Woman's Reproductive Life Research Articles

The Reproductive Life Index

INTRODUCTION: The Centers for Disease Control and Prevention's (CDC) reproductive life plan is designed to reflect a woman's family plans in the context of personal values and life goals, but it does not incorporate visual and quantitative indicators. The objective of this study is to describe a simple quantitative and visual tool, the Reproductive Life Index, and its unit of measure, the Family Planning Quotient. METHODS: In response to the CDC's reproductive life plan, the Reproductive Life Index and Family Planning Quotient have been developed to visually depict and quantify a woman's reproductive life plan and assist health care providers in speaking to a woman's family planning needs and interests. RESULTS: The Reproductive Life Index longitudinally graphs measures of the Family Planning Quotient over time as well as adverse pregnancy outcomes. The Family Planning Quotient captures the number of children a woman has (the numerator) divided by the number of children she wants (the denominator) at one time point. A Family Planning Quotient of less than 1 indicates a woman desires more children and a Family Planning Quotient equal to or greater than 1 indicates a woman has achieved or exceeded her family plans. The Family Planning Quotient can also be used on a population level to capture the overall reproductive health status of a study sample. Five theoretical cases were developed to represent the utilization of the Reproductive Life Index Family Planning Quotient. The quotient was also sampled in 2,372 women from three different populations. CONCLUSION: The Reproductive Life Index/Family Planning Quotient is a novel tool to assist patients and health care providers in reproductive health planning. This tool may become a standard index to measure a woman's reproductive health goals. The Reproductive Life Index/Family Planning Quotient must be further implemented to demonstrate its effect on reproductive health planning.

Healthy excessive weight in Portuguese women 4 years after delivery of a liveborn

ObjectiveTo quantify the prevalence of healthy excessive weight and determinants of metabolic profile, considering women's reproductive life. MethodsWe evaluated 1847 mothers of a birth cohort assembled after delivery and reevaluated 4years later. A healthy profile was defined as the absence of hypertension, diabetes, dyslipidemia, C-reactive protein <3mg/l and being below the second tertile of HOMA-IR. Adjusted odds ratios (OR) and confidence intervals (95% CI) were computed using multinomial logistic regression, taking women with normal BMI as the reference category of the outcome. ResultsFour years after delivery, 47% of women had normal BMI, 33% were overweight and 20% obese. In each BMI class, 61%, 33% and 12% presented a healthy metabolic profile, respectively. Family history of CVD/cardiometabolic risk factors was associated with a higher probability of obesity with a not healthy metabolic profile (OR=1.39 95% CI: 0.98–1.98). Women who breastfed the enrolled child for >26weeks and practiced physical exercise were less likely to be obese and metabolically unhealthy (OR=0.39 95% CI: 0.23–0.68; OR=0.48 95% CI: 0.33–0.70, respectively), with no effect on healthy excessive weight. ConclusionsThese results support the existence of a healthy excessive weight phenotype in women after motherhood, influenced by anthropometrics, genetic and lifestyles characteristics.

Knowledge on Perimenopausal Symptoms among Women Attending Lumbini Medical College Teaching Hospital

Introduction: Perimenopause is an unavoidable stage of a woman's reproductive life that starts several years before menopause. Due to declining estrogen level, women experience physiological and psychological changes during perimenopausal period and sometimes symptoms are very distressing that affect the women’s quality of life negatively. This study was done to assess the knowledge of women about perimenopausal symptoms.&#x0D; Methods: A cross-sectional analytical study was done at Lumbini Medical college (LMC) throughout the months of November and December, 2013. Women of age 40-60 years, attending various clinics in LMC and ready to take part in the study were included. A total of 142 women were selected purposefully. The data was collected using the semi structured interview schedule.&#x0D; Results: The study revealed that half of respondents were between age group 40-44 years, 141 (99.3%) were married and 82 (57.7%) were literate. Three quarter of respondents (74.6%) were menstruating women. The main source of information on perimenopausal symptoms was friends and relatives (81.2%). Majority of respondents (n=90, 63.4%) had poor, 52 (33.8%) had fair and only 2.8% had good level of knowledge on perimenopausal symptoms. The respondents’ level of knowledge on perimenopausal symptoms was statistically significant with educational status (p&lt;0.001), level of education (p=0.048) and economic status (p=0.02).&#x0D; Conclusion: Many women have poor knowledge on perimenopausal symptoms. The role of health care provider is that they should seriously discuss about mid-life women’s health problems including perimenopausal symptoms and treatment modality including hormonal replacement therapy so the quality of life of women can be improved.

Tissue-Specific Stem Cells in the Myometrium and Tumor-Initiating Cells in Leiomyoma1

Tissue-specific (or somatic) stem cells constitute a subset of cells residing in normal adult tissues. By undergoing asymmetric division, they retain their ability to self-renew while producing daughter cells that go on to differentiate and play a role in tissue regeneration and repair. The human uterus consists primarily of endometrium and myometrium (the smooth muscle layer) that rapidly enlarges through its tremendous regenerative and remodeling capacity to accommodate the developing fetus. Such uterine enlargement and remodeling can take place repeatedly and cyclically over the course of a woman's reproductive life. These unique properties of the uterus suggest the existence of endometrial and myometrial stem cell systems. In addition, like somatic cells, tumor stem cells or tumor-initiating cells, a subset of cells within a tumor, retain the ability to reconstitute tumors. Uterine smooth muscle cells are thought to be the origin of leiomyomas that are the most common type of gynecologic tumor. Recent work has identified, isolated, and characterized putative stem/progenitor cells in the myometrium and in leiomyomas. Here, we review current studies of myometrial and leiomyoma stem/progenitor cells and provide a new paradigm for understanding myometrial physiology and pathology and how these cells might contribute to uterine remodeling during pregnancy and the formation of leiomyomas. The role of the WNT/CTNNB1 pathway in the pathogenesis of leiomyoma is also discussed.

Hormonal effects on women's facial masculinity preferences: The influence of pregnancy, post-partum, and hormonal contraceptive use

Here, we investigate changes in women's facial masculinity preferences across pregnancy and the post-partum period. The majority of previous research demonstrating changes in women's masculinity preferences has examined the impact of hormonal variation across the female menstrual cycle. Hormonal changes experienced during pregnancy and the post-partum period, critical periods in women's reproductive life histories, are considerably more extreme than the variation that occurs across the menstrual cycle, suggesting that differences in preferences may also be displayed during these times. We find that women's preference for masculinity in men's faces, but not women's faces, decreases in the post-partum period relative to pregnancy. Furthermore, when compared to a sample of nulliparous control participants, post-partum participants showed different masculinity preferences compared with women who were using hormonal contraception, with the direction of this difference dependent upon the sex of the face assessed.

A comparison of self-reported oral contraceptive use and automated pharmacy data in perimenopausal and early postmenopausal women

PurposeOral contraceptive (OC) use can occur throughout a woman's reproductive life span with the potential for long-term impacts on health. To assess potential measurement error in prior OC use, this study compared level of agreement between self-reported prior OC use and pharmacy dispensing data in perimenopausal and/or early postmenopausal women. MethodsThe study's 1399 women (ages, 45–59 years) were participants in a population-based case-control study of the association between OC use and fracture risk. Episodes of lifetime self-reported OC use (in months) were collected, by telephone interview, for January 1, 2008 through November 25, 2012. Pharmacy fills, back to 1980, were collected from automated data. Agreement was measured using the prevalence-adjusted and bias-adjusted kappa index. ResultsThe number of women with OC pharmacy fills was 11% to 45% higher than those who reported OC use during each time period. Between-measures agreement was better for more recent use. Prevalence-adjusted and bias-adjusted kappa index values ranged from 0.88 (95% confidence interval, 0.85–0.90) within 5 years from the reference date to 0.65 (95% confidence interval, 0.59–0.71) within 15 to 20 years. ConclusionsFor studies designed to assess the long-term effects of OC use, the current results are reassuring in noting moderate agreement between self-reported OC use and pharmacy data for up to 15 to 20 years before the interview.

Endometrial stem/progenitor cells.

Human endometrium regenerates and regresses with each menstrual cycle under hormonal control throughout a woman's reproductive life. The cyclical regeneration and remodeling potentials allude to the existence of stem/progenitor cells in the endometrium. There is increasing evidence that human endometrium contains small numbers of stem-like cells capable of self-renewal, multiple differentiation and tissue reconstitution. Although the precise identity of endometrial stem/progenitor cells remains elusive, these cells are thought to play pivotal role(s) in the physiological remodeling and regeneration of the human endometrium and also in the pathogenesis of endometrium-associated diseases, such as endometriosis.

Approaches to identify genetic variants that influence the risk for onset of fragile X-associated primary ovarian insufficiency (FXPOI): a preliminary study.

Fragile X-associated primary ovarian insufficiency (FXPOI) is due to an X-linked mutation that results from the expansion of a CGG repeat sequence located in the 5′ untranslated region of the FMR1 gene (premutation, PM). About 20% of women who carry the PM have cessation of menses before age 40, a clinical condition known as premature ovarian failure (POF). This leads to a 20-fold increased risk over women in the general population. Thus, this single gene mutation has a major effect on reducing a woman's reproductive life span. Based on survival analysis of about 1300 women, we showed that the mean age at menopause among PM carriers is reduced compared with noncarriers, even after removing women who reported POF. This suggests that the majority of women with the PM, not just a subset, experience ovarian insufficiency earlier than noncarriers. To better understand the underlying mechanism of the PM and to identify genes that modify the variable expressivity of FXPOI, we conducted two pilot studies. The first focused on five common variants known to reduce age at menopause. We genotyped these SNPs in 72 women with a PM who experienced menopause and found a significant association with the total SNP risk burden and age at menopause. This suggests that these SNPs influence onset of FXPOI, after adjusting for the effect of the PM allele. In the second approach, we conducted whole genome sequencing on 10 PM carriers, five with onset of FXPOI prior to age 30 and five who experienced menopause after age 47 years. Although only a pilot study, we describe our preliminary approach to identify potential variants that may play a role in modifying onset of FXPOI and potentially play a role in idiopathic primary ovarian insufficiency. The overarching goal of both approaches is to identify predictor variants that may identify women predisposed to early onset FXPOI and to further identify genes involved in defining a woman's reproductive life span.

Defining what is normal at menopause: How women's and clinician's different understandings may lead to a lack of provision for those in most need

Many aspects of women's reproductive life have fallen under the medical gaze and the end of women's fertility has been no exception. For several years hormone therapy (HT) was considered the best solution for menopause symptoms and in some countries more than 50% of eligible women were prescribed oestrogen. Clinicians were accused of ‘medicalising the normal’ by applying the biomedical model to a natural lifestage and thus defining menopause as an illness which deviates from biological normality. The purpose of this paper is to review what women and their clinicians ‘know’ about menopause, and what happens when these two different types of knowledge collide. In the last decade, menopause has been demedicalised, partly because of criticism from feminist researchers, partly due to the publication of major studies indicating elevated risk of breast and ovarian cancers and venous thromboembolisms and, partly because neither physicians nor women experiencing menopause know what constitutes normality. The combined result has been that many clinicians have been cautious about prescribing drugs to treat problematic symptoms. This raises the concern that demedicalisation of menopause may have gone too far, leaving the 20–30% of women who experience distressing symptoms without adequate help or relief.

Role of uterine contraction in regeneration of the murine postpartum endometrium.

The endometrium undergoes continuous repair and regeneration without scarring throughout the reproductive life of women. However, the mechanisms responsible for this complete restoration remain mostly unexplored. We hypothesized that the ischemic state and local hypoxia present after parturition may create a special microenvironment for endometrial healing, and that this ischemia might be caused by reduction in organ volume via postpartum uterine contraction. Here, we developed a mouse model using a combination of cesarean section and the administration of a beta 2 adrenergic receptor agonist (ritodrine hydrochloride) in postpartum mice that had been ovariectomized to exclude the effect of ovarian hormones. Our results revealed that transient hypoxia indeed occurred in postpartum uteri. Furthermore, we found that the number of M2 macrophages, which play a central role in wound healing, peaked on Postpartum Day 3 and gradually decreased thereafter in hypoxic injury sites. Almost concurrently, significant upregulation of vascular endothelial growth factor and transforming growth factor beta (TGFbeta) was observed. In particular, the antifibrotic factor TGFbeta3 was released during the endometrial healing process. These changes were significantly suppressed by inhibition of uterine contraction. Taken together, these results suggest that uterine contraction is essential, not only for hemostasis, but also for endometrial regeneration, leading to a process that involves the activation of macrophages, increased endometrial cell proliferation, and upregulation of nonfibrotic growth factors. This study paves the way to a novel approach for investigating the process of scarless wound healing.

‘As many options as there are, there are just not enough for me’: Contraceptive use and barriers to access among Australian women

Objective A comprehensive life course perspective of women's experiences in obtaining and using contraception in Australia is lacking. This paper explores free-text comments about contraception provided by women born between 1973 and 1978 who participated in the Australian Longitudinal Study on Women's Health (ALSWH).Methods The ALSWH is a national population-based cohort study involving over 40,000 women from three age groups, who are surveyed every three years. An initial search identified 1600 comments from 690 women across five surveys from 1996 (when they were aged 18–23 years) to 2009 (31–36 years). The analysis included 305 comments from 289 participants. Factors relating to experiences of barriers to access and optimal contraceptive use were identified and explored using thematic analysis.Results Five themes recurred across the five surveys as women aged: (i) side effects affecting physical and mental health; (ii) lack of information about contraception; (iii) negative experiences with health services; (iv) contraceptive failure; and (v) difficulty with accessing contraception.Conclusion Side effects of hormonal contraception and concerns about contraceptive failure influence women's mental and physical health. Many barriers to effective contraception persist throughout women's reproductive lives. Further research is needed into reducing barriers and minimising negative experiences, to ensure optimal contraceptive access for Australian women.Chinese 摘 要 目的 从一种全面的生命历程的角度来看，澳大利亚妇女缺乏获取和采用避孕方法方面的经验。本文探究了1973年至1978年间出生，参加澳大利亚妇女健康纵向研究（ALSWH）的女性所提供的关于避孕的自由评论。方法 ALSWH是一项国家性的以人群为基础的群组研究项目，有来自各个年龄组的40,000多名女性参加，每三年对她们进行一次调查。最初搜索到的是在1996年（当时她们18-23岁）至2009年（当时她们31-36岁）参与五项研究的690名女性所做的1600条评论。本项分析包括289名参与者的305条评论。采用主题分析方法确定并探究了与所面临的障碍和采用理想避孕方法等方面的经验相关的因素。结果 随着这些女性年龄的增长，五项研究的五个主题再次出现：（i）影响生理和心理健康的副作用；（ii）缺乏避孕相关的信息；（iii）卫生服务的负面经历；（iv）避孕失败；（V）成功避孕的困难。结论 激素避孕和对担心避孕失败的副作用影响女性的生理和心理健康。许多有效避孕的障碍会始终贯穿女性的育龄期。下一步的研究应减少障碍并使负面的经历最小化，为澳大利亚妇女确保最佳的避孕方法。

The Influence of Socio-Demographic Factors on Miscarriage Incidence Among Italian and Immigrant Women: A Critical Analysis from Italy

Miscarriage is one of the most relevant adverse events in women's reproductive life. The purpose of the study was to describe miscarriage trend in Italy during the last years among Italian and immigrant women, to compare miscarriage rates of the two groups and to evaluate the effect of age, nationality and educational level on the incidence of having a miscarriage. Then, a brief critical review of other miscarriage risk factors was performed. This study is based on ISTAT database. All data were analyzed through the statistical software SPSS and the following analytical techniques were used: multivariate logistic regression, factorial analysis of variance and Chi square test. Immigrant miscarriage rates resulted higher than Italian ones and they decreased from 2003 to 2009 unlike Italian ones, which remained unchanged. The effect of maternal age on the miscarriage incidence resulted different, depending on the nationality; for Italian women it increased with increasing of age and for immigrant women the opposite trend was found. Moreover, miscarriage incidence resulted significantly different depending on the maternal educational level. Whereas immigrant women considered did not belong to the same ethnic group, biological or genetic factors underlying these differences were excluded and a socioeconomic explanation was provided. Finally, in order to provide more complete information, other miscarriage risk factors were discussed through a brief review of the literature.

Meta-analysis of loci associated with age at natural menopause in African-American women.

Age at menopause marks the end of a woman's reproductive life and its timing associates with risks for cancer, cardiovascular and bone disorders. GWAS and candidate gene studies conducted in women of European ancestry have identified 27 loci associated with age at menopause. The relevