To analyse the impact of a comprehensive range of menstrual symptoms-including various physical and psychological symptoms associated with menstruation-on work productivity and quality of life (QoL). A cross-sectional study. A menstrual cycle tracking application in Japan; current app users were recruited via in-app notification provided electronic informed consent from June to August 2022. Japanese women who have experienced menarche. Menstrual Distress Questionnaire (mMDQ) was used to determine severity of menstrual symptoms, and participants with mMDQ score ≥ 103 were grouped as severe. Work productivity was assessed using the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH), and QoL was measured using the 36-Item Short Form Survey version 2 (SF-36v2). Differences in absenteeism, presenteeism, overall work impairment and activity impairment on the WPAI-GH between the severe and normal groups; differences in the summary scores of the SF-36v2; correlation coefficients between scores of symptom groups of the mMDQ, WPAI-GH and the summary scores of the SF-36v2. Overall, 456/1988 (23.0%) women had severe mMDQ scores (≥ 103). The median overall work impairment was 30% higher in the severe group than in the normal group. In multiple regression analysis, mMDQ severity was significantly associated with increased absenteeism, presenteeism and activity impairment, as well as reduced mental and social QoL. Negative affect, impaired concentration and behaviour change were associated with greater presenteeism, while pain showed weaker correlations. Negative affect was strongly associated with reduced mental QoL. Our findings demonstrate that, in addition to pain, mental and psychosocial symptoms are significantly associated with both work productivity and QoL.

Breast cancer incidence has historically been higher in Western countries; however, rates have increased substantially in East Asia, with variation by age and generation. Direct comparisons between native Asians and their US counterparts remain limited. We examined the effects of age-period-cohort (APC) on breast cancer incidence among native Japanese women, with comparisons with Japanese Americans, native Korean women, Korean Americans, and US White and Black women. We analyzed population-based cancer registry data from Japan (1985-2019), Korea (1993-2017), Hawaii (1988-2017), Los Angeles County (1988-2017), and Surveillance, Epidemiology, and End Results 8 (1985-2019). Women 25 to 84 years of age were grouped into 5-year age groups and calendar periods, and APC analyses were conducted using the NCI APC web-based tool. Incidence increased with age in all populations; however, the patterns differed. Native Japanese and Koreans had the lowest overall rates with an early-midlife peak, whereas Japanese Americans resembled US Whites, with incidence increasing into older ages. Period and cohort effects were strongest among native Japanese and Koreans, with sustained increases among women born after 1950. Annual incidence increases were highest among native Koreans (5.3%) and native Japanese (3.8%), followed by Korean Americans (2.8%) and Japanese Americans (1.6%), whereas US Whites were stable or declining and US Blacks showed modest increases. These findings indicate an ongoing epidemiologic transition in East Asia and demonstrate how migration and generational change shape breast cancer risk across populations. Direct comparison of native and US Asian populations reveals migration-related divergence in breast cancer risk.

Association of premenstrual syndrome and premenstrual dysphoric disorder with suicidal ideation and violence toward family members in Japan.

Lipoprotein glomerulopathy (LPG) is a rare hereditary glomerular disease characterized by lipoprotein thrombi within dilated glomerular capillaries for which effective treatments remain limited. This report concerns a 25-year-old Japanese woman with an 8-year history of persistent proteinuria and severe dyslipidemia who presented with heavy proteinuria (3.31g/gCr) despite preserved renal function. Kidney biopsy revealed features typical of LPG on light and electron microscopy, and serum apoE levels were markedly elevated. The patient was started on pemafibrate, a selective peroxisome proliferator-activated receptor-alpha modulator known to exert stronger triglyceride-lowering effects and to have a more favorable hepatic and renal safety profile compared with conventional fibrates. Following treatment, the patient's triglyceride levels decreased substantially and her proteinuria progressively improved. Complete remission (0.05g/gCr) was achieved within 7months, and she remained stable thereafter. Although partial remission with fibrates has been previously reported in patients with LPG, there have been no reports of complete remission in those treated with pemafibrate. To our knowledge, this is the first documented case of complete remission of proteinuria induced by pemafibrate in a patient with LPG. Pemafibrate may be a promising targeted therapy for this rare glomerular disorder.

Obstructive sleep apnea (OSA) is common during pregnancy, and maternal intermittent hypoxemia has been suggested to affect fetal growth. However, diagnosis-based risk assessment and research in East Asian pregnant women remain insufficient. In this study, we aimed to clarify the prevalence of sleep-disordered breathing in Japanese pregnant women and to examine its association with neonatal outcomes. We included 185 pregnant women aged ≥ 20 years and their newborns. A questionnaire was administered, and sleep evaluation was performed using a portable monitoring device (WatchPAT) at ≥ 28 weeks of gestation. OSA severity was classified, based on the apnea-hypopnea index (AHI), as mild (5 ≤ AHI < 15), moderate (15 ≤ AHI < 30), and severe (AHI ≥ 30). Neonatal physical growth was evaluated at birth and compared between the OSA (AHI ≥ 5) and non-OSA groups. The prevalence of OSA (AHI ≥ 5) was 15.7%, comprising 23 mild (5 ≤ AHI < 15), 5 moderate (15 ≤ AHI < 30), and 1 severe (AHI ≥ 30) cases. Pre-pregnancy weight and body mass index (BMI) were significantly higher in the OSA group than in the non-OSA group, whereas the rate of BMI change during pregnancy was significantly lower. Regarding neonatal outcomes, no significant differences in physical growth or gestational age at delivery were observed between the two groups. This study provides insights into the phenotype of pregnancy-related OSA in a lean Japanese population, where OSA may develop at lower BMI levels than those reported in Western cohorts.

BackgroundTo improve the management of premenstrual disorders, it is important to understand the prevalence of symptoms and their relationship with age among patients seeking treatment.MethodsIn this retrospective cross-sectional study, we investigated the prevalence of 31 premenstrual symptoms among 199 patients (aged 20-49 years) who visited a gynecology clinic seeking treatment for premenstrual symptoms between November 2022 and May 2023. We also compared symptom prevalence across age groups.ResultsWomen in their 20s comprised the largest group, with 89.9% reporting dysmenorrhea. Fatigue (71.9%) and mood swings (70.9%) were the most prevalent moderate-to-severe symptoms, with psychological symptoms reported more frequently than physical symptoms. Multivariable logistic regression analysis showed that, compared with women in their 20s (reference group), those in their 40s had significantly lower odds of experiencing changes in appetite (adjusted odds ratio [aOR]:0.10), overeating (aOR:0.19), and specific food cravings (aOR:0.09), independent of potential confounders.ConclusionsPsychological symptoms were the most common among gynecological patients seeking treatment for premenstrual disorders. Eating-related symptoms differed by age group. Future longitudinal studies using validated prospective symptom records are warranted.

The ability to produce equol varies considerably among individuals due to differences in gut microbiota. Bile acids exert strong selective pressure on the intestinal microbiota, and their profiles in feces are considered to reflect the overall intestinal environment. However, the relationship between fecal bile acid profiles and human equol production has not yet been established. In this study, we investigated the association between equol production and fecal bile acid profiles in 15 young Japanese women. Following approximately one year of 24 h urine analyses conducted at 1-2 month intervals, four participants were classified as equol producers, ten as non-producers, and one as a crosser. Although 14 participants exhibited stable equol production status during the interventional trial, the composition of individual urinary daidzein metabolites, including equol, varied over a relatively wide range. Cluster analysis classified fecal bile acid profiles into primary and secondary bile acid-dominant groups. No equol producers were included in the primary bile acid-dominant group, whereas all equol producers were included in the secondary bile acid-dominant group. Therefore, bile acids are likely one of the key factors influencing equol production ability in humans.

