Women's Reproductive Health Research Articles

Synthetic Phenolic Antioxidants and Their Metabolites in Follicular Fluid and Association with Diminished Ovarian Reserve: A Case-Control Study.

Diminished/decreased ovarian reserve (DOR) is a disorder of ovarian function, which severely affects women's reproductive health. Accumulating evidence has found that adverse environmental factors can affect ovarian function. However, whether synthetic phenolic antioxidants (SPAs) exposure is associated with DOR is still unknown. We explored whether concentrations of SPAs and their metabolites are associated with DOR. A case-control study was conducted from January 2019 to January 2020 in China. One hundred eighty-one women 20-44 years of age, with (case group, ) and without DOR (control group, ) were included in our study. The follicular fluid concentrations of typical SPAs and their metabolites were measured, including butylated hydroxyanisole (BHA), tert-butylhydroquinone (TBHQ), butylated hydroxytoluene (BHT), and five BHT metabolites [3,5-di-tert-butyl-4-hydroxy-benzylalcohol (BHT-OH), 3,5-di-tert-butyl-4-hydroxybenzaldehyde (BHT-CHO), 3,5-di-tert-butyl-4-hydroxybenzoic acid (BHT-COOH), 2,6-di-tert-butyl-1,4-benzoquinone (BHT-Q), and 2,6-di-tert-butyl-4-hydroxy-4-methylcyclohexa-2,5-dien-1-one (BHT-quinol)]. Information about serum basal concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Müllerian hormone (AMH) and the basal antral follicle count (AFC) was collected. The measured frequencies of BHA, TBHQ, BHT, BHT-OH, BHT-CHO, BHT-COOH, BHT-Q, and BHT-quinol in follicular fluid were 1.7%, 2.2%, 40.3%, 46.4%, 57.5%, 100%, 64.6%, and 49.2%, respectively. The concentrations of BHT-CHO ( vs. , ), BHT-COOH ( vs. , ), BHT-Q ( vs. , ), and the sum of five BHT metabolites (; vs. , ) in the case group were significantly higher than those in the control group. The risk of DOR was further analyzed according to the tertiles of chemical concentration. Compared with the low levels of BHT metabolites, the adjusted odds ratios (ORs) for DOR were significantly increased in the high levels of BHT-CHO [, 95% confidence interval (CI): 1.22, 8.31, ], BHT-COOH [ (95% CI: 1.63, 13.71), ], and BHT-Q [ (95% CI: 1.69, 11.86), ] after adjusting for age, body mass index, education, infertility type, triglycerides, and total cholesterol. Moreover, compared with the low level of , increased adjusted ORs for DOR were found both in the middle level [ (95% CI: 1.44, 11.75), ] and high level [ (95% CI: 1.81, 16.77), ], showing an obvious dose-response relationship (). In this study, we report the measured frequency and concentrations of BHA, TBHQ, BHT, and their metabolites in follicular fluid. Moreover, we found the concentrations of BHT metabolites, especially BHT-CHO, BHT-COOH, and BHT-Q, are positively associated with the increased risk of DOR. https://doi.org/10.1289/EHP11309.

Effects of Cyanobacterial Harmful Algal Bloom Toxin Microcystin-LR on Gonadotropin-Dependent Ovarian Follicle Maturation and Ovulation in Mice.

Cyanobacterial harmful algal blooms (CyanoHABs) originate from the excessive growth or bloom of cyanobacteria often referred to as blue-green algae. They have been on the rise globally in both marine and freshwaters in recently years with increasing frequency and severity owing to the rising temperature associated with climate change and increasing anthropogenic eutrophication from agricultural runoff and urbanization. Humans are at a great risk of exposure to toxins released from CyanoHABs through drinking water, food, and recreational activities, making CyanoHAB toxins a new class of contaminants of emerging concern. We investigated the toxic effects and mechanisms of microcystin-LR (MC-LR), the most prevalent CyanoHAB toxin, on the ovary and associated reproductive functions. Mouse models with either chronic daily oral or acute intraperitoneal exposure, an engineered three-dimensional ovarian follicle culture system, and human primary ovarian granulosa cells were tested with MC-LR of various dose levels. Single-follicle RNA sequencing, reverse transcription-quantitative polymerase chain reaction, enzyme-linked immunosorbent assay, western blotting, immunohistochemistry (IHC), and benchmark dose modeling were used to examine the effects of MC-LR on follicle maturation, hormone secretion, ovulation, and luteinization. Mice exposed long term to low-dose MC-LR did not exhibit any differences in the kinetics of folliculogenesis, but they had significantly fewer corpora lutea compared with control mice. Superovulation models further showed that mice exposed to MC-LR during the follicle maturation window had significantly fewer ovulated oocytes. IHC results revealed ovarian distribution of MC-LR, and mice exposed to MC-LR had significantly lower expression of key follicle maturation mediators. Mechanistically, in both murine and human granulosa cells exposed to MC-LR, there was reduced protein phosphatase 1 (PP1) activity, disrupted PP1-mediated PI3K/AKT/FOXO1 signaling, and less expression of follicle maturation-related genes. Using both invivo and in vitro murine and human model systems, we provide data suggesting that environmentally relevant exposure to the CyanoHAB toxin MC-LR interfered with gonadotropin-dependent follicle maturation and ovulation. We conclude that MC-LR may pose a nonnegligible risk to women's reproductive health by heightening the probability of irregular menstrual cycles and infertility related to ovulatory disorders. https://doi.org/10.1289/EHP12034.

Knowledge, Power, and Women's Reproductive Health in Japan, 1690–1945 by Yuki Terazawa (review)

Knowledge, Power, and Women's Reproductive Health in Japan, 1690–1945 by Yuki Terazawa (review)

How the COVID‐19 global pandemic further jeopardized women's health, mental well‐being, and safety: Intersectionality framework and social policy action

AbstractThe COVID‐19 pandemic has disproportionately endangered women's health, well‐being and safety. According to the World Health Organization, nearly 7 million people worldwide have died from the virus by May 2023. While COVID‐19 posed an immediate threat to the lives of people around the world, the interconnections of gender, race, ethnicity, and class resulted in differential consequences of the global pandemic. With a focus on intersecting identities, this special issue explores how women became more vulnerable during the pandemic and suggest what policies and interventions would work to buffer against such risks. In this issue, authors use empirical, review, and policy implication work to demonstrate how women, particularly those with other minoritized intersecting identities, were impacted by COVID‐19. The authors of this special issue examine the impacts of COVID‐19 on women's physical, emotional, and reproductive health, along with issues of safety. The unique role that women play in mothering and caretaking, within their homes, workplaces, and communities, means that this endangerment has widespread and potentially intergenerational impacts. Moreover, it is clear that empirically‐driven social policy and resource responses are crucial.

Association of sexual relationship power with PrEP persistence and other sexual health outcomes among adolescent and young women in Kenya and South Africa.

Gendered power inequalities impact adolescent girls' and young women's (AGYW) sexual and reproductive health (SRH) outcomes. We investigated the influence of sexual relationship power on AGYW's SRH outcomes, including HIV pre-exposure prophylaxis (PrEP) persistence. The POWER study in Kisumu, Kenya, and Cape Town and Johannesburg, South Africa provided PrEP to 2,550 AGYW (aged 16-25). AGYW's perceived power in their primary sexual relationship was measured among the first 596 participants enrolled using the Sexual Relationship Power Scale's (SRPS) relationship control sub-scale. Multivariable regression was used to test for (1) key sociodemographic and relationship characteristics associated with relationship power; and (2) the association of relationship power with SRH outcomes including PrEP persistence. In this cohort, the mean SRPS score was 2.56 (0.49), 542 (90.9%) initiated PrEP; 192 (35.4%) persisted with PrEP at 1 month of which 46 (24.0% of 192) persisted at 6 months. SRPS were significantly lower among AGYW who cohabited with their sex partner (-0.14, 95% CI: -0.24 to -0.04, p = 0.01), or had ≥1 sex partner (-0.10, 95% CI: -0.19 to -0.00, p = 0.05). AGYW with lower SRPS were more likely to not know their partner's HIV status (aOR 2.05, 95% CI: 1.27 to 3.33, p < 0.01), but SRPS was not associated with PrEP persistence, STI infection, condom, or hormonal contraception use. AGYW's reasons for initiating PrEP and reasons for continuously using PrEP may be different. While low relationship power was associated with perceived HIV vulnerability, AGYW's PrEP persistence may be influenced by more than relationship power.

