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BMC Women's Health[JOURNAL]

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A multilevel analysis of the factors associated with the use of different types of modern contraceptive methods: permanent methods, LARCs, MARCs, and SARCs, among married or in-union Nigerian women with a demand for family planning.

Odjesa E, Okonofua FE, Ntoimo LF

BMC Womens Health · 2026 Jun · PMID 42365305 · Full text

BACKGROUND: This study aimed to investigate the factors associated with the use of different modern contraceptives (MCs) by Nigerian married or in-union women of reproductive age with a demand for family planning (DFP).... BACKGROUND: This study aimed to investigate the factors associated with the use of different modern contraceptives (MCs) by Nigerian married or in-union women of reproductive age with a demand for family planning (DFP). These MCs are permanent methods and long-acting reversible contraceptives (PLARCs), medium-acting reversible contraceptives (MARCs), and short-acting reversible contraceptives (SARCs). METHODS: An unweighted sample size of 9,983 women nested in a total of 1,118 communities was extracted from the 2024 Nigeria Demographic and Health Survey. A multilevel multivariable multinomial logistic regression analysis was carried out using Stata 17.0. Two levels of analysis were utilised: the individual and the community level, with the accompanying variables adjusted for. RESULTS: The DFP satisfied by modern methods (DFPSM) was approximately 33.9%, with the DFP satisfied by PLARCs, MARCs, and SARCs estimated as approximately 17.1%, 9.1%, and 7.8%, respectively. We found large remaining significant between-community variances in the odds of women satisfying their DFP with the different MCs. This was shown by the various estimated median odd ratios for the DFP satisfied by PLARCs, MARCs, and SARCs: approximately 3.870, 4.830, and 4.532, respectively. These remaining between-community variances were of greater relevance than the associated effects of most of the adjusted individual and household-level variables. This was with the exception of only the regression effects on DFP satisfied with MARCs of women in households with 1 to 2 dejure children at most 5 years old (aOR = 5.514, 95%CI = 2.226 to 13.658, p < 0.001); and those in households with no children at most 5 years old (aOR = 9.359, 95%CI = 3.656 to 23.954, p < 0.001). However, other variables that significantly increased the use of the different types of MCs by women with a DFP were their formal education level and women being usual residents of communities with high age at first marriage/cohabitation, low fertility clusters, and low polygyny clusters. CONCLUSION: To increase the very low DFPSM in Nigeria using different types of MCs, government policies/interventions aimed at improving the educational level of girls beyond the primary level should be implemented. A greater concentration should be within communities with low age at first marriage/cohabitation, high polygyny, and high fertility clusters.
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Correlation analysis of bacterial vaginosis with HPV infection and different grades of cervical lesions.

Wang K, Lin L, Lin H … +1 more , Chen Z

BMC Womens Health · 2026 Jun · PMID 42365274 · Full text

OBJECTIVE: To analyze the correlations between bacterial vaginosis (BV), human papillomavirus (HPV) infection and cervical lesions of varying grades in a single-center population from southeastern China, so as to provide... OBJECTIVE: To analyze the correlations between bacterial vaginosis (BV), human papillomavirus (HPV) infection and cervical lesions of varying grades in a single-center population from southeastern China, so as to provide a reference for optimizing early cervical cancer screening strategies. METHODS: A retrospective analysis was conducted on the clinical data of 1427 women who underwent combined cervical cancer screening at the gynecology outpatient/inpatient department of The Affiliated Hospital (Group) of Putian University from January 2022 to March 2025. The data included results for BV, HPV, and ThinPrep cytologic test (TCT). Chi-square tests or Fisher's exact tests were used to analyze the distribution characteristics of HPV infection in patients with different cervical lesions, explore the relationship between BV and single, dual, or multiple HPV infections, assess the correlation between BV and different types of cervical lesions, and evaluate the association and influencing factors of BV combined with HPV infection on different grades of cervical lesions. RESULTS: High-risk HPV types were predominantly HPV-52 (19.3%) and HPV-16 (17.5%), while low-risk HPV-81 (20.5%) was the most common. The rates of dual and multiple (≥ 3 types) HPV infections were significantly higher in the BV-positive group than in the BV-negative group (37.1% vs. 27.4%, P = 0.009). The BV-positive rate increased with the severity of cervical lesions, being highest in high-grade squamous intraepithelial lesion (HSIL) (46.4% vs. NILM 10.5%, P < 0.001). Within the BV-positive subgroup, individuals with multiple HPV infections were more likely to present with atypical squamous cells of undetermined significance (ASC-US). Both multiple HPV infection and BV positivity were statistically significant correlates for higher-grade cervical lesions in the multivariable ordinal logistic regression model (P < 0.001). CONCLUSION: This study demonstrated a significant association between bacterial vaginosis (BV) positivity and multiple HPV infection as well as high-grade cervical lesions in a female population from southeastern China. It provides regional epidemiological data that suggest a potential role for BV testing in risk stratification. Nevertheless, these findings are preliminary, and any clinical application would require rigorous prospective validation of predictive performance, cost-effectiveness, and impact on screening outcomes before implementation can be considered.
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Elevated urinary succinate in women with symptom-defined overactive bladder without clinically recognized cardiometabolic disease: a cross-sectional study.

Öz ÖF, Seval MM, Doğan Ö … +3 more , Varli B, Çetinkaya ŞE, Dökmeci F

BMC Womens Health · 2026 Jun · PMID 42363135 · Full text

BACKGROUND: Overactive bladder (OAB) is a symptom-defined syndrome, and its metabolic correlates remain incompletely understood. This study investigated whether urinary tricarboxylic acid cycle metabolites differ between... BACKGROUND: Overactive bladder (OAB) is a symptom-defined syndrome, and its metabolic correlates remain incompletely understood. This study investigated whether urinary tricarboxylic acid cycle metabolites differ between women with symptom-defined probable OAB and controls without clinically recognized cardiometabolic disease. METHODS: In this cross-sectional clinic-based study, women aged 18 years and older attending a gynecology outpatient clinic were enrolled. Participants with self-reported cardiometabolic disease or related medication use were excluded. Probable OAB was defined by an Overactive Bladder Awareness Tool Version 8 score of 8 or higher. Midstream urine samples were analyzed for succinate and malate by gas chromatography-mass spectrometry and normalized to urinary creatinine. Group comparisons, Spearman correlations, multivariable log-linear regression, sensitivity analyses, and exploratory receiver operating characteristic analyses were performed. RESULTS: A total of 186 women were included, comprising 81 with OAB and 105 controls. Women with OAB were older, had slightly higher body mass index, higher parity, and were more frequently postmenopausal. Urinary succinate and malate levels were higher in the OAB group. After adjustment for age, body mass index, parity, and menopausal status, OAB remained associated with higher urinary succinate (adjusted geometric mean ratio, 1.69; 95% CI, 1.34-2.12) and malate (1.25; 95% CI, 1.02-1.52). Succinate showed modest exploratory discrimination (AUC, 0.678), whereas malate showed limited discrimination (AUC, 0.560). CONCLUSIONS: Urinary succinate was higher in women with symptom-defined probable OAB even after adjustment for major demographic covariates, while the association with malate was weaker. These findings are hypothesis-generating and require confirmation in adequately powered, prospectively phenotyped cohorts with standardized metabolic, dietary, and urinary microbiome assessment.
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Factors associated with breast self-examination and mammography screening among women attending primary healthcare centers in central Tunisia.

Bennasrallah C, Youssef YB, Kacem M … +7 more , Maatouk A, Dhouib W, Fredj MB, Bouanène I, Abroug H, Zemni I, Sriha AB

BMC Womens Health · 2026 Jun · PMID 42363129 · Full text

BACKGROUND: Breast cancer remains a major public health concern in Tunisia. Despite national efforts, significant gaps persist in women's knowledge and uptake of early detection practices. Understanding the determinants... BACKGROUND: Breast cancer remains a major public health concern in Tunisia. Despite national efforts, significant gaps persist in women's knowledge and uptake of early detection practices. Understanding the determinants of these behaviors is critical for improving screening coverage. This study aimed to identify factors associated with breast self-examination (BSE) and mammography screening among women attending primary healthcare centers in Monastir, Tunisia. METHODS: We conducted a cross-sectional study in the governorate of Monastir from May to October 2023. Data were collected using a structured questionnaire specifically developed for the study objectives. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of BSE and mammography uptake. Data were analyzed using IBM SPSS statistics version 21. RESULTS: Among 439 women included, 80.6% reported awareness of BSE as an early detection method and 53.1% reported performing it monthly. In multivariate analysis, awareness of BSE (Adjusted odds ratio: AOR = 6.38; 95% CI: 3.41-11.90), having a family history of breast cancer (AOR = 2.03; 95% CI: 1.07-3.87) and older age (AOR = 1.042; 95% CI: 1.024-1.060) were independent associated factors with BSE practice. Among 192 women aged over 45 years, 35% had undergone mammography at least once. In multivariate analysis, the factors associated with mammography screening were BSE practice (AOR = 2.60; 95% CI: 1.22-5.55) and the knowledge of the recommended age for mammography initiation (AOR = 2.28; 95% CI: 1.17-4.45). CONCLUSION: The practice of BSE and especially mammography among participants remains relatively low. Targeted education and awareness-raising efforts are therefore essential to increase the use of breast cancer screening and early detection methods.
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Association of PAX1/JAM3 gene methylation, HR-HPV, and TCT with high-grade cervical lesions in a high-risk cohort: a multinomial logistic regression analysis.

Geng T, Li S, Bian Y … +2 more , Li X, Bian Y

BMC Womens Health · 2026 Jun · PMID 42351112 · Full text

OBJECTIVE: To investigate the risk factors associated with pathological progression of cervical lesions, specifically focusing on high-risk human papillomavirus (HR-HPV) infection, ThinPrep Cytologic Test (TCT), and PAX1... OBJECTIVE: To investigate the risk factors associated with pathological progression of cervical lesions, specifically focusing on high-risk human papillomavirus (HR-HPV) infection, ThinPrep Cytologic Test (TCT), and PAX1/JAM3 gene methylation in a high-risk colposcopy-referred cohort. METHODS: A total of 409 patients who underwent colposcopy-directed biopsy at the First Hospital of Hebei Medical University between January, 2023 and April, 2025 due to abnormal TCT results, HR-HPV infection, or positive PAX1/JAM3 gene methylation were analyzed. The sensitivities of different methods were compared, and unordered multivariate logistic regression was used to analyze the risk factors for high-grade cervical lesions and pathological progression. RESULTS: Univariate analysis demonstrated that age, gravidity, age at first sexual intercourse, number of sexual partners, menopausal status, HR-HPV infection, TCT results, and PAX1/JAM3 methylation were significantly associated with pathological grade (all P < 0.05). In the multinomial regression analysis, compared to the inflammation group, both other high-risk HPV (OR = 3.930) and very-high-risk (16/18) HPV infections (OR = 3.725), as well as non-NILM TCT (OR = 2.435), were significantly associated with an increased risk of LSIL. For the progression to HSIL, very-high-risk HPV (OR = 6.801), non-NILM TCT (OR = 2.399), positive PAX1 methylation (OR = 4.145), and positive JAM3 methylation (OR = 8.215) were identified as strong independent risk factors. CONCLUSION: In a high-risk colposcopy-referred cohort, HR-HPV infection, non-NILM TCT results, and positive PAX1/JAM3 gene methylation are independently associated with the presence of high-grade cervical lesions. These biomarkers have the potential to enhance clinical risk stratification and inform decision-making in cervical cancer screening. However, their clinical utility and cost-effectiveness need to be further evaluated through larger, prospective studies to validate their role in routine clinical practice.
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Mediterranean diet adherence and metabolic parameters in women with polycystic ovary syndrome: a retrospective cross-sectional study.