BackgroundTo investigate the association between menstrual-related disorders and sexually transmitted infections (STI) among young women in Japan, and to examine differences according to disorder type and hormonal therapy use.MethodsThis cross-sectional study used the Japan Medical Data Center Claims Database and included women younger than 40 years who had at least one healthcare visit in 2023. Menstrual-related disorders were defined as endometriosis or dysmenorrhea based on ICD-10 codes. The prevalence of five STIs—gonorrhea, genital chlamydia infection, trichomoniasis, genital herpes, and other sexually transmitted conditions—was compared between women with and without menstrual-related disorders. Subgroup analyses were conducted for endometriosis, dysmenorrhea, and hormonal therapy (low-dose estrogen–progestin combinations or dienogest). Prevalence ratios (PR) and prevalence differences (PD) with 95% confidence intervals (CI) were estimated.ResultsAmong 3,440,929 women, 257,897 (7.5%) had menstrual-related disorders. All STI were substantially more prevalent in this group than in women without menstrual-related disorders, with PRs ranging from 4.31 to 5.29. Endometriosis showed the highest prevalence, particularly for genital chlamydia infection (4.98%; PR 7.44). Dysmenorrhea was also associated with consistently elevated STI prevalence. Among women with menstrual-related disorders, STI prevalence differed only slightly according to hormonal therapy use, with differences generally within one percentage point.ConclusionMenstrual-related disorders were strongly associated with increased diagnosis of STI in Japanese young women. These findings highlight the importance of integrating STI screening and reproductive health education into routine gynecologic care for women with endometriosis or dysmenorrhea. The influence of healthcare-seeking behavior and diagnostic patterns should be considered when interpreting claims-based STI data.

Women's delayed childbearing results in negative effects on maternal health and may restrict women from achieving their reproductive goals. By the age of 30 years, Japanese women are typically in the process of acquiring a more autonomous and fulfilling work status. Conversely, this is also the time when women experience a decline in fertility. Therefore, it is necessary to explore how reproductive and career visions affect intentions and behaviors toward the Reproductive Life Plan (RLP) to build support for achieving their reproductive goals. The objective of this study was to examine the associations between RLP and the reproductive and career visions of employed, married, and childless Japanese women in their 30s. We administered a questionnaire comprising 29 items on RLP (i.e., pregnancy timing considerations and attitudes favoring pregnancy delay), reproductive and career visions, and participants' demographics. A multi-logistic regression analysis was used to explore the factors influencing "absence of pregnancy timing consideration" and "attitude favoring pregnancy delay." Approximately half of the participants had completed a university education, most of them were in non-management positions, and 36.1% were working 40 h or more per week. The average number of desired children was 1.7 ± 0.6. The factor "absence of pregnancy timing consideration" was associated with education, marriage duration, infertility concerns, self-perceived pregnancy probability, the number of desired children, and the intention to return to work after delivery. "Attitude favoring pregnancy delay" was associated with infertility concerns, scores of fertility knowledge, the interval between the ideal age for the first pregnancy and current age, the number of desired children, and working more than 40 h per week. Absence of pregnancy timing consideration" and "Attitude favoring pregnancy delay" were associated with different factors. Developing support systems for RLP, including the development of reproductive and career visions, will help prevent delayed childbearing among employed, married, and childless Japanese women in their 30s.

IntroductionIn the USA, studies often show that immigrants exhibit relatively favourable perinatal outcomes compared with their US-born counterparts of the same race/ethnicity, despite socioeconomic and language barriers in healthcare. However, studies with individuals in their home country are limited.Methods and resultsWe analysed 32 028 Japanese who gave singleton births from two data sources: the US vital statistics records (N=19 462) and the Birth and Three-Generation Cohort Study conducted by the Tohoku Medical Megabank Organization (N=12 566) between 2015 and 2017. The US data were divided into two groups based on nativity: the first generation and the second generation and later. Using Japanese women who delivered in Japan as the reference, associations between nativity and perinatal outcomes were evaluated using regression models, with analyses stratified by pre-pregnancy body mass index category. The ORs (95% CI) of preterm birth were higher among Japanese women in the USA (the first generation: 1.20 (1.15 to 1.33); the second generation and later: 1.40 (1.28 to 1.54)), as were the ORs of macrosomia (1.71 (1.48 to 1.98) and 1.98 (1.68 to 2.32), respectively). In contrast, the ORs of term or post-term low birth weight were lower among Japanese women in the USA (0.77 (0.71 to 0.84) and 0.81 (0.71 to 0.91), respectively). The association of nativity on the ORs of low birth weight differed depending on the term of birth.ConclusionsJapanese immigrants to the USA have heterogenous risk of perinatal outcomes compared with Japanese who remain in Japan. Including home country data in immigration studies may provide a more detailed understanding of the impact of immigration on their perinatal outcomes.

