Current Women's Health Reviews - Volume 20, Issue 2, 2024

Background: The prevalence of functional ovarian cysts in women is high, and choosing an appropriate, and uncomplicated treatment is necessary. Objective: Compare the effectiveness of honey, olive, and propolis combined vaginal cream with OCP in the treatment of functional ovarian cysts in women of reproductive age in Iran. Methods: This randomized clinical trial study was performed on 40 women of reproductive age referred to Hamadan health centers in 2020. Patients were randomized into two groups, A and B. Group A received oral contraception pills for two consecutive cycles from the seventh day of the menstrual cycle tablets for 21 days after the end of menstruation until the beginning of the next menstruation. Group B received honey, olive, propolis combined vaginal cream. In both groups, the treatment continued for two consecutive cycles. Data was collected through a checklist that included clinical symptoms and ultrasound results. The results were analyzed by Stata-13 and the significance level cut-off was considered less than 0.05. Results: Intra-group comparisons showed that there was a statistically significant (P < 0.05) decrease in cyst size after the intervention in both groups. Intergroup differences were not statistically significant (P #131; 0.05). Conclusion: Honey, olive, propolis combined vaginal cream (Nika) can be effective like oral contraceptive pills in reducing the size of ovarian cysts. It can be recommended for the treatment of functional ovarian cysts.

Clinical practices vary significantly between countries, so healthcare providers must be aware of the differences in recommendations among guidelines to give the best care possible. It is up to the clinician to decide whether and to what extent to follow guidelines, based on each patient's special situation. This study aimed to review the updated evidence regarding practical aspects required for midwives to do postpartum care for mothers and newborns during COVID-19. The relevant guidelines in English were searched through databases including Cochrane Library, PubMed, EBSCO, and Scopus, from December 2019 to May 17, 2022, using keywords of ‘puerperium ‘, ‘newborn ‘, ‘2019- nCoV’ ‘SARS-CoV-2‘, ‘coronavirus ‘, and ‘guideline‘. Recommendation reports of WHO, FIGO, RCOG, UNFPA, CDC, and APA were also searched. Out of the 40 guidelines retrieved, 15 met the inclusion criteria. Postnatal care is divided into two general categories: maternal and neonatal care. The principles of postpartum care for maternal consisted of maternal assessment, venous thromboembolism prophylaxis, postnatal visits schedule, visitor restriction, vaccination, and postnatal mental support. Also, care for the neonatal included newborn assessment, visitation in the neonatal intensivecare units, breastfeeding, vaccination, circumcision, the decision for location and the separation of the newborn and mother, and discharge. During the COVID-19 pandemic, midwives and other maternal care professionals faced issues due to discrepancies between the guidelines of various global organizations. By obtaining recommendations and guidance and keeping up with the latest data, midwives can help women and their newborns get the best care possible.

Background: Serum periostin in cancer patients and chronic periodontitis (CP) is the lowest and could be linked to the association between CP and endometrial cancer (EC). Periostin is a matricellular protein secreted by fibroblasts associated with cancer and is also secreted in chronic inflammatory conditions such as CP. Objective: The aim of this study is to compare the GCF periostin level among CP, EC, and healthy people and the evaluation of the plausible role of periostin in this association. Methods: This case-control study was conducted on 80 participants including 20 people with both EC and CP (EC-CP), 20 only CP cases (H-CP), 20 only EC cases (EC-H), and 20 healthy people (H-H). Then, the gingival crevicular fluid (GCF) periostin levels for all the participants were measured through enzyme-linked immunosorbent assay (ELISA). Finally, the data were analyzed using Stata software version 11. Results: The mean value of periostin levels was significantly different between groups (p < 0.001) and the lowest and highest mean was observed in EC-CP and H-H groups, respectively. The mean of GCF periostin before treatment in the EC-CP group was 2.14 which was lower than that after treatment; however, this difference was not significant (p = 0.086). Also, the mean of GCF periostin in the H-CP group was 3.96 before non-surgical treatment and after treatment it significantly raised to 6.79 (p = 0.049). Conclusion: Periostin is a potential biomarker for CP diagnosis in EC patients and also can be used to prevent CP. However, further studies are required to confirm this role.