Yurtseven K, Akbaba AK, Pınarlı Falakacılar Ç … +2 more , İbanoğlu MC, Engin-Üstün Y

BMC Womens Health · 2026 Jun · PMID 42343384 · Full text

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common endocrine disorder frequently accompanied by metabolic disturbances and low-grade inflammation. The Mediterranean diet (MD) has been associated with improved cardio... OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common endocrine disorder frequently accompanied by metabolic disturbances and low-grade inflammation. The Mediterranean diet (MD) has been associated with improved cardiometabolic health; however, evidence in women with PCOS remains limited and inconsistent. MATERIALS AND METHODS: This retrospective cross-sectional study aimed to assess adherence to the MD and examine its relationship with biochemical and anthropometric parameters in women with PCOS. Data from 420 women aged 18-50 years who received medical nutrition therapy between December 2023 and June 2024 were analyzed. Adherence to the MD was evaluated using the 14-item Mediterranean Diet Adherence Screener (MEDAS). Anthropometric measurements and biochemical markers, including lipid profile, oral glucose tolerance test (OGTT) values, HbA1c, insulin and C-reactive protein (CRP), were obtained from medical records. RESULTS: The mean MEDAS score was 6.8 ± 2.3, indicating generally low adherence. MEDAS scores showed weak negative correlations with body mass index (BMI), body fat percentage, CRP, and 1-hour OGTT, and weak positive correlations with HDL-C, HbA1c, fasting glucose, 2-hour OGTT, and insulin (p < 0.05). CRP levels were moderately positively correlated with BMI and body fat percentage (r = 0.501 and r = 0.522, respectively; p < 0.001). CONCLUSIONS: Low adherence to the Mediterranean diet was common among women with PCOS. Although several statistically significant associations were observed between MEDAS scores and metabolic parameters, these relationships were generally weak. Larger prospective studies are needed to clarify the potential role of the Mediterranean diet in modulating inflammation and metabolic health in PCOS.
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Does surgeon expertise influence long-term outcomes in ovarian endometrioma rupture cases?

Lyu S, Wu Y, Dai Y … +8 more , Li X, Shi J, Gu Z, Zhang C, Li Q, Yan H, Zhang B, Leng J

BMC Womens Health · 2026 Jun · PMID 42343353 · Full text

BACKGROUND: Spontaneous ovarian endometrioma rupture typically presents with acute abdominal pain, a condition often complicated by tissue edema and pelvic adhesions that increase surgical difficulty. This study aims to... BACKGROUND: Spontaneous ovarian endometrioma rupture typically presents with acute abdominal pain, a condition often complicated by tissue edema and pelvic adhesions that increase surgical difficulty. This study aims to evaluate the impact of surgical expertise on long-term outcomes in patients with a history of spontaneous ovarian endometrioma rupture. METHODS: This is a retrospective cohort study at Peking Union Medical College Hospital between January 2012 and December 2022, which analyzed patients with spontaneous ovarian endometrioma rupture who underwent surgery. Patients were categorized into specialist or non-specialist surgery groups based on the expertise level of the surgical team. Clinical characteristics, postoperative treatment and recurrence data were collected and compared. Of the 122 patients, 32 were treated by specialists and 90 by non-specialists. All participants received laparoscopic surgery. RESULTS: Baseline characteristics and intraoperative findings were comparable between the two groups. Elective surgery was performed more frequently in the specialist group (81.2%) than in the non‑specialist group (45.6%, p = 0.001). The crude recurrence risk was 15.6% (5/32) in the specialist group, compared with 33.3% (30/90) in the non-specialist group (p = 0.264). Time-to-event analysis demonstrated a significantly lower 10-year cumulative recurrence risk in the specialist group (log-rank p = 0.033). In multivariable Cox regression analysis adjusting for surgery timing, maximum ovarian endometrioma diameter, rASRM score, and treatment duration, specialist surgery remained associated with a lower hazard of recurrence (adjusted HR 0.378, 95% CI 0.140-1.021), although this did not reach statistical significance (p = 0.055). None of the other covariates were significantly associated with recurrence. No between‑group difference was observed in clinical pregnancy rates. CONCLUSIONS: For patients with a history of spontaneous rupture of ovarian endometrioma, surgery performed by specialists with more extensive experience in endometriosis may be associated with a lower long-term recurrence risk. This finding should be interpreted with caution given the borderline statistical significance after Cox adjustment. Nonetheless, the observed trend highlights the potential importance of surgical expertise and the need for specialized training in endometriosis management.
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Feasibility and short-term comparative outcomes of a digital-assisted community-based electrical stimulation rehabilitation program for postmenopausal women with pelvic floor dysfunction: a non-randomized controlled study.

Yang Q, Hu Q, Zhou W … +4 more , Chu Q, Zhuang J, He J, Liang Y

BMC Womens Health · 2026 Jun · PMID 42337782 · Full text

AIM: This study aimed to assess the feasibility and short-term comparative outcomes of a community-based BES rehabilitation program assisted by a digital service package for postmenopausal women with PFD, and to explore... AIM: This study aimed to assess the feasibility and short-term comparative outcomes of a community-based BES rehabilitation program assisted by a digital service package for postmenopausal women with PFD, and to explore whether pelvic floor muscle strength outcomes were compatible with a prespecified exploratory margin compared with tertiary hospital care. METHODS: We conducted a non-randomized controlled study involving 200 community-dwelling postmenopausal women with PFD. Participants in the intervention group received community-based BES plus a digital service package, while contemporaneous controls received standard BES care at a tertiary hospital. Follow-up lasted 1 month. Because treatment allocation was non-randomized, doubly robust estimation and multivariable regression were used to reduce measured confounding; findings should therefore be interpreted as exploratory rather than causal. RESULTS: The observed rate differences in improvement of Type I and Type II pelvic floor muscle strength were 0.008 and 0.054, respectively. The lower bounds of the 98.75% confidence intervals remained above the prespecified exploratory margin of - 0.20, suggesting that the observed differences were compatible with the prespecified exploratory margin in this exploratory analysis. While no significant between-group difference was found for self-perceived symptom severity, the intervention group was associated with higher self-reported adherence (β = 4.604, P < 0.001), health knowledge awareness (β = 24.419, P < 0.001), and quality of life (OR = 5.292, P = 0.023). Feasibility metrics were favorable, with a mean System Usability Scale score of 81.40. However, given the non-randomized design and the prespecified margin, these findings should be interpreted cautiously. CONCLUSIONS: This pragmatic, digital-assisted community-based rehabilitation program appears feasible and was associated with favorable short-term outcomes in postmenopausal women with PFD. Compared with tertiary hospital care, the integrated community-based program showed pelvic floor muscle strength outcomes that were compatible with the prespecified exploratory margin, while also being associated with higher self-reported adherence, health knowledge, and quality of life. However, because of the non-randomized design, retrospective registration, short follow-up, and potential residual confounding, these findings should be considered preliminary and hypothesis-generating rather than confirmatory evidence of non-inferiority, equivalence, or causal effects. REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400088675); Registered on 23 August 2024, retrospectively registered.
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E-cigarette use (vaping) and cigarette smoking are associated with reduced markers of ovarian reserve: a cross-sectional study of 16,087 women.

Getreu N, Wainwright E, Crawford L … +5 more , Nedelcu S, Dhonnabháin BN, Vaz SR, Vasavan T, O'Neill HC

BMC Womens Health · 2026 Jun · PMID 42337735 · Full text

BACKGROUND: E-cigarette use (vaping) is rapidly increasing among women of reproductive age, with an estimated one in five women aged 15-45 now using e-cigarettes in England. Despite being promoted as a safer alternative... BACKGROUND: E-cigarette use (vaping) is rapidly increasing among women of reproductive age, with an estimated one in five women aged 15-45 now using e-cigarettes in England. Despite being promoted as a safer alternative to cigarettes, the reproductive health consequences of e-cigarettes remain poorly understood, despite products being on the market for 2 decades. This study aimed to investigate the association between e-cigarette use, cigarette smoking, and two hormonal markers of ovarian reserve in women of reproductive age. METHODS: A cross-sectional analysis was conducted using data from 16,087 women aged 18-45 who accessed a private reproductive hormone testing service between 11/2022 and 02/2025. Women with pre-existing reproductive health conditions (including PMOS, endometriosis, POI, and hypothalamic amenorrhoea) and those using hormonal contraception were excluded, ensuring a reproductively healthy population for analysis. Self-reported vaping and smoking were primary exposures, captured as never, former, occasional, or current use. Serum AMH and FSH were measured via standardised immunoassay from capillary blood samples. Multiple linear regression with log-transformed outcomes was performed, adjusting for age, BMI, and ethnicity. Vaping and smoking were modelled simultaneously to account for overlap between the two behaviours. RESULTS: Current vaping was associated with 5.6% lower serum AMH compared to never-vapers (p=0.023), with no significant association observed for FSH. Current cigarette smoking was associated with a 9.4% reduction in AMH (p=0.005) and a 7.7% increase in FSH (p<0.001). Neither occasional nor former vaping or smoking was significantly associated with either marker. Sensitivity analyses excluding dual users of tobacco and e-cigarettes (n=64, 0.4% of sample) and excluding all former users produced consistent results. No significant interaction between smoking and vaping status was detected (p=0.271 for AMH; p=0.244 for FSH). CONCLUSIONS: In this large study of reproductively healthy women, current vape use was independently associated with lower AMH, a commonly used marker of ovarian reserve, after adjustment for smoking status and relevant confounders. These findings warrant further investigation, particularly given the widespread and growing use of e-cigarettes among women of reproductive age.
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An exploration of sexual and relational impacts of transvaginal mesh injury: a systematic review using thematic synthesis.

Beer N, De Boos D, Gresswell M

BMC Womens Health · 2026 Jun · PMID 42337597 · Full text

BACKGROUND: Transvaginal mesh, used to treat Pelvic Organ Prolapse and Stress Urinary Incontinence, has caused substantial injury to a growing number of women. The impact of mesh injury is far-reaching, significantly dis... BACKGROUND: Transvaginal mesh, used to treat Pelvic Organ Prolapse and Stress Urinary Incontinence, has caused substantial injury to a growing number of women. The impact of mesh injury is far-reaching, significantly disrupting women's lives. Whilst there is a growing body of literature examining the impacts, there is little research that specifically aims to understand the sexual and relational implications of mesh injury. This study aimed to systematically review evidence regarding the impacts of mesh injury reported by women in relation to sexual and relational functioning. METHODS: A systematic search of five databases (CINAHL, MEDLINE, PubMed, PsycINFO, and ProQuest Dissertations and Theses) and a grey literature search was conducted in April 2026. Studies and inquiries reporting data about women's experiences of mesh injury where sexual and relational impacts were reported were included. The quality of each study was assessed using the qualitative CASP checklist. The data was thematically synthesised. RESULTS: A total of nine reports were included, comprising of six published studies, one unpublished Doctoral thesis, and two government inquiries. Sample sizes were varied, with individual study sample sizes ranging from 7-84, and a secondary analysis of 399 accounts from one study. Participants included in government inquiries ranged between 517 and 555. A conservative total of 1483 participants is represented, reflecting the heterogeneity of the evidence base and limitations in the reporting of inquiry data. Of the nine included reports, eight were rated high quality with one rated as moderate. Seven overlapping themes were developed from the data: 1) Sexual functioning: changes due to pain, 2) Changes to sexuality, 3) Relational activity: changes due to pain, 4) Changes to relationship satisfaction, 5) Identity: changing sense of self navigating life with mesh injury, 6) Changes in relational roles and a seventh central theme of disrupted embodied sexual-relational self. CONCLUSION: Women with mesh injury experience significant sexual and relational disruption as a result of chronic pain, contributing to psychological distress. Psychological flexibility may be a protective mechanism for relational distress. Further research that seeks to understand these impacts is needed, which may inform the development of appropriate psychological interventions. TRIAL REGISTRATION: PROSPERO ID: CRD420251077730.
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Examination of the relationship between post-voiding residual urine volume and patient-reported urinary symptoms in postmenopausal women.