Nearly 50% of Japanese women report impaired work performance due to menstrual symptoms. Our objectives were to describe the real-world experiences of patients living with dysmenorrhea with a focus on work productivity and its association with treatments. Our exploratory objective was to understand the coping methods for menstrual pain in Japanese women. Using an anonymized database consisting of linked Japanese health insurance claims and Work Productivity and Activity Impairment Questionnaire - General Health (WPAI-GH) responses for women aged between 18 and 50 years, we conducted descriptive analyses of work productivity impact among patients with dysmenorrhea, other chronic diseases and individuals without medical records. Analysis of work productivity impact was conducted per dysmenorrhea treatment. The analyses were descriptive and unadjusted thus the generalizability and external validity of differences between conditions and treatments are limited. Among 9,235 individuals in the employer-sponsored insurance claims database, 956 (10.4%) had diagnosed dysmenorrhea. The unadjusted mean WPAI-GH scores for the dysmenorrhea patient population demonstrated absenteeism at 2.5 ± 0.3% (mean ± standard error) and presenteeism at 26.8 ± 0.9%, similar to groups with mental disorders, headaches, or low back pain. Dysmenorrhea patients receiving low-dose estrogen progestin, also known as combined oral contraceptives, was the largest treatment group and had the lowest mean absenteeism and presenteeism scores among treatment groups in this unadjusted descriptive analysis. In 5,471 respondents who responded on coping methods for menstrual pain, 2,250 (41.1%) used over-the-counter medications, while 329 (6.0%) sought medical care. The productivity impact observed in patients with dysmenorrhea was substantial and found to be similar to that of patient groups with major chronic conditions such as mental disorders, headaches, and low back pain. We further found that dysmenorrhea patients' productivity outcomes varied across treatment groups. Whilst prospective studies with adjustment for confounding factors are needed to establish the generalizability of differences between treatment- and condition-based subgroups, our findings underscore the need for greater awareness of dysmenorrhea as a condition that deserves medical attention, and timely medical care may help reduce the burden and improve the quality of life.

Clozapine can trigger early inflammatory adverse reactions ranging from transient fever to organ-dominant syndromes. It remains unclear whether this spectrum can also present as a systemic adult-onset Still's disease (AOSD)-like phenotype. A 54-year-old Japanese woman with long-standing treatment-resistant schizophrenia, psychogenic polydipsia with water intoxication, and overweight/obesity underwent olanzapine-to-clozapine cross-titration. Under the standard Japanese Clozaril Patient Monitoring Service procedure, clozapine was increased to 75mg/day by day 23. Psychosis improved, but on day 27 she developed spike fever to 39.2°C and fever-associated arthralgia. Infection was initially suspected, and empiric piperacillin/tazobactam was started while clozapine was continued because no neutropenia, marked eosinophilia, or severe organ-dominant reaction was evident. During days 27-30, no infectious focus was identified, and an evening spike-fever pattern with arthralgia and sore throat increased suspicion for clozapine-associated inflammation. Ferritin and interleukin-18 (IL-18), an autoinflammatory cytokine associated with Still's disease, were measured after a Still-like phenotype was suspected. Clozapine was discontinued on day 35. However, the syndrome evolved with recurrent fever up to 40.2°C, evanescent rash, edema/hypoxemia, neutrophil-predominant inflammation, hypoalbuminemia, ferritin elevation, and serial IL-18 increase from 470 pg/mL on day 33 to 1,160 pg/mL on day 49. Infection, established autoimmune disease, drug reaction with eosinophilia and systemic symptoms, and neuroleptic malignant syndrome were not favored. Overt myocarditis was not supported by normal troponin/creatine kinase and nonspecific electrocardiographic findings, but echocardiography was not performed. She fulfilled Yamaguchi and Fautrel classification criteria for AOSD-like illness. Consequently, hydrocortisone and supportive care were used, and no further spike fever occurred after day 49. This case expands the clozapine inflammatory spectrum to a systemic AOSD-like phenotype with marked serial IL-18 elevation. When spike fever with systemic inflammation emerges during clozapine titration, early temporary interruption of clozapine should be considered, and persistent Still-like inflammation after discontinuation may warrant anti-inflammatory supportive treatment, including corticosteroids in selected cases.