Background: Women with breast cancer in Iran face challenges requiring support. Yet the provision of support may have changed during the coronavirus disease 2019 (COVID-19) pandemic. Objective: The aim of the present study was to explore the perceptions of women with breast cancer about the support they received during the COVID-19 pandemic. Methods: This study was qualitative in nature. Semi-structured interviews were conducted with Iranian women with breast cancer. The interviews were transcribed verbatim and analysed via conventional content analysis. Results: Participants (n = 33) were Iranian women aged 29-58 years. All women included were married and were working in the role of a housewife. Women's perceptions of breast cancer during the COVID-19 pandemic of support were identified under two main categories; Constructive support and Lack of support. Sub-categories related to constructive support included receiving support from family, peers, and nurses. Sub-categories related to lack of support included a perceived lack of spousal and sociocultural support. Conclusion: Anti-stigma interventions (AS interventions) are suggested to increase both spousal and sociocultural support in this context. Further studies may usefully be conducted with the participation of Iranian women's family members in order to gain a deeper understanding of the support received and required by Iranian women with breast cancer during the COVID-19 pandemic and beyond.

Background: Having an only child has positive and negative consequences for the health of the child, mother, and family. However, when one-child families become the norm, the risks of negative long-term impacts increase. In Iran, couples now prefer to have one child. This paper reports on an investigation into the effectiveness of training based on the theory of planned behavior (TPB) on the pregnancy intention in women with one child. Methods: The trial was conducted in 2019 with 102 women with one child, who was supported by the Health Centers in Qom, Iran. They were randomly divided into two groups: TPB theory-based training (n = 52) and control (routine healthcare training, n = 50) groups. ANCOVA was used to compare the groups' post-training pregnancy intention and its theoretical antecedents. Results: Three months post-training, participants in the TPB group had higher pregnancy intention (η² = .4, P<0.001), attitude to having a second child (η² = .41, P<0.001), subjective (perceived) norm for having a second child (η² = .08, P<0.004), and perceived control for having a second child (η² = .35, P<0.001). The TPB-based training intervention increased women's awareness of the consequences of having an only child significantly more than routine training (P<0.001). Conclusion: Health center training can increase women's intention to have a second child. In this trial, theory-based training resulted in stronger pregnancy intention than participation in routine training. As health centers in Iran update their programs, this trial highlights the value of course design based on established theory.

Background: Domestic violence against women is defined as physical, sexual, and emotional abuse, that women experience. During the COVID-19 quarantine, homes have become very dangerous places for domestic violence against women. Methods: Following PRISMA guidelines, Medline, Scopus, Embase, Google scholar, and web of science were searched. Two independent authors screened all identified titles, abstracts, and relevant full texts for inclusion in the systematic review. 7 primary studies that were published between December 2019 and March 2021 were examined. The risk of bias in the retrieved articles was assessed by the Newcastle–Ottawa Scale. Results: During the COVID-19 lockdown, people have experienced different situations that lead to increasing aggressive behavior with possible trauma and violence, especially against women. Conclusion: During the quarantine of the COVID-19 pandemic around the world, we need programs aimed at preventing acts of domestic violence against women, such as trained multi-disciplinary staff, including psychologists, sexologists, and clinical psychiatrists.

Background: Maternal-infant attachment is the first social relationship between mother and baby that keeps the baby close to the mother. The conflicting results of the studies regarding the effect of kangaroo mother care (KMC) on maternal-infant attachment show the necessity of conducting a meta-analysis study. Objective: The study aimed to investigate the effects of KMC on mother-infant attachment through a systematic review and meta-analysis of randomized controlled trials. Methods: Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, ProQuest, SID, and Iranmedex databases were searched to find clinical trial studies in English and Persian without a time limit. The Cochrane checklist was used to check the bias of the articles. Data analysis was performed using STATA. I2 index was used in order to assess the heterogeneity, and the funnel plot and the Egger test were used in order to examine the publication bias. Standardized mean difference (SMD) and random effects models were used to combine the studies and perform a meta-analysis. Results: In this study, 10 articles were selected for the systematic review and meta-analysis. The results of the present meta-analysis based on the random model showed SMD as -1.33 (95% CI: (-2.12, - 0.54), P = 0.001), and there was observed a statistically significant relationship between the control and intervention groups. So, the mother-infant attachment in the intervention group was higher than in the control group. Conclusion: This study showed that KMC improves mother-infant attachment. The results of this study can be applied to evidence-based decision-making by healthcare providers, and can also be suggested as a method to develop mother-infant attachment.