Umudova K, Demir Ö

BMC Womens Health · 2026 Jun · PMID 42337567 · Full text

INTRODUCTION AND HYPOTHESIS: Post-void residual (PVR) urine volume is routinely evaluated in women with urinary incontinence and/or pelvic organ prolapse (POP). However, its clinical relevance in postmenopausal women wit... INTRODUCTION AND HYPOTHESIS: Post-void residual (PVR) urine volume is routinely evaluated in women with urinary incontinence and/or pelvic organ prolapse (POP). However, its clinical relevance in postmenopausal women without these conditions remains insufficiently defined. This exploratory study aimed to investigate the association between PVR volume and patient-reported urinary symptom burden, as measured by the King's Health Questionnaire (KHQ), in postmenopausal women without urinary incontinence or prolapse. A secondary objective was to descriptively compare PVR volumes and uroflowmetry parameters between women reporting no urinary impact and those reporting mild-to-moderate impact. METHODS: Seventy postmenopausal women evaluated at the Gynecology and Urogynecology Clinics of Karadeniz Technical University Faculty of Medicine between 2022 and 2024 were enrolled in this cross-sectional observational study. Demographic data, uroflowmetry parameters, PVR volumes measured by transabdominal ultrasonography, and KHQ scores were recorded. Participants were stratified according to their response to a global KHQ impact item reflecting perceived urinary burden. Statistical analyses were conducted using SPSS, with significance set at p < 0.05. No a priori sample size or power calculation was performed, and the study should therefore be interpreted as exploratory. Correlation coefficients and 95% confidence intervals were calculated. RESULTS: The mean age of participants was 55.5 ± 4.1 years. As expected based on the stratification criterion, women reporting urinary impact demonstrated higher KHQ domain scores. However, no statistically significant differences were observed between groups in uroflowmetry parameters or PVR volumes. Furthermore, no significant correlations were identified between PVR volume and KHQ scores in the overall cohort (p > 0.05). All correlations were weak and confidence intervals crossed zero. CONCLUSIONS: In this exploratory cross-sectional cohort of postmenopausal women without incontinence or prolapse, no statistically significant association was detected between PVR volume and patient-reported urinary impact. Given the limited sample size, exploratory symptom stratification, and use of a predominantly incontinence-oriented questionnaire, these findings should be interpreted as inconclusive rather than confirmatory of absence of association. In addition, the use of the King's Health Questionnaire, which is primarily designed for urinary incontinence, may have limited the ability to capture voiding-specific symptoms. Larger, methodologically standardized studies are warranted to clarify the role of PVR in this population.
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Psychophysiological changes during breast cancer treatment: a longitudinal analysis of subjective and objective indicators.

Burešová I, Květon P, Jelínek M … +4 more , Halámková J, Kiss I, Hrnčiříková I, Kapounková K

BMC Womens Health · 2026 Jun · PMID 42337506 · Full text

BACKGROUND: Advances in early detection and treatment of breast cancer have led to improved survival rates, shifting attention toward the physical and psychological consequences of treatment. Adjuvant therapies are frequ... BACKGROUND: Advances in early detection and treatment of breast cancer have led to improved survival rates, shifting attention toward the physical and psychological consequences of treatment. Adjuvant therapies are frequently associated with fatigue, reduced quality of life, sleep disturbances, and psychological distress, yet longitudinal data capturing changes in both subjective and objective health indicators during treatment remain limited. The present study aimed to examine changes in selected psychophysiological characteristics in breast cancer patients from diagnosis through completion of adjuvant treatment. METHODS: A longitudinal design with two assessment points was employed: before treatment initiation and after completion of adjuvant therapy. The sample consisted of 75 women with breast cancer (mean age = 52.04; sd = 11.63). Self-report measures assessed fatigue (MFI), quality of life (EORTC QLQ-C30), anxiety and depression (HADS), sleep quality (PSQI), and motivation for physical activity (MPAM-R). Objective indicators included body mass index (BMI) and functional exercise capacity measured by the six-minute walk test (6MWT). Changes over time were analyzed using General Linear Models for repeated measures, with age and treatment duration included as covariates. Holm-Bonferroni correction was applied to control for multiple testing. RESULTS: Following treatment, patients exhibited significant increases in physical and general fatigue and a marked deterioration in the physical component of quality of life. BMI increased modestly but significantly over time. In contrast, no significant change was observed in objectively measured physical fitness (6MWT). Depressive symptoms significantly decreased after treatment, suggesting psychological adaptation despite physical deterioration. Age-related effects indicated greater post-treatment worsening of sleep quality in younger women, whereas older women showed a more pronounced decline in physical quality of life. CONCLUSIONS: The findings reveal a notable discrepancy between subjective health perceptions and objective physical capacity during breast cancer treatment. They underscore the importance of routine monitoring of fatigue, quality of life, and body weight, and support the implementation of individualized, age-sensitive supportive care strategies. Addressing psychophysiological burden during treatment may improve long-term well-being and clinical outcomes in breast cancer survivors.
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A case of omental endometriosis complicated by hemorrhagic ascites leading to pelvic encapsulated effusion.