ObjectivesA self-care smartphone application, JoyHer Pro, was developed to support midlife women experiencing menopausal symptoms by providing daily symptom tracking, personalized healthcare plan recommendations, and educational content. A proof-of-concept study was conducted to explore its feasibility and preliminary impact.MethodsThis single-arm pre–post study simulated a health checkup–based model of digital intervention. Ninety-one Japanese women aged 45–55 years with moderate menopausal symptoms used JoyHer Pro for six months. The primary outcome was the change in total scores on the scaled Questionnaire for the Assessment of Climacteric Symptoms in Japanese Women (sQACS) from baseline to six months.ResultsThe six-month follow-up rate was 96%. Participants recorded symptoms on a median of 165 days (90% of the study period) and logged self-care activities on 59% of days. They accessed a median of 42 educational topics (72% of available content). The total sQACS score significantly decreased from baseline to three and six months (both p < 0.001). Participants also reported improvements in their perception and attitude toward menopause, as well as greater self-assessed knowledge and coping ability. Some participants newly sought or planned medical consultation following app use.ConclusionThis proof-of-concept study suggests that JoyHer Pro is a feasible digital self-care support tool for midlife women with menopausal symptoms and may provide a basis for future research on integrating digital interventions into preventive care and public health strategies.

Attitudes toward life and death often shift during the perinatal period. However, previous research has been qualitative or cross-sectional, leaving longitudinal patterns largely unexplored. This study examined changes in attitudes toward life and death among Japanese women from pregnancy to eight months postpartum. A total of 1,464 women completed an online questionnaire assessing sociodemographic variables and attitudes toward life and death, and 496 completed the same questionnaire approximately three months later. Linear mixed-effects models indicated modest but significant increases in Fear of Death and Concern for Others after Death across the perinatal transition. Analyses restricted to participants who completed both surveys yielded similar results. These associations remained after adjustment for age, educational attainment, religious faith, and bereavement experience. The findings suggest that the transition to motherhood may be associated with shifts in specific attitudes toward life and death, particularly Fear of Death and Concern for Others after Death.

Acrodermatitis continua of Hallopeau (ACH) is a rare, localized variant of pustular psoriasis characterized by painful paronychia. It primarily affects the distal phalanges and is frequently refractory to standard topical treatments. Establishing an optimal systemic therapy is clinically challenging, particularly for women of childbearing age, given the teratogenicity of retinoids and methotrexate, as well as the adverse effect profiles associated with cyclosporine. Herein, we present two cases of Japanese women in their 30s with recalcitrant ACH who were treated with apremilast. In Case 1, erythema and pain resolved within two months. In Case 2, while skin lesions responded favorably, persistent joint symptoms and headaches necessitated a switch to risankizumab. To evaluate broader utility, we analyzed 10 ACH cases (our two and eight from literature). Clinical efficacy for skin lesions was observed in 90% (9/10), and the response rate for joint pain reached 80% (4/5), with a median response time of 2 months. Notably, apremilast also demonstrated a favorable safety profile even with comorbidities like viral hepatitis. Although 30% of patients experienced mild adverse events (e.g., nausea, headache), the medication was generally well-tolerated. While this review is limited by potential publication bias inherent to case reports, and treatment responses vary, with one study showing limited efficacy, apremilast may be considered among systemic treatment options. Given its non-teratogenic nature and cost-effectiveness compared to biologics, we recommend apremilast as one of the first-line systemic treatment options for ACH patients resistant to topical regimens, especially those of childbearing potential.

To assess the reliability and validity of the Japanese version of the Menopause Rating Scale (MRS). The English-language version of the MRS was translated into Japanese using recommended methodology. A cross-sectional, web-based survey was conducted among 1,600 Japanese women aged 45-60 years. Participants completed the Japanese MRS, 36-Item Short Form Health Survey (SF-36), Hospital Anxiety and Depression Scale, and modified Kupperman Index. Psychometric properties included internal consistency, test-retest reliability, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), criterion-related validity, and receiver operating characteristic (ROC) analysis. The Japanese MRS exhibited high internal consistency (Cronbach's α = 0.884) and excellent test-retest reliability (intraclass correlation coefficient = 0.834). According to the EFA, three factors, similar to those of the original MRS, were identified for the Japanese version, accounting for 66.8% of the total variance. CFA supported the original three-factor structure of the MRS, demonstrating acceptable model fit (comparative fit index = 0.930, root mean square error of approximation = 0.081). Regarding criterion-related validity, the MRS Psychological subscale showed a strong negative correlation with the SF-36 Mental Component Summary (r = -0.604) and a weak negative correlation with the Physical Component Summary (r = -0.256), indicating robust convergent and discriminant validity. Furthermore, the ROC analysis revealed high diagnostic accuracy of MRS for detecting severe menopausal symptoms (area under the ROC curve [AUC] = 0.894). The Japanese version of the MRS is highly reliable, valid, and can be used to evaluate menopausal symptoms and quality of life in women in menopause.

Endometriosis symptoms often first appear during adolescence, yet delays in seeking gynecologic consultation remain a persistent challenge worldwide. Despite growing international evidence, the specific patterns of symptom recognition and consultation delay among Japanese women - particularly in relation to self-monitoring behaviors and cultural barriers - remain poorly understood. This study aimed to provide foundational data to guide menstrual education and preconception care strategies by conducting a cross-sectional online survey with retrospective recall among women with endometriosis to assess menstrual characteristics and symptom patterns from adolescence to initial care seeking. The survey was conducted in Japan in January 2024 and enrolled 166 women with endometriosis and 200 controls. Participants reported current and adolescent menstrual characteristics, symptom recognition, analgesic and low-dose estrogen-progestin use, school/work impact, and age at first gynecologic consultation for menstrual problems. Women with endometriosis reported heavier bleeding, stronger pain, and greater school/work absence than controls, both currently and retrospectively. The median age at first recognition of heavy bleeding or school/work absence was 16 years, whereas consultation occurred at approximately 21-23 years, indicating a consultation delay of 5-6 years. Notably, while self-monitoring of symptoms was more frequent among women with endometriosis, it only modestly shortened consultation delays. This study provides evidence from Japan that consultation delay persists despite active self-monitoring of symptoms, highlighting the influence of educational and cultural barriers on health-seeking behavior. These findings underscore the importance of integrating menstrual education with clinical guidance to promote timely gynecologic consultation.

Background/Objectives: The objective of this study is to evaluate whether maternal genetic variants previously associated with gestational duration in European-ancestry populations are associated with gestational duration in Japanese women. Methods: We analyzed 347 women with a history of delivery from a community-based cohort in Aomori Prefecture, Japan. Gestational age at first delivery (weeks) was obtained from the Maternal and Child Health Handbook. Four representative maternal single-nucleotide polymorphisms were analyzed: rs2946169 near EBF1, rs2955117 in/near EEFSEC, rs12037376 in/near WNT4, and rs9861425 in/near ADCY5. Maternal genotype data were obtained from existing Japonica Array data generated as part of the Iwaki Health Promotion Project. Associations with gestational age at first delivery were tested using linear regression under an additive genetic model, adjusted for maternal age at first delivery. A Bonferroni-corrected threshold of p < 0.0125 was applied for four SNPs. Results: Mean gestational age at first delivery was 39.4 weeks. Each additional rs2946169 T allele was nominally associated with shorter gestation (adjusted β = −0.2679 weeks per allele; p = 0.021), but this association did not remain significant after Bonferroni correction. No significant associations were observed for rs2955117, rs12037376, or rs9861425. Conclusions: These findings provide suggestive evidence that maternal variation at the EBF1 locus may be related to gestational duration in Japanese women. However, the association did not remain significant after multiple-testing correction, and larger studies are needed to confirm this finding and clarify population-specific genetic effects.

Consultation rates, comorbidities, and prescriptions for menopausal disorders among Japanese working women: a descriptive study using a nationwide administrative insurance claims database.

Mycoplasma genitalium infection and pelvic inflammatory disease: A 12-month prospective study in Japanese women.