Student midwives' perspectives of women's sexual and reproductive health literacy in Turkey

ObjectiveThis study focused on the issues surrounding health literacy in the context of women’s sexual and reproductive health (SRH), the significance and availability of information for midwives and women; and the socio-cultural influences and barriers related to women’s level of health literacy. MethodsA cross sectional on-line survey was distributed to 280 student midwives in their 2nd 3rd and 4th year of a midwifery programme. This paper focuses on the responses from 138 students which were analysed using descriptive and non-parametric tests. ResultsStudent midwives indicated their level of agreement regarding women’s ability to access, understand, and appraise information they received verbally and in written form about the six main SRH topics (namely contraception, STIs, abortion, Pap tests and cervical cancer, and fertility and pregnancy), from their midwife but agreement was much lower regarding women’s access to SRH information from peers and their families. False beliefs were ranked as the most common barrier to accessing information and services. Students ranked being a refugee, being from a rural area, being educated to a primary school level or not formally educated, as having the greatest negative impact on women’s health literacy. ConclusionsFindings from this study indicate the role that the sociocultural background of Islamic culture plays in the disparities in sexual and reproductive health literacy (SRHL) for women from the perspective of student midwives. Our findings indicate the need for future research to focus on women as participants to gain their first-hand experiences of SRHL.

Laparoscopic management of an invasive mole combined with iatrogenic uterine perforation

ObjectiveHydatidiform mole is a common placental proliferative disease which is harmful to women's reproductive health. It is characterized by abnormal fertilization and subsequent trophoblastic proliferation. Invasive mole originates from hydatidiform mole, but its pathogenesis is still unclear. It has been reported that hydatidiform mole mainly develop with the uterine cavity. Invasive mole caused by iatrogenic uterine perforation is rarely reported. Here, we reported a rare case of invasive mole initially presented with uterine iatrogenic perforation after suction curettage. Case reportA 25-year-old nulliparous woman (gravida 1 para 0) who presented with acute hemoperitoneum was admitted to our hospital. Her clinical manifestation was mimicked by uterine iatrogenic perforation, and mole tissues were found on the left posterior wall of uterus. Laparoscopic management was performed to clear the lesions away thoroughly and repair the uterus. The operation was successful, and the reproductive function was preserved. The patient gave a birth to a healthy baby four years after the operation. ConclusionLaparoscopic minimally technique plays a very good therapeutic effect on invasive mole initially presented with iatrogenic uterine perforation.

Mortality trends and disease burdens of cervical, endometrial and ovarian cancers from 1981 to 2020 in Taiwan