Cao S, Zhang T

BMC Womens Health · 2026 Jun · PMID 42337492 · Full text

BACKGROUND: Endometriosis is an estrogen-dependent benign inflammatory disorder characterized by the implantation of active endometrial tissue (glands or stroma) outside the uterus, with pelvic adhesions as a core hallma... BACKGROUND: Endometriosis is an estrogen-dependent benign inflammatory disorder characterized by the implantation of active endometrial tissue (glands or stroma) outside the uterus, with pelvic adhesions as a core hallmark. Omental endometriosis is an extremely rare subtype of extra-pelvic endometriosis (accounting for < 5% of all extra-pelvic endometriosis cases), and its concurrent presentation with massive hemorrhagic ascites and de novo pelvic encapsulated effusion without predisposing factors (e.g., pelvic surgery, pelvic inflammatory disease) remains scarcely reported in existing clinical literature. CASE PRESENTATION: A 45-year-old premenopausal woman (gravida 4, para 2) presented with the chief complaint of increased menstrual flow and prolonged menstruation, without classic endometriosis symptoms such as dysmenorrhea or chronic pelvic pain and no history of abdominal/pelvic surgery or pelvic inflammatory disease. Examination revealed a significant amount of hemorrhagic ascites, pelvic encapsulated effusion, multiple omental nodules on abdominal CT, mildly elevated serum CA125 (85.51 IU/ml) with normal HE4 (61.22 pmol/L), and no malignant cells in ascitic cytology. The cause of hemorrhagic ascites was not definitively diagnosed preoperatively due to overlapping clinical and imaging features with malignant tumors; postoperative pathological and immunohistochemical findings confirmed omental endometriosis. CONCLUSION: Omental endometriosis should be considered in premenopausal women presenting with unexplained hemorrhagic ascites and pelvic encapsulated effusion, even in the absence of classic endometriosis symptoms, prior pelvic surgery, or malignant cytology-particularly when serum CA125 is elevated but HE4 remains normal. This case broadens the recognized clinical spectrum of extra-pelvic endometriosis and highlights the value of comprehensive preoperative evaluation combined with individualized, fertility-sparing surgical management.
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Body roundness index and a body shape index and their associations with menopausal symptoms: a comparative cross-sectional study.

Polat M, Erbey S, Sapmaz MA … +1 more , Soysal Ç

BMC Womens Health · 2026 Jun · PMID 42332739 · Full text

BACKGROUND: Menopause is accompanied by a considerable symptom burden, and although body mass index (BMI) is commonly used to assess its association with menopausal symptoms, BMI does not capture central fat distribution... BACKGROUND: Menopause is accompanied by a considerable symptom burden, and although body mass index (BMI) is commonly used to assess its association with menopausal symptoms, BMI does not capture central fat distribution. The Body Roundness Index (BRI) and A Body Shape Index (ABSI) specifically reflect central adiposity. This study aimed to investigate the associations of BRI and ABSI with menopausal symptom severity in perimenopausal and menopausal women, and to compare these indices with BMI. METHODS: This cross-sectional study included 638 women aged 44-56 years (319 perimenopausal, 319 menopausal) recruited from a gynaecology outpatient clinic. Menopausal symptom burden was assessed using the Menopause-Specific Quality of Life Scale (MENQOL), and physical activity was evaluated with the International Physical Activity Questionnaire (IPAQ). BMI, BRI, and ABSI were calculated from anthropometric measurements. Kruskal-Wallis test, Spearman correlation analysis, and crude and adjusted multiple linear regression models were used for statistical analysis. RESULTS: All three indices showed significant positive associations with total MENQOL scores. In Spearman correlation analysis, ABSI demonstrated the strongest correlation with total symptom burden (r = 0.677, p < 0.01), followed by BRI (r = 0.494, p < 0.01) and BMI (r = 0.332, p < 0.01). In multiple regression models, all associations remained statistically significant after adjustment for age, smoking status, history of chronic disease, BMI (BMI only in BRI and ABSI models) and physical activity. Obese women had the highest MENQOL scores across all subscales in both groups, while overweight women paradoxically showed lower scores than normal-weight women. Physical activity was negatively correlated with total symptom burden (r = - 0.084, p < 0.05), though its independent effect was limited in adjusted models. CONCLUSIONS: BRI and ABSI were independently and significantly associated with menopausal symptom burden, with ABSI showing the strongest correlation. Central adiposity indices may add clinically relevant information beyond BMI in menopausal women, and prospective studies are needed to clarify causality.
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Incidence and remission of endometriosis in Germany based on prevalence data from 35 million patients from the statutory health insurance.

