Associations between pollutants, the regularity of daily sex hormone patterns, and hormone profiles over a complete menstrual cycle.

Burden of anemia in women with uterine fibroid-associated heavy menstrual bleeding.

Navigating benign gynecological care in a pandemic: A qualitative exploration of patient experiences during COVID-19.

Measurement of medicationabortion-related bleeding: A systematic scoping review.

To investigate performance, recovery, sleep, nocturnal physiology, ovarian hormone concentrations, and menstrual cycle symptoms within and between menstrual cycle phases and establish within-phase reliability of these measures. Twenty naturally cycling, trained female participants (age 27 ± 5 yr) completed a repeated measures study design. Serum estradiol and progesterone concentrations, countermovement jumps, isometric mid-thigh pulls, a repeated 5 km cycle time trial, and two nights of sleep architecture were measured in phases one, three, and four of two menstrual cycles. Sleep and wake measures from activity monitoring, nocturnal heart rate (HR) measures from the Oura Ring, and menstrual cycle symptoms were monitored daily. Statistical analyses included linear mixed models and reliability measures. Estradiol concentrations were significantly lower in phase one versus three, one versus four, and three versus four ( P < 0.001 to 0.04) in both menstrual cycles. Progesterone concentrations were significantly lower in phase one versus four, and three versus four ( P < 0.001) in both menstrual cycles. Symptoms were significantly higher in phase one versus three and four ( P < 0.001) in cycle one only. No significant differences between phases were found for performance, recovery, and sleep in either cycle, except for the nonrapid eye movement stage three (N3%) sleep in cycle two. Nocturnal average HR was significantly lower ( P < 0.001) and HR variability higher ( P < 0.001) in phase one versus four in both cycles. Ovarian hormone concentrations were highly variable within each phase (coefficients of variance 28%-95%), while performance and recovery demonstrated minimal variability in both cycles. Performance, recovery, and sleep in trained female participants remained consistent despite ovarian hormone fluctuations. Consequently, practitioners should test athletes when convenient, using accurate and reliable assessments rather than synchronizing testing with specific menstrual cycle phases.

Females are underrepresented in research often due to concerns about potential variability introduced by the menstrual cycle. Although the cycle influences motor output, these effects are small and inconsistent, and are rarely interpreted relative to sex-related differences. This review compares sex and menstrual cycle effects on motor output, and we hypothesize sex-related differences have a substantially larger influence on motor output than the menstrual cycle.

Evidence linking menstrual characteristics to knee-related functional measures in female athletes remains inconsistent, partly due to an emphasis on menstrual phase without adequate consideration of cycle regularity. This study examined associations between menstrual cycle regularity, neuromuscular activation variables, and Dynamic Postural Stability Index (DPSI) measures across standardized menstrual phases. A longitudinal repeated-measures study was conducted among 90 female athletes (46 with regular cycles and 44 with irregular cycles). Participants were assessed during the early follicular, ovulatory, and mid-luteal phases across three consecutive menstrual cycles. DPSI was used to assess dynamic postural stability, while quadriceps activation latency and hamstring-to-quadriceps co-contraction ratio were assessed using surface electromyography. Linear mixed-effects models were used to examine group, phase, and interaction effects, adjusting for age and training volume. Athletes with irregular cycles demonstrated higher DPSI values overall compared with athletes with regular cycles (β=+0.05, 95% CI: 0.01-0.09; p=0.012). No significant main effect of menstrual phase was observed; however, significant group×phase interactions were identified, with the largest between-group differences occurring during the ovulatory phase. Athletes with regular cycles demonstrated shorter quadriceps activation latency and higher hamstring-to-quadriceps co-contraction ratios across phases. Menstrual cycle regularity was significantly associated with DPSI values (r=-0.38, p<0.001). Menstrual cycle regularity was associated with DPSI and neuromuscular activation variables across menstrual phases. These findings support the consideration of cycle regularity as a stratification variable in future studies examining knee function-related outcomes in female athletes.