Cervical, endometrial, and ovarian cancers are major gynecologic cancers in Taiwan. Although cervical cancer has received attention through nationwide screening program and the rollout of the human papillomavirus vaccine, endometrial and ovarian cancers have attracted less attention. The age–period–cohort analysis of constant-relative-variation method was used to estimate the mortality trends of cervical, endometrial, and ovarian cancers for population aged 30–84 years during 1981–2020 in Taiwan. The years of life lost was used to estimate the disease burden due to premature death from gynecological cancers. The age effect of endometrial cancer mortality was greater than those of cervical and ovarian cancers. The period effects decreased during 1996–2000 for cervical cancer and plateaued for endometrial and ovarian cancers during 2006–2020. The cohort effect decreased after the birth year 1911 for cervical cancer, increased after 1931 for endometrial cancer, and increased in all birth years for ovarian cancer. For both endometrial and ovarian cancers, the Spearman's correlation coefficients revealed the strong negative correlations between the fertility and the cohort effects, and the strong positive correlations between the average age at first childbirth and the cohort effects. The burden of premature death from ovarian cancer was higher than those of cervical and endometrial cancers during 2016–2020. Due to increasing cohort effect and burden of premature death, endometrial and ovarian cancers will become the largest threat to women's reproductive health in Taiwan.

Single-Molecule Approach to 16S rRNA for Vaginal Microbiome Signatures in Response to Metronidazole Treatment.

Bacterial vaginosis (BV) is the most common infection of the lower reproductive tract among women of reproductive age, characterized by a depletion of health-associated Lactobacillus and an overgrowth of anaerobes. Metronidazole has been recommended as a first-line therapy for treating BV for decades. Although most cases are cured by the treatment, recurrent infections of BV seriously affect women's reproductive health. Until now, limited information on the vaginal microbiota has been explored at the species level. Here, we adopted a single molecular sequencing approach for the 16S rRNA gene, named FLAST (full-length assembly sequencing technology), to analyze the human vaginal microbiota that improved species-level resolution for taxonomy and identified microbiota alterations in the vaginal tract in response to treatment with metronidazole. Appling high-throughput sequencing, we identified 96 and 189 novel full-length 16S rRNA gene sequences in Lactobacillus and Prevotella, respectively, which had not previously been reported in vaginal samples. Moreover, we found that Lactobacillus iners was significantly enriched in the cured group before metronidazole treatment, and that was maintained in a high frequency after the treatment, suggesting an important role for this species in response to metronidazole treatment. Our research also highlights the importance of the single-molecule paradigm for progressing the field of microbiology and applying these insights to better understand the dynamic microbiota during BV treatment. Subsequent novel treatment approaches should be proposed to improve BV treatment outcomes, optimize the vaginal microbiome, and reduce gynecological and obstetric sequelae. IMPORTANCE Bacterial vaginosis (BV) is a common infectious disease of the reproductive tract. Metronidazole treatment, as the first line of treatment, frequently fails at recovery of the microbiome. However, the precise types of Lactobacillus and other bacteria involved in BV remain unclear, and this has resulted in a failure to identify potential markers to predict clinic outcomes. In this study, we adopted a 16S rRNA gene full-length assembly sequencing technology for the taxonomy analysis and evaluation of vaginal microbiota before and after treatment with metronidazole. We additionally identified 96 and 189 novel 16S rRNA gene sequences in Lactobacillus and Prevotella species, respectively, in vaginal samples, which improves our understanding of the vaginal microbiota. Moreover, we found that the abundance of Lactobacillus iners and Prevotella bivia before treatment was associated with a lack of cure. These potential biomarkers will help to facilitate future studies aimed at improving BV treatment outcomes, optimize the vaginal microbiome, and reduce adverse sexual and reproductive outcomes.

Gambaran Usia Menarche dan Kejadian Dismenore Primer pada Siswi SMA di Kecamatan Sale Rembang

Adolescent girls who were experiencing menstruation often experienced primary dysmenorrhea. Primary dysmenorrhea can be triggered by early menarche. Based on the preliminary survey that has been carried out, it is known that 80% of high school students in Sale District of Rembang were experiencing primary dysmenorrhea. This study aimed to determine the description between the age of menarche and the incidence of primary dysmenorrhea in high school students in Sale District of Rembang. The type of research used was observational with a cross sectional approach. Age of menarche was obtained by filling a questionnaire and the incidence of primary dysmenorrhea through filling a Numeric Rating Scale questionnaire. The sampling was using simple random sampling techniques with research subjects obtained as many as 59 people. The statistical test used to determine the correlation between variables are a chi-square test. The results of the univariate analysis obtained on the age of early menarche was 27,1% and the female students who were experiencing primary dysmenorrhea was 79,7%. The results of the bivariate analysis on the age of menarche, a p-value of 0,018 (p&lt;0,05) was shown. There was a significant correlation between the age of menarche and the incidence of primary dysmenorrhea in high school students in Sale District of Rembang. The research suggests that providing counselling about women's reproductive health and the importance of implementing a healthy lifestyle should be given to high school students.