Schütte Saem M, Voß S, Pytlik T … +3 more , Schiermeier S, Brinks R, Ickstadt K

BMC Womens Health · 2026 Jun · PMID 42332663 · Full text

Endometriosis is a chronic gynecological disease that can potentially develop as early as birth and can restrict the life of the patient. With the increasing prevalence of endometriosis in Germany, it has recently gained... Endometriosis is a chronic gynecological disease that can potentially develop as early as birth and can restrict the life of the patient. With the increasing prevalence of endometriosis in Germany, it has recently gained attention and priority for consideration. While numerous studies have examined endometriosis in Germany and other countries, studies on its incidence and remission rates are rare. Therefore, this study aimed to estimate the incidence and remission rates of endometriosis based on its age-specific prevalence in German women from 2012 to 2022.This study utilized data from the Central Institute (Zi) for Statutory Health Insurance (SHI) in Germany [1], which observed more than 35 million SHI-insured adolescents and women aged ≥ 10 years in 2012 and 2022, to determine the age-specific prevalence of ascertained diagnoses of endometriosis. The Illness-Death Model was used to estimate the incidence and remission rates of endometriosis. The estimation is based on a bootstrapping approach with 5000 replicates-samples. Results are the median incidence and remission rates, reported with 95% confidence intervals (CIs) based on 2.5% and 97.5% percentiles-quantiles, which quantify the uncertainty of the estimated incidence and remission rates.The bootstrapping approach estimated the incidence (median incidence across all bootstrap samples) about 1.73 per 1,000 person-years at around age of 32 years, and the highest remission rate was about 70.04 at the age of 52 years. The estimated 95% (CI) for the incidence and remission rates were (95% CI 1.71-1.78) and (95% CI 68.1-75.0), respectively.The Illness-Death Model and the prevalence of endometriosis from the Zi enabled the incidence rate of ascertained endometriosis for German women to be estimated. This study was the first to estimate the remission rate of endometriosis in Germany, aiming to better understand the condition.
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Exploring quality of life and physical-physiological characteristics in obese patients with and without lipedema: insights from the LipObes study.

Gursen C, Cools J, Claes L … +7 more , De Groef A, Meeus M, Spincemaille L, Pouchele F, Thomis S, Cornelissen V, Devoogdt N

BMC Womens Health · 2026 Jun · PMID 42321781 · Full text

BACKGROUND: Lipedema is a prevalent chronic condition in women, characterized by a painful and symmetrical accumulation of adipose tissue primarily in the lower limbs. Its diagnosis is based on specific clinical characte... BACKGROUND: Lipedema is a prevalent chronic condition in women, characterized by a painful and symmetrical accumulation of adipose tissue primarily in the lower limbs. Its diagnosis is based on specific clinical characteristics; however, these characteristics lack robust scientific validation. Furthermore, lipedema is frequently misdiagnosed as obesity. This study aims to compare quality of life and physical and psychological characteristics between patients with obesity with and without lipedema. METHODS: This cross-sectional study included 30 patients with obesity and lipedema (Lip-Obes group) and 29 patients with only obesity (nonLip-Obes group). Quality of life, body composition (BMI, fat free mass, fat mass, waist-to-hip ratio, waist-to-height ratio, leg volume), pain (pain pattern, pressure pain thresholds, pain interference, pain distribution, symptoms of neuropathic pain), physical functioning (hand grip strength, quadriceps strength, functional exercise capacity, functional mobility and physical activity level), and psychosocial functioning (pain catastrophizing, depression, anxiety, and stress, body image dissatisfaction, self-efficacy, and eating difficulties) were assessed using clinical measurements and self-reported outcomes. Statistical analyses were performed using independent t-tests or Mann-Whitney U tests for continuous variables and Chi-square or Fisher's exact tests for categorical variables. A two-sided p-value of < 0.05 was considered statistically significant. RESULTS: Compared to the nonLip-Obes group, the Lip-Obes group showed greater impairments in quality of life (p < 0.05). Despite similar body composition variables, the Lip-Obes group had lower waist-to-hip, waist-to-height, upper leg-to-waist, and lower leg-to-waist ratios, as well as higher total limb volume than the nonLip-Obes group. Additionally, the Lip-Obes group reported higher pain intensity, lower pressure pain thresholds in the arms and legs, and greater pain interference than the nonLip-Obes group (p < 0.05). Although hand-grip strength and physical activity levels were comparable, the Lip-Obes group exhibited lower quadriceps strength, functional exercise capacity, and functional mobility (p < 0.05). Additionally, the Lip-Obes group reported higher pain catastrophizing, greater body image dissatisfaction, and more severe eating difficulties than the nonLip-Obes group (p < 0.05). No significant differences were found in depression, anxiety, stress, or self-efficacy between groups (p > 0.05). CONCLUSION: This cross-sectional study highlights the complex nature of lipedema, providing preliminary evidence of differences in quality of life and distinct body composition and physical and physiological characteristics between patients with obesity with and without lipedema. These results emphasize the need for further research to identify diagnostic biomarkers for lipedema through in-depth investigations. Future studies should also focus on developing and optimizing a multidisciplinary treatment approach tailored to the unique characteristics of patients with lipedema.
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Giant mucinous ovarian cyst filling the abdominal cavity: clinical presentation, imaging findings, and surgical management.

Karakaya H, Gümüş M, Akarsu GD

BMC Womens Health · 2026 Jun · PMID 42316207 · Full text

BACKGROUND: Mucinous ovarian cystadenomas are benign epithelial tumors that may reach considerable size when diagnosis is delayed. Although most cases remain asymptomatic, giant cysts can produce significant compressive... BACKGROUND: Mucinous ovarian cystadenomas are benign epithelial tumors that may reach considerable size when diagnosis is delayed. Although most cases remain asymptomatic, giant cysts can produce significant compressive symptoms and mimic acute abdominal conditions. Early recognition and appropriate surgical planning are essential to prevent complications. CASE PRESENTATION: A 45-year-old woman presented with dyspnea and progressive abdominal distension. Imaging revealed a giant cystic mass measuring approximately 45 × 20 cm, occupying almost the entire abdominal cavity. The patient underwent total abdominal hysterectomy, bilateral salpingectomy, and left oophorectomy. A 42 cm mucinous cyst compressing adjacent organs was successfully removed without complications. Histopathology confirmed a benign mucinous ovarian cystadenoma. CONCLUSION: Giant mucinous ovarian cystadenomas, although rare in modern clinical practice, may cause severe compressive symptoms and require multidisciplinary management. Comprehensive radiological assessment and timely surgical intervention are crucial for optimal outcomes and prevention of life-threatening complications.
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Qualitative exploration of using hormonal contraception on mental health and wellbeing: Diverse experiences and a call for more support.