Background: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of reproductive age. PCOS leads to metabolic dysfunction such as dyslipidemia, obesity, and glucose intolerance based on hyperandrogenemia, hyperinsulinemia, and dysregulated adipokine secretion. Objective: The aim of this study was to investigate whether a new marker, InsuTAG (fasting insulin×fasting triglycerides) could predict insulin resistance (IR) in patients of PCOS. Methods: In this study, retrospective data of 300 female patients diagnosed with PCOS were analyzed. The relationship between InsuTAG and HOMA-IR, TyG, and TG/HDL-C scores related to insulin resistance was evaluated. In addition, the distribution of the cases according to the cut-off values was determined. Results: Log-transformed forms of InsuTAG and HOMA-IR, TyG and TG/HDL-C results were positively correlated, respectively. (r = 0.85, p < 0.001; r = 0.78, p < 0.001; r = 0.72, p 0.001). Sensitivity, specificity, positive predictive value and negative predictive values for InsuTAG were calculated as 85%, 85%, 82% and 88%, respectively. Conclusion: This study is the first to compare the InsuTAG, another predictor of insulin resistance, with other IR markers in women with PCOS. InsuTAG is a novel biomarker based on plasma sampling of insulin and triglyceride, with minimally invasive, inexpensive and orientally accessible features.

Background: Cesarean scar pregnancy is one of the rare and challenging forms of ectopic pregnancy in treatment. Surgical and medical treatment options are available. Nevertheless, no approach is superior. Case Presentation: The present case reports a 29 years-old lady, presented with 12 weeks and 6 days, cesarean scar pregnancy without any symptoms, with a live fetus that underwent curettage two times. Conclusion: We can use curettage frequently for CSP treatment without methotrexate and, without side effects of other treatments.

Objective: Abdominal wall endometriosis (AWE) is a rare form of extragenital endometriosis that usually develops in association with a prior surgical scar. The purpose of the study was to review the clinical characteristics, diagnostic methods, treatment modalities, and outcomes of patients with AWE. Methods: A descriptive cross-sectional study was performed in a Gynecology Department of a Portuguese tertiary hospital, concerning patients with histologic-proven AWE, between January 2012 and December 2020 (n = 22). Statistical analysis was performed using IBM SPSS Statistics Version 27.00, with a significance level of p < 0.05. Results: The most common locations of extrapelvic endometrial ectopic implants were cesarean delivery scar (n = 13, 59.1%) and the umbilicus (n = 5, 22.7%). The median (range) age was 36 (30-42) years old, and all patients had a history of previous surgery but one. Nineteen patients had undergone a previous cesarean section, and the mean (range) time from surgery to the onset of symptoms was 100 (32-168) months. All patients were symptomatic and presented with a palpable mass at physical examination. The majority complained of a painful abdominal mass (n = 20, 90.9%) which was associated with cyclic pain in thirteen patients (65%). Ultrasound scan was performed in all patients and the nodules had a median size of 20.5 mm (5-93 mm). One patient received hormonal therapy and surgical resection was performed in the remaining patients. The nodule’s median (range) size was 31 (12-50) mm on gross examination. Conclusion: AWE should be considered in the presence of a previous pelvic surgery history associated with abdominal scar cyclic pain and swelling. A careful history and clinical examination are essential for diagnosis to avoid unnecessary delay before surgical intervention.

Background: Women with premature ovarian insufficiency (POI) have more difficulty concerning their physical and psychological health, indicating a need to provide adequate psychosocial and clinical support for these women to minimize the repercussion of this diagnosis on their activities and quality of life. Objective: To determine the predictors of quality of life in women with premature ovarian insufficiency (POI). Methods: This cross-sectional study was performed on 130 women with POI in Tabriz in 2021 by convenience sampling. Data were collected using the socio-demographic characteristics questionnaire, Spielberger state-trait anxiety inventory (STAI), Beck depression scale (BDI), female sexual function index (FSFI), and the World Health Organization quality of life questionnaire (WHOQOL). The adjusted general linear model was used to estimate the impact and determine the relationship between independent variables (socio-demographic characteristics, anxiety, depression, and sexual function) and dependent variables (quality of life and its domains). Results: The mean total score of quality of life was 46.3 (SD: 18.3) out of 0 to 100. The lowest mean score belonged to the social relations domain (35.6 (17.0)), and the highest mean score belonged to the physical health domain (40.0 (16.0)). Sexual function was one of the predictors of overall quality of life score, and all its domains except environmental health. Depression was one of the predictors of psychological health. Education was also a predictor of psychological and environmental health. Conclusion: Sexual function and mental health are directly related to the quality of life of women with POI.