Rational Design of Nanomedicine for Placental Disorders: Birthing a New Era in Women's Reproductive Health.

The placenta is a transient organ that forms during pregnancy and acts as a biological barrier, mediating exchange between maternal and fetal circulation. Placental disorders, such as preeclampsia, fetal growth restriction, placenta accreta spectrum, and gestational trophoblastic disease, originate in dysfunctional placental development during pregnancy and can lead to severe complications for both the mother and fetus. Unfortunately, treatment options for these disorders are severely lacking. Challenges in designing therapeutics for use during pregnancy involve selectively delivering payloads to the placenta while protecting the fetus from potential toxic side effects. Nanomedicine holds great promise in overcoming these barriers; the versatile and modular nature of nanocarriers, including prolonged circulation times, intracellular delivery, and organ-specific targeting, can control how therapeutics interact with the placenta. In this review, nanomedicine strategies are discussed to treat and diagnose placental disorders with an emphasis on understanding the unique pathophysiology behind each of these diseases. Finally, prior study of the pathophysiologic mechanisms underlying these placental disorders has revealed novel disease targets. These targets are highlighted here to motivate the rational design of precision nanocarriers to improve therapeutic options for placental disorders.

Maternal cardiovascular disorders before and during pregnancy and offspring cardiovascular risk across the life course.

Obesity, hypertension, type 2 diabetes mellitus and dyslipidaemia are highly prevalent among women of reproductive age and contribute to complications in >30% of pregnancies in Western countries. An accumulating body of evidence suggests that these cardiovascular disorders in women, occurring before and during their pregnancy, can affect the development of the structure, physiology and function of cardiovascular organ systems at different stages during embryonic and fetal development. These developmental adaptations might, in addition to genetics and sociodemographic and lifestyle factors, increase the susceptibility of the offspring to cardiovascular disease throughout the life course. In this Review, we discuss current knowledge of the influence of maternal cardiovascular disorders, occurring before and during pregnancy, on offspring cardiovascular development, dysfunction and disease from embryonic life until adulthood. We discuss findings from contemporary, large-scale, observational studies that provide insights into specific critical periods, evidence for causality and potential underlying mechanisms. Furthermore, we focus on priorities for future research, including defining optimal cardiovascular and reproductive health in women and men before their pregnancy andidentifying specific embryonic, placental and fetal molecular developmental adaptations from early pregnancy onwards.Together, these approaches will help stop the intergenerational cycle of cardiovascular disease.

Child marriage as a risk factor for non-communicable diseases among women in India.

Child marriage, defined as marriage under the age of 18 years, remains pervasive in India. Global evidence documents a negative association between child marriage and women's reproductive and sexual health outcomes; however, its relationship with non-communicable diseases (NCDs) remains underexplored. We utilize biomarkers and self-reported data from the nationally representative National Family and Health Survey 4 (2015-2016) to examine the associations between child marriage and hypertension, diabetes, heart disease, asthma and thyroid disorder among currently married women (N = 421 107). We use regression models adjusted for a range of demographic and socio-economic controls to assess the association between child marriage and NCDs among women in India. We further assess whether and to what extent these relationships are mediated by early motherhood using the Karlson, Holm and Breen method of decomposition. Child marriage was associated with hypertension [adjusted odds ratio 1.20 (95% CI: 1.17-1.24)], diabetes [1.29 (1.22-1.37)], heart disease [1.27 (1.18-1.36)], asthma [1.19 (1.11-1.28)] and thyroid disorder [1.10 (1.02-1.18)]. Early motherhood also increased the risk of NCDs among women. Furthermore, it emerged as a pathway linking child marriage with hypertension, diabetes and heart disease; however, it provided a partial explanation for the disadvantage associated with child marriages. Child marriage emerges as a risk factor for NCDs among women in India. Health systems need to recognize the enduring influence of child marriages on women's health and ensure early detection and effective treatment of NCDs for this vulnerable group.

Association of Pregnancy and HIV Status With Molecular-Bacterial Vaginosis in Indian Women.

Bacterial vaginosis (BV) is a highly prevalent disorder of the cervicovaginal microbiota. Molecular-BV may put women at increased risk for adverse reproductive and obstetric outcomes. We investigated the association of HIV and pregnancy on the vaginal microbiota and associations with molecular-BV in women of reproductive age from Pune, India. We studied vaginal samples from N = 170 women, including N = 44 nonpregnant HIV seronegative, N = 56 pregnant seronegative, N = 47 nonpregnant women with HIV (WWH), and N = 23 pregnant WWH, and collected data on clinical, behavioral, and demographic factors. We used 16S rRNA gene amplicon sequencing to characterize the composition of the vaginal microbiota. We classified the vaginal microbiota of these women into community state types based on bacterial composition and relative abundance and further categorized them into molecular-BV versus Lactobacillus -dominated states. To determine associations between pregnancy and HIV status with outcome of molecular-BV, logistic regression models were used. There was a high prevalence of molecular-BV (30%) in this cohort. We found that pregnancy was associated with decreased odds of molecular-BV (adjusted OR = 0.35, 95% CI: 0.14 to 0.87), while HIV was associated with increased odds of molecular-BV (adjusted OR = 2.76, 95% CI: 1.33 to 5.73), even when controlling for multiple relevant factors such as age, number of sexual partners, condom use, and douching. Larger and longitudinal studies are needed to further characterize molecular-BV and the vaginal microbiota in pregnant women and WWH and relate these factors to infectious, reproductive, and obstetric outcomes. In the long term, these studies may lead to novel microbiota-based therapeutics to improve women's reproductive and obstetric health.

An Exploratory Model of Shared Decision-Making in Women's Reproductive Health in Indiana: A Cross-Sectional Study

An Exploratory Model of Shared Decision-Making in Women's Reproductive Health in Indiana: A Cross-Sectional Study

Sars-CoV-2 infection leads to significant and long-lasting changes in women's reproductive health

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The Effects of Latitude and Temperate Weather on Vitamin D Deficiency and Women's Reproductive Health: A Scoping Review.

We conducted a scoping review to analyze the effects and implications of vitamin D deficiency on female reproductive health during the last decade, considering temperate planetary zones and climate change impacts. We used a qualitative methodology for a panoramic database review of PubMed, Web of Science, and Scopus covering articles from the last decade focused on populations living at latitudes higher than 40°N and 40° S. As descriptors, we used the phrases climate change, cholecalciferol or vitamin d3, pregnancy, and woman health and the Boolean operators AND and OR. We excluded letters to the editor, reviews, protocols, and clinical trials without human participants, as well as duplicate articles. We included 35 studies in English, the majority of which were from North America or Europe. No studies were found from the Southern Hemisphere or having any direct relation with climate change, although studies demonstrated that latitude and environmental factors affected vitamin D deficiency, which had an impact on pregnant women and their children. Supplementation guidelines were not well developed, and there was a lack of studies among at-risk groups of women (eg, darker skin, higher latitudes, immigrants) across the life span. Vitamin D deficiency is a global environmental problem that affects female reproductive health and depends on multiple environmental factors and human behavior. Therefore, we recommend consideration of environmental and sociocultural factors in public policy and clinical research and more research on the effectiveness of supplementation and fortification strategies. Health care professionals working in reproductive health need to generate actions for detection of, education on, and prevention of vitamin D deficiency among women across their life spans, considering the multicausality of the phenomenon, which includes environmental and climate factors in population health.