Jones C, McAdams TA, Akintoye Z … +1 more , Zavos HMS

BMC Womens Health · 2026 Jun · PMID 42316157 · Full text

INTRODUCTION: Quantitative research examining hormonal contraception and its relationship with health, particularly mental health and wellbeing, has been inconclusive with mixed evidence regarding the magnitude and direc... INTRODUCTION: Quantitative research examining hormonal contraception and its relationship with health, particularly mental health and wellbeing, has been inconclusive with mixed evidence regarding the magnitude and direction of associations. Qualitative approaches that focus on women's perspectives and lived experiences may offer valuable insights into the inconsistent results reported. In the present study we take a qualitative approach to exploring the lived experiences of mental health and wellbeing among young women when using hormonal contraception. METHODOLOGY: Data were collected as part of the Twins Early Development Study (TEDS) when participants were aged 26. A total of 5594 women completed a questionnaire assessing mental and physical health. At the end of a section of a series of closed questions about menstruation and hormonal contraception, 626 respondents answered an open-ended question in which they were invited to share their thoughts on their related experiences. Of these responses, 272 specifically addressed links between mental health, wellbeing, and hormonal contraception and were included in the final analysis. Responses were analysed using thematic analysis. RESULTS: Our analysis generated five themes representing positive, neutral, uncertain, and negative experiences of health and wellbeing whilst using hormonal contraception. The importance of choice and autonomy was emphasised. Many respondents reported feeling a lack of adequate care and support from healthcare professionals. CONCLUSION: Women report a range of experiences whilst using hormonal contraception that have positive and negative consequences on health and wellbeing. Healthcare providers should offer clear, detailed information and tailored support to women regarding the range of options available for hormonal contraception, and possible outcomes.
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Aetiological pattern of infertility cases managed at the University of Ilorin Teaching Hospital in Ilorin, North-Central Nigeria: a 3-year retrospective study.

Odeigah LO, Owolabi BO, Obalowu IA … +3 more , Mutalub YB, Agede OA, Jimoh AAG

BMC Womens Health · 2026 Jun · PMID 42310708 · Full text

OBJECTIVE: The aetiological pattern of infertility in most African countries appeared to differ from that in developed countries. The aim of this study was to identify significant causes of infertility among infertile wo... OBJECTIVE: The aetiological pattern of infertility in most African countries appeared to differ from that in developed countries. The aim of this study was to identify significant causes of infertility among infertile women attending the gynaecological clinics of the University of Ilorin Teaching Hospital. MATERIALS AND METHODS: It was a hospital-based retrospective cross-sectional study of infertility cases managed at the gynaecology clinics of the hospital between 2016 and 2018. A total of 797 infertile women were recruited for the study. Aetiologic factors and patterns of infertility data were extracted from the participants' case files. Chi-square test of association and logistic regression analyses were done to assess the significant association between studied aetiological factors and the pattern of infertility among them. RESULTS: The mean age of the participants was 32.9 ± 6 years. About a third of the participants had at least one form of menstrual disorder (35%), and fewer of them had PID (20.8%), obesity (14.2%), and hypertension (3.6%). More than half of them were with male partners with abnormal seminal fluid analysis results (55%). Regression analysis revealed that the most significant aetiological factor for the type of infertility among the patients studied was history of having had dilatation and curettage procedure (P < 0.001). CONCLUSION: The predominant aetiologic factor in the study was male factor infertility with more than half of the women married to men with abnormal seminal fluid parameters. This finding underscores the growing significance of male factor in the aetiology of infertility among Nigerian women.
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Factors influencing fear of cancer recurrence in breast cancer survivors: a multicenter cross-sectional study.

Liu W, Liu J, Su Y … +5 more , Ji X, Yu J, Zhang H, Chui PL, Che CC

BMC Womens Health · 2026 Jun · PMID 42310615 · Full text

PURPOSE: Fear of cancer recurrence (FCR) is a prevalent psychological concern among breast cancer survivors, and identifying influencing factors is crucial for designing effective interventions. We aimed to investigate t... PURPOSE: Fear of cancer recurrence (FCR) is a prevalent psychological concern among breast cancer survivors, and identifying influencing factors is crucial for designing effective interventions. We aimed to investigate the relationship of FCR with sociodemographic characteristics, clinical features, physical and psychological symptoms, and social support among survivors of breast cancer. METHODS: A cross-sectional study performed between November 2024, and January 2025. 387 potential participants were screened using convenience sampling. Fear of cancer recurrence, symptoms, and social support were assessed using the FCR Inventory-Short Form (FCRI-SF), the Memorial Symptom Assessment Scale (MSAS), and the Social Support Rating Scale (SSRS), respectively. Factors influencing FCR in survivors of breast cancer were determined using multiple linear regression. RESULTS: The findings revealed that age < 40 years (B = 3.505, p = 0.012), severe medical burden (B = 5.079, p < 0.001), tumor stage III (B = 4.309, p = 0.018), cancer diagnosis time of 6-12 months (B = 2.174, p = 0.014), and chemotherapy (B = 2.077, p = 0.031) were significantly associated with higher FCR. Endocrine therapy was positively associated with FCR scores, although this association did not reach statistical significance (B = 2.300, p = 0.054). Among the psychological factors, worrying (B = 2.213, p < 0.001) and feeling nervous (B = 0.880, p = 0.006) were significantly associated with higher FCR. Among the physical factors, "I do not look like myself" (B = 0.796, p = 0.010) and lack of energy (B = 0.662, p = 0.018) were also significantly associated with higher FCR. CONCLUSIONS: FCR in this population is influenced by age, medical burden, cancer stage, duration of cancer diagnosis, treatment methods, and physical and psychological symptoms. Although social support was not significant in this study, its potential role, as reported in previous literature, warrants further attention.
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