Background: Preeclampsia affects pregnant women, resulting in stroke, organ failure, and other health problems like seizures. The effect of preeclampsia is most pronounced in developing countries and it affects about 4% of pregnant women causing several illnesses and even death. The key to solving the problem of preeclampsia is its early detection and use of machine learning algorithms that can take various demographic features, biochemical markers, or biophysical features, select important features and find hidden patterns that point to preeclampsia. Objective: The objective of this research is to develop a machine-learning framework to detect Preeclampsia in pregnant women. Methods: This research develops a model to detect preeclampsia using principal component analysis (PCA) as a feature selection, k-means as an outlier detection, a combination of SMOTE oversampling, random under sampling and the decision tree (DT) to classify and predict the risk of preeclampsia among pregnant women. The data was obtained from the University of Abuja Teaching Hospital, Abuja, Nigeria. Results: Findings revealed that the combination of the PCA, SMOTE and random undersampling and DT outcome resulted in the best accuracy of 96.8% which is better than the accuracy of existing work (92.1%). Furthermore, the reliability of the model was measured and tested using Bayesian Probability. Conclusion: The developed model can be helpful to Health care providers in checking preeclampsia among women with high blood pressure during their second antenatal visits.

Background: Ultrasound-guided sclerosis has been used to treat ovarian endometriotic cysts since 1988. However, compared with cystectomy, sclerotherapy's effectiveness and safety are questionable. Objective: To compare ultrasound-guided sclerotherapy and ovarian cystectomy in the treatment of ovarian endometriosis through a systematic review and meta-analysis. Methods: PubMed-MEDLINE, EMBASE, Cochrane, and Scopus databases were searched, and related literature was collected. The two treatments' recurrence rate, pain relief rate, pregnancy rate, technical success rate, and complication rate were directly compared. Results: Six studies (386 patients) were included. The risk of recurrence with sclerotherapy was higher than that with cystectomy (OR 1.57, p = 0.52). Subgroup analysis showed that an indwelling time > 10 min was not significantly different regarding recurrence risk between sclerotherapy and cystectomy (OR 1.01, p = 0.99). When the indwelling time was ≤ 10 min, the risk of recurrence with sclerotherapy was significantly higher than that with cystectomy (OR 22.01, p = 0.001). The pregnancy rate after cystectomy was lower than that after sclerosis (OR 1.67, p = 0.22). Complications in the study were graded according to the Clavien128;’Dindo classification and statistical analysis showed that the probability of serious complications (Grade III-V) with cystectomy was higher than that with sclerosis (16.67% vs. 0%). Conclusion: Ultrasound-guided sclerotherapy was not inferior to cystectomy in terms of recurrence rate or pregnancy rate, and the incidence of severe complications was lower than that in the cystectomy group. Sclerotherapy is a safe and effective alternative treatment for ovarian endometriosis.

Pregnancy, childbirth, and becoming a parent cause different physical, mental, and social changes, so it is a critical life period for women. The well-being of the perinatal period, in which this complex and unique process is experienced, contains different characteristics from the general population. Therefore, the importance of conceptualizing the concept of “perinatal well-being” and defining the relevant dimensions has recently gained attention. The potential to develop a tool to measure the concept, along with the conceptualization process adequately, makes this subject remarkable.

Background: Implant as long-acting reversible contraception (LARC) is ideal for Indonesian women. Two-rod implant (2x75mg levonorgestrel) is the most common implant used in Indonesia. Another alternative method is a one-rod implant (1x150mg levonorgestrel). Objective: This study evaluated the effectiveness, changes in body weight (BW), and menstrual cycle between the one-rod and two-rod implant acceptors. Methods: This study was an RCT design with phase II clinical trials; 179 subjects were recruited. Subjects were met with inclusion and exclusion criteria and divided into one-rod and two-rod groups. The variables were evaluated within 12 months. Results: This study involved 70 subjects in the one-rod implant group and 66 subjects in the two-rod implant group. At 12 months, there were no differences between the effectiveness of the two types of contraception, and pregnancy was reported in 1.26% vs 1.31%. The concentration of levonorgestrel in the one-rod group was 0.31 ng/dL as the median (IQR: 0.33 ng/dL) and 0.34 ng/dL as the median (IQR: 0.33 ng/dL) in the two-rod group (p = 0.438). The BW in the two-rod group increased significantly in month six (p = 0.035) and twelve (p = 0.017) but not in the one-rod group. Menstrual cycle changes occurred in 51.4% of subjects and 57.6% of subjects in the one- and two-rod groups (p = 0.584), respectively. Conclusion: At 12 months, one-rod and two-rod implants had similar effectiveness and concentration of levonorgestrel. Significant weight gain happened in the two-rod group, and the weight gain increased in months six and twelve. Menstrual cycle changes have occurred in both.

