although there was no difference between groups in the removal rate or whether the women would recommend the contraception to others. Conclusions: IUD users reported a higher level of satisfaction than did Implanon users at 6 months. Side effects in women using IUDs and Implanon are common. The range of likely side effects should be included in counseling women about long-term reversible contraception. [Copyright &y& Elsevier]

Introduction. A validated questionnaire to assess the nature and quality of the recent female sexual experience and that can be employed to evaluate acute therapeutic effects does not exist. Aim. To validate an instrument with which researchers can evaluate the nature and quality of the female sexual experience within 24 hours of a sexual event. Methods. A cross-sectional questionnaire study in 349 sexually active community-based women, aged 20–65 years, who self-identified as being either satisfied or dissatisfied with their sexual life. Main Outcome Measures. Scores from the Monash Women's Health Program Female Sexual Satisfaction Questionnaire (MFSSQ), completed within 24 hours of sexual activity, on two occasions. Results. Participants were 349 women who were sexually active at least once per fortnight, but not necessarily partnered. Almost equal groups of self-identified satisfied, dissatisfied, premenopausal, and postmenopausal women participated. Three hundred forty-five women (99%) completed one MFSSQ, and 326 women (94%) completed two separate questionnaires, each within 24 hours of a sexual event. Missing responses were few, good inter-item correlation was seen, and excellent reliability was demonstrated for most items, based on test–retest data. The questionnaire was able to discriminate well between sexually satisfied and dissatisfied women. Conclusions. The MFSSQ is a 12-item questionnaire specifically designed to assess the quality and nature of a recent sexual experience. It is easy and quick to administer, is reliable and valid, and has the potential to be used to assess the efficacy of acute interventions in the area of female sexual dysfunction. Davison SL, Bell RJ, La China M, Holden SL, and Davis SR. Assessing sexual function in well women: Validity and reliability of the Monash Women's Health Program Female Sexual Satisfaction Questionnaire. J Sex Med 2008;5:2575–2586. [ABSTRACT FROM AUTHOR]

Context It has been proposed that low sexual desire and sexual dysfunction are associated with low blood testosterone levels in women. However, evidence to support this is lacking. Objective To determine whether women with low self-reported sexual desire and sexual satisfaction are more likely to have low serum androgen levels than women without self-reported low sexual desire and sexual satisfaction. Design, Setting, and Participants A community-based, cross-sectional study of 1423 women aged 18 to 75 years, who were randomly recruited via the electoral roll in Victoria, Australia, from April 2002 to August 2003. Women were excluded from the analysis if they took psychiatric medication, had abnormal thyroid function, documented polycystic ovarian syndrome, or were younger than 45 years and using oral contraception. Main Outcome Measures Domain scores of the Profile of Female Sexual Function (PFSF) and serum levels of total and free testosterone, androstenedione, and dehydroepiandrosterone sulfate. Results A total of 1021 individuals were included in the final analysis. No clinically significant relationships between having a low score for any PFSF domain and having a low serum total or free testosterone or androstenedione level was demonstrated. A low domain score for sexual responsiveness for women aged 45 years or older was associated with higher odds of having a serum dehydroepiandrosterone sulfate level below the 10th percentile for this age group (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.54-9.81; P = .004). For women aged 18 to 44 years, having a low domain score for sexual desire (OR, 3.86; 95% CI, 1.27-11.67; P = .02), sexual arousal (OR, 6.39; 95% CI, 2.30-17.73; P<.001), and sexual responsiveness (OR, 6.59; 95% CI, 2.37-18.34; P<.001) was associated with having a dehydroepiandrosterone sulfate level below the 10th percentile. Conclusions No single androgen level is predictive of low female sexual function, and the majority of women with low dehydroepiandrosterone sulfate levels did not have low sexual function. [ABSTRACT FROM AUTHOR]

More than half of Victorian pregnant women are undergoing prenatal testing for birth defects, although little is known about the factors that are influencing their decisions. To examine whom women perceived as influencing their decision about prenatal testing for birth defects, with whom they would have liked to talk more, and what sources of information they preferred. A total of 737 pregnant women aged 37 years and over, who either had or had not undergone prenatal testing (screening and/or diagnosis) completed a questionnaire in 18 hospitals throughout Victoria. Over 90% reported that they themselves had a strong influence on their decision, and 70% reported their partner as strongly influencing their decision. Approximately 30% of women who had both screening and diagnosis and more than 20% of women who had no prenatal testing, would like to have discussed prenatal testing with women who had previously had testing. Face-to-face counselling with a doctor or counsellor was the preferred source of information, followed by a pamphlet as the second choice. Given that both tested and untested women felt so strongly that they were responsible for their own decisions about prenatal testing, it is unlikely that universal acceptance and uptake will occur, even in this group of women of advanced maternal age. A support network of women who have already had testing could supplement existing sources of support. However, there continues to be a need for face-to-face sessions with a doctor or counsellor in combination with printed material. [ABSTRACT FROM AUTHOR]

The article discusses a study for creating awareness regarding the application of using the iodine supplementation by the women of Australia leading to the growth and development of infant along with the maintenance of the maternal health. Topics include the results of a survey conducted on pregnant women using iodine supplements, understanding of women for taking iodine supplements, and the need for the involvement of the general practitioners (GPs) for creating awareness.

This letter replies to Dr. Dhatariya who mentioned de novo biosynthesis of DHEA in the brain and commented on the authors' research on androgens.