To assess the accuracy of using the last menstrual period (LMP) date for determining gestational age, compared with ultrasonography, among patients aged younger than 16 years at British Pregnancy Advisory Service (BPAS), a large national abortion service in England and Wales. This evaluation was undertaken in the context of national discussion and guidance about adolescent no-test medication abortion access. We analyzed routinely collected gestational age data for all patients younger than 16 (herein referred to as adolescents) who underwent abortion at BPAS between May 1, 2021, and April 30, 2024. We compared gestational age from ultrasonography (reference) to that from LMP date, overall and by eligibility for no-test medication abortion (where ineligibility was indicated by an unknown gestational age or gestation that exceeded 69 days). We calculated diagnostic measures of accuracy that included sensitivity, specificity, and proportion of false-negative results. For a subsample, we incorporated additional menstrual history indicators into a composite screening variable and recalculated measures. During the evaluation period, 1,555 adolescents underwent abortion; 1,282 (82.4%) provided an LMP date. On average, LMP dating overestimated gestational age by 3 days compared with ultrasonography. When using the LMP date alone, the sensitivity for correctly detecting ineligible patients was 86.6% (95% CI, 82.5-90.1) and the specificity for correctly identifying eligible patients was 78.8% (95% CI, 76.4-81.1). The proportion of false-negative results (patients incorrectly classified as eligible) was 2.8% (95% CI, 2.0-3.7). With the composite measure, sensitivity rose to 93.9% (95% CI, 90.8-96.2, P <.05) but specificity declined to 54.2% (95% CI, 51.4-57.0). The false-negative proportion reduced to 1.3% (95% CI, 0.7-1.9), including 0.5% with a gestational age beyond 83 days (8/1,555) on ultrasonography. Menstrual dating provides high sensitivity for identifying adolescents as ineligible for no-test medication abortion, with very low risk of clinically important misclassification. Adding menstrual history indicators improves sensitivity but indicates unnecessary scans for many eligible individuals. Policy must balance the rare risk of misestimation against costs of restricting adolescents' access, where disproportionate care barriers already exist.

Use of chemical hair straighteners ("relaxers") is associated with higher risks of hormonally mediated conditions. We hypothesized users of relaxers would have a higher prevalence of abnormal uterine bleeding (AUB) and dysmenorrhea. We analyzed baseline data from Pregnancy Study Online, an internet-based preconception cohort study of North American pregnancy planners. We included 14,366 participants aged 21-39 years who enrolled during 2014-2024 and reported on their typical menstrual cycle characteristics when not using hormones. We collected data on history of use, age at first use, frequency per year, duration of use, and number of burns. We defined AUB as cycle length <24 or >38 days, flow ≥ 7 days, irregular cycles, and/or heavy flow (>30 pads/tampons per menses). We defined dysmenorrhea as severe cramps requiring medication and bed rest. We used modified Poisson regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations of relaxer use with AUB and dysmenorrhea, adjusted for potential confounders. Overall, 2% of participants were current users and 10% were former users of relaxers. The frequencies of AUB and dysmenorrhea were 31% and 8%, respectively. PRs for current (versus never) relaxer use were 1.16 (95% CI: 1.00-1.33) for AUB and 1.30 (95% CI: 0.94-1.80) for dysmenorrhea. Participants who reported ever experiencing burns (versus never use) had a higher prevalence of dysmenorrhea (1-4 burns: PR = 1.42, 95% CI: 1.04-1.93; ≥5 burns: PR = 1.46, 95% CI: 1.00-2.13). Relaxer use was associated with a higher prevalence of menstrual disturbances.

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.

Infertility is an increasing concern for many women and can affect both physical and emotional well-being. The central nervous system (CNS) - particularly the hypothalamus, pituitary gland, and pineal gland - plays a crucial role in female reproductive health. We conducted a narrative review of relevant studies published between 2015 and 2025, sourcing data from PubMed and Scopus. Our goal was to investigate how dysregulation of hormones from the hypothalamus, pituitary gland, and pineal gland contributes to fertility-related disorders, such as impairments in ovulation, oocyte quality, and embryo development. Both human and significant animal studies were considered to better understand how CNS hormones affect fertility. The findings emphasize the roles of key hormones, including gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), melatonin, adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), and vasopressin (ADH). The proper timing and balance of these hormones are vital. For instance, GnRH pulses regulate the release of LH and FSH, which are essential for ovulation and follicle development. Melatonin supports oocyte health and helps maintain the menstrual cycle, while ACTH and TSH are also involved in reproductive function. Vasopressin affects uterine activity and hormone production. Understanding these hormonal interactions may lead to better diagnostic tools and more effective treatment strategies for conditions such as polycystic ovary syndrome (PCOS) and other fertility-related disorders. Unlike previous studies, this research provides a comprehensive investigation of how CNS-mediated hormonal regulation influences female reproductive outcomes, examining the roles of all involved hormones.