Introduction: Leptin hormone is produced by adipose tissue and soluble leptin receptor (sOB-R) influences leptin's free bioavailability. Obese individuals have unusually elevated leptin levels. Obesity influences insulin and other hormone levels and is a key risk factor for developing polycystic ovarian syndrome (PCOS) and mutations such as rs2025804 and G2548A (rs7799039). PCOS is a hormonal condition that affects females of reproductive age primarily. Although there is no known cause of PCOS, studies have linked it to various factors, including insulin resistance, obesity, and genetics. Till now, research indicates a substantial correlation between leptin and female reproductive hormones, and PCOS. Thus, the purpose of this study is to compile the available data for a better understanding of the link between leptin and its effect on female reproductive hormones and PCOS and to determine whether the leptin receptor polymorphism (LEPR) influences the start of PCOS. Methods: Following a review of the relevant papers, it was determined that there is an association between leptin and female reproductive hormones such as luteinizing hormone (LH), folliclestimulating hormone (FSH), estradiol (E2), progesterone, and prolactin. It was observed that Gln223Arg (Q223R/rs1137101), Pro1019Pro (A3057G), Lys109Arg (K109R/rs1147100), rs2025804, and G2548A (rs7799039) are the LEPR polymorphisms associated with PCOS. Gln223Arg is the most frequently studied variant in the LEPR gene across populations. Results: Interestingly, different groups demonstrated varying relationships between leptin receptor polymorphisms and PCOS, particularly for Gln223Arg, which contains two alleles (G allele and A allele). The G allele was protective against PCOS in the Korean population but increased the frequency of PCOS in countries such as Bahrain, India, Iran, and Iraq. There was no significant difference between PCOS and controls with this polymorphism in places such as China, Turkey, Saudi Arabia, and Helsinki. Conclusion: To summarize, the association between multiple leptin receptor polymorphisms and PCOS is complex and varies by research region. There hasn't been much research done on the gene polymorphism "Gln223Arg" or the other polymorphisms. While certain research findings were notable, each came with its limitations. As a result, additional interventional studies, including precise criteria in bigger and more diverse groups, are required.

Background: Pharmacological treatment influence men and women in distinct ways. Over the last decade, pharmacological research has significantly enhanced our understanding of many elements determining medicine prescription. The objective of this study is to carefully assess the clinical pharmacokinetic studies involved female subjects in India. Methods: We conducted a systematic review to assess clinical trial records’ pharmacokinetic data in the female population of all age groups. The keywords ‘pharmacokinetics’ or ‘pharmacokinetic parameters’ or ‘bioavailability’ was used in the clinicaltrials.gov website and clinical trial registry of India [CTRI] website to find eligible clinical trials or records carried out between January 1, 2000 and June 30, 2022. Interventional studies, pharmacokinetics, pharmacokinetic parameters, bioavailability, female participants, India were all included in an advanced search filter on the two websites. Results: In a total of 714 records, 17 (2.4%) records of interventional clinical trials with pharmacokinetic data involving the female population were assessed. All 17 trials were conducted in 15 research settings, with 27.3% of studies conducted in Maharashtra, followed by Karnataka (12.7%) and New Delhi (9.1%). A total of 30 pharmacokinetic parameters were studied in trials with peak concentration (C max) and area under the curve (AUC) of plasma or tissue concentration, accounting for 23.3% of the trials. The majority of drug trials focused on treating neoplasms accounted for 14 trials (76.4%). Conclusion: This review provides an overview of the current status and gaps in pharmacokinetic research in female populations. More studies should be conducted to properly examine the often limited data available on pharmacokinetic studies to guide trial design to make future clinical trials feasible and economical.