Effectiveness of Health Education using the PASTORA Application on Early Cancer Detection

Women's reproductive health problems, especially cancer, are health problems faced by women in the world , including in Indonesia. Nurses as an integral part of health services have the responsibility to carry out health promotion and innovate in developing health promotion media, especially during the Covid-19 pandemic. The purpose of this activity is to find out the differences in women's knowledge about early detection of cancer after health education using online media: the PASTORA application. The PASTORA application is an alternative media to increase health knowledge independently and complete it with online consultations with professional health workers. This research method is descriptive quantitative with participants in education totaling 105 women of reproductive age from four provinces in Indonesia, the education process was facilitated by 3 lecturers from the Faculty of Nursing and 16 students participating in the Virtual Integrative KPM at Gajah Mada University. The activity process includes the preparation, implementation and evaluation stages. Before and after education, a pre- posttest was carried out consisting of 15 questions. The results of the analysis of the test showed an increase in knowledge which was marked by an increase in pre-posttest scores for 94 (89.5%) participants, a fixed score of 7 (6.7%) and a decrease in value of 4 (3.8%). The PASTORA application based on Android technology is proven to increase women's knowledge about early cancer detection. It is necessary to develop the PASTORA application with IOS technology to increase the reach of female users in Indonesia. The PASTORA application can be used by nurses as an alternative medium for conducting reproductive health education for women.

Factors Affecting Married Women’s Intention to Have a Second Child: Focusing on Reproductive Health Factors

Purpose: This study analyzed factors that influence married women's intentions to have a second child from the perspective of reproductive health in Korea.Methods: The analysis included 332 married women whose first child birth was within the last 3 years from the 2021 National Family and Fertility Survey data. First, the general characteristics of married women was presented through frequency analysis. The differences in the characteristics of married women regarding their intention to have a second child were also analyzed using a chi-square test and independent samples t-test. Second, we analyzed the reproductive health characteristics of married women according to age using a chi-square test. Finally, logistic regression analysis was performed to investigate the effect of married women's reproductive health factors on their intention to have a second child.Results: With various variables controlled, age, infertility, and negative pregnancy experiences had a negative effect on the intention to have a second child, whereas child values and trust in the government had a positive effect. In addition, differences in the reproductive health of married women were found according to age, and the proportions of infertility, negative pregnancy experiences, and preterm birth or low birth weight of the first child were high in elderly married women.Conclusion: To alleviate the low fertility rate in terms of additional childbirth, it is necessary to combine and strengthen not only medical treatment related to women's reproductive health but also psychoemotional counseling as a non-medical treatment, with support from the government.

Physiological endocrinology and causes of disorders of the menstrual cycle

The menstrual cycle is the result of a complex interaction between the hormonal system and the body's organs, namely the hypothalamus, pituitary, ovaries and uterus. Regular menstrual cycle is an indicator of women's reproductive health, changes in the menstrual cycle can be associated with ovarian-thyroid dysfunction and pituitary axis. This article aimsto understand the role of endocrinology in the process of the menstrual cycle as well as review the currently available literature on the causes of disorders of the menstrual cycle.The method used is Systematic Literature Review using the Preferred Reporting Items for Systematic Reviews (PRISMA) flow by collecting articles, according to those obtained from the PubMed database, Wiley Online Library, Science Direct and Cochrane, with the keywords "Menstrual cycle, hormone disruption, gynecological disease , and endocrinology” from the results of the analysis, 6 articles were selected that met the criteria. The conclusion ismany factors influence the occurrence of disturbances in the menstrual cycle that can affect reproductive health, including diabetes, night shift work schedules, nutritional intake, smoking habits, as well as psychological stress and anxiety during the pandemic due to the Covid-19 disease and vaccine administration.