Evidence-based nutrition guidance for female athletes remains limited relative to that available for males; in part, this has contributed to widespread reliance on social media for dietary information. Whilst social media can enhance health communication, it also facilitates the rapid dissemination of unverified, commercially driven nutrition claims. This narrative review critically synthesises the current scientific literature underpinning four prevalent claims targeting nutrition close to exercise for active females; (1) fasted training is harmful for all females, (2) menstrual cycle-related hormonal fluctuations require sex-specific hydration strategies, (3) carbohydrate differences by sex and menstrual cycle phase, and (4) precise protein timing is essential for optimal adaptation in females. Despite social media and 'influencer' claims of no evidence in humans for many of the claims, there is some, albeit limited, evidence. This review evaluates the available research and the evidence supporting these claims to provide practical advice for active females. Collectively, this review demonstrates that many widely circulated nutrition claims directed at active females lack robust scientific support. The findings emphasise the importance of individual context, including training load, energy availability, environmental conditions and total dietary intake, over rigid, sex-specific nutrition rules. Improved translation of female-specific sports nutrition research into accurate, accessible public messaging is urgently needed to counter persistent misinformation in digital media.

Electrocortical correlates of facial expression processing: Assessing associations with stress, loneliness and exploring sex and hormone interactions.

Female athletes have a greater risk of anterior cruciate ligament (ACL) injuries, a disparity partly attributed to hormonal influences on ligament biomechanics and collagen metabolism. Oral contraceptives (OCs) may stabilize hormonal fluctuations and have been associated with a reduced risk of ACL injury; however, their potential effect on biological healing after ACL reconstruction (ACLR) remains unclear. To investigate whether the use of OCs affects graft maturation, assessed by the signal-to-noise quotient (SNQ) of postoperative magnetic resonance imaging (MRI), in female patients who have undergone ACLR with hamstring tendon autograft and associated lateral extra-articular tenodesis (LET). Cohort study; Level of evidence, 3. This retrospective comparative cohort study included a series of female patients with an active menstrual cycle, aged 16 to 45 years, who underwent anatomic ACLR with hamstring tendon autograft and LET between January 2022 and December 2023. Patients were stratified based on OC use at the time of surgery and postoperatively. Thus, the study included patients who underwent ACLR+LET with and without OC treatment. The 2 groups were comparable based on all the criteria analyzed. Follow-up MRI (3.0 T) was performed at a mean of 7 months postoperatively to analyze graft maturity using circular region of interest measurements in the proximal, midsubstance, and distal ACL graft regions, by measuring the SNQ. Lower SNQ ratios indicate less water content and better graft maturity and healing. A total of 55 patients with ACLR+LET were included (30 without OC use [R group] and 25 with OC use [R+OC group]). There were no significant demographic differences between the 2 groups. The median global graft SNQ was significantly lower in the R+OC group (1.8 [IQR, 0.6-3.3]) in comparison to the group in which no OC was used (3.7 [IQR, 2.0-6.0]) (P = .001). All graft regions-distal, midsubstance, and proximal-also showed significantly lower SNQ values in patients using OCs (R+OC group) compared to those not using them: distal (1.2 [IQR, 0.3-2.6] vs 3.2 [IQR, 1.5-6.0], P = .007), midsubstance (1.3 [IQR, 0.5-3.3] vs 3.7 [IQR, 2.1-7.8], P = .002), and proximal (1.3 [IQR, 0.7-3.3] vs 3.5 [IQR, 2.0-4.9], P = .006). OC use in female patients undergoing ACLR with hamstring tendon autograft and concomitant LET is associated with lower MRI-based SNQ values.

Asthma heterogeneity remains a defining challenge driven by multiple factors, including hormonal influences that contribute to distinct phenotypic and endotypic manifestations during the menopausal transition. Fluctuations in sex hormones such as estrogen and progesterone during this period do not merely alter reproductive physiology but they fundamentally modulate immune regulation, airway homeostasis, and inflammatory thresholds in ways that give rise to distinct clinically underrecognized asthma phenotypes and endotypes. This review examines how the hormonal milieu during the menopausal transition, defined as the period marked by changes in menstrual cycle regularity and ending 12 mo after the final menstrual period (menopause), may influence the classical asthma subtypes. We highlight the hormonal dynamics, clinical features of asthma, asthma endotypes and phenotypes, and therapeutic modifiers of asthma during the menopausal transition. Collectively, this review underscores the need to reframe menopause-associated asthma as hormonally driven, biologically distinct subtypes while highlighting the critical gaps in knowledge that must be addressed to develop effective therapeutic strategies for this vulnerable and understudied population.

Adolescent females are at a higher risk of anterior cruciate ligament (ACL) injury than males. While prior studies have associated injury timing and menstrual cycle phase, these data are limited by indirect cycle tracking and lack of analysis on ACL structure, mechanics, or composition. Additionally, little is known about how female sex hormones influence the distinct ACL bundles. This exploratory study investigated associations between serum sex hormone concentrations and size, mechanics, and composition of the ACL and its bundles in a female adolescent pig model. Serum from nine adolescent female Yorkshire crossbreed pigs was collected pre-euthanasia and analyzed for levels of estradiol, progesterone, and testosterone. The ACL and its bundles were assessed for size via magnetic resonance imaging (MRI), mechanics via robotic testing, and composition via biochemical and histological analyses. While individual hormone levels and the estradiol-to-progesterone (E/P) ratio had no association with most metrics, the E/P ratio was significantly associated with ACL size and T2* relaxation time. Higher E/P ratios were negatively associated with anteromedial (AM) bundle cross-sectional area (CSA) (R2 = 0.44) and overall ACL volume (R2 = 0.49) and positively associated with posterolateral (PL) bundle T2* relaxation time (R2 = 0.69, p < 0.05). Serum E/P ratio was also positively associated with normalized ACL stiffness, but there were no associations observed for tissue composition. The results of this exploratory study indicate that the ACL may be responsive to exposure to the relative concentration of female sex hormone in a bundle-specific manner.

Venous Thromboembolism in Women and Gender-Diverse Populations: A Call for Specific and Inclusive Care.

Cerebral venous thrombosis is a rare stroke type that primarily affects younger women. Contemporary large international efforts have improved our understanding of the natural history and management of this rare disease, yet important evidence gaps persist across the disease continuum. Management of cerebral venous thrombosis can be conceptualized into multiple phases: acute management, post-acute management (including primary anticoagulation and secondary prevention), and recovery. Acute treatment centers on anticoagulation, including in the presence of intracranial hemorrhage. Endovascular therapy and decompressive craniectomy are reserved for selected severe cases. Direct oral anticoagulants appear comparable to vitamin K antagonists for most patients during primary treatment, though optimal lead-in duration and treatment length remain uncertain. Decisions regarding extended anticoagulation for secondary prevention require individualized assessment of recurrence and bleeding risk. Patients with cancer, antiphospholipid antibody syndrome, prior venous thromboembolism, and idiopathic events are at the highest thromboembolic risk. Long-term sequelae, including fatigue, headache, cognitive and mood disturbances, epilepsy, and intracranial hypertension, contribute substantially to morbidity despite high rates of functional independence. Heavy menstrual bleeding may impact young women on anticoagulation. Recognition and management of these outcomes are essential for comprehensive care.

Endometriosis is a common chronic disease in women of reproductive age, and long-term postoperative medical management is a key strategy for preventing recurrence. Currently used clinical medications include dienogest (DNG), GnRH agonists (GnRH-a), combined oral contraceptives (COC), and the levonorgestrel-releasing intrauterine system (LNG-IUS). However, comparative effectiveness of different hormonal therapies for preventing recurrence in real-world clinical practice and the basis for individualised patient selection remain insufficient. To systematically evaluate the efficacy and safety of DNG, GnRH-a, COC, and LNG-IUS in preventing postoperative recurrence of ovarian endometriomas; to analyse independent risk factors for postoperative recurrence, providing evidence-based support for individualised clinical treatment decisions. A retrospective cohort study design was adopted. A total of 167 patients who underwent laparoscopic cystectomy at our hospital between January 2020 and January 2022, had a postoperative pathological diagnosis, and received sequential GnRH-a maintenance therapy were enrolled. According to the sequential maintenance regimen, patients were divided into three groups: GnRH-a + DNG group (n = 61), GnRH-a + COC group (n = 64), and GnRH-a + LNG-IUS group (n = 42). The primary outcome was the recurrence rate within 3 years after surgery. Secondary outcomes included menstrual bleeding profiles, recurrent cyst diameter, and adverse drug reactions. Cumulative recurrence rates were calculated using the Kaplan‑Meier method, and intergroup comparisons were performed using the log‑rank test. Multivariate logistic regression analysis was used to identify independent risk factors for postoperative recurrence. There were no statistically significant differences in baseline data among the three groups (P > 0.05), indicating comparability. The 3‑year cumulative recurrence rate in the GnRH-a + DNG group was 19.67% (12/61), significantly lower than that in the GnRH-a + LNG-IUS group (45.24%, 19/42; P = 0.003). The recurrence rate in the GnRH-a + DNG group was also lower than that in the GnRH-a + COC group (34.38%, 22/64), although this difference did not reach statistical significance (P = 0.053). No significant differences were observed among the three groups in mean daily menstrual blood loss, incidence of dysmenorrhoea, or menstrual cycle length (P > 0.05). However, the incidence of spotting in the LNG-IUS group (52.38%) was significantly higher than that in the DNG group (24.59%) and the COC group (12.50%, P < 0.001). There were no statistically significant differences in the total incidence of adverse drug reactions (13.11%, 14.06%, 11.90%) or recurrent cyst diameter among the groups (P > 0.05). Multivariate logistic regression analysis suggested that higher dysmenorrhea VAS score (OR = 1.376), history of pelvic procedures (OR = 1.483), and r-AFS stage IV (OR = 2.676) were independent risk factors for postoperative recurrence (all P < 0.05), while older age at surgery was a protective factor (OR = 0.891) (P < 0.05). Among sequential GnRH-a maintenance regimens, DNG was associated with a lower recurrence rate than LNG-IUS in preventing 3‑year recurrence after laparoscopic cystectomy in this cohort. Although the recurrence rate in the DNG group was lower than that in the COC group, the difference did not reach statistical significance, indicating only a trend toward superiority. All three regimens have a favourable overall safety profile, but the LNG-IUS group has a higher incidence of spotting. Severe dysmenorrhoea, previous pelvic operation history, and r-AFS stage IV are independent risk factors for postoperative recurrence, whereas older age at surgery has a protective effect.

Sleep disorders and anxiety-depression symptoms can significantly impair the quality of life and treatment adherence among breast cancer patients undergoing chemotherapy, while also increasing the risk of disease recurrence and mortality. Early identification of the progression trajectory and underlying causes of these symptoms is essential for providing personalized interventions for deteriorating cases. This study aims to analyze the trajectories of sleep disorders and anxiety-depression symptoms in breast cancer patients during chemotherapy using a group-based Multi-Trajectory Model (GBMTM) and to identify influencing factors through machine learning. Prospective data from 150 breast cancer patients undergoing four cycles of chemotherapy were collected. A GBMTM was employed to identify distinct trajectories, with 70 predictive variables included in the analysis. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select the optimal subset of variables. Seven machine learning models were compared, and the optimal model was chosen for result interpretation using SHAP (SHapley Additive exPlanations) analysis. Among breast cancer patients undergoing chemotherapy, two distinct trajectories of sleep disorders and anxiety-depression symptoms were identified: the "stable group" (74.7%) and the "deteriorating group" (25.3%). SHAP analysis revealed that high levels of C-reactive protein, high uric acid, high hemoglobin, smoking, presence of invasive cancer with ductal carcinoma in situ, prior chemotherapy, being married, regular menstrual cycles in the past, and lack of family history were significant risk factors associated with the "deteriorating group." Our findings indicate two distinct trajectories of sleep disorders and anxiety-depression symptoms in breast cancer patients undergoing chemotherapy, with the majority falling into the "stable group". The identified risk factors associated with the "deteriorating group" should be closely monitored to facilitate early intervention and improve patient outcomes. The trial was registered on Chinese Clinical Trial Registry (Trial ID: ChiCTR2300077667 on 15 November 2023; available at https://www.chictr.org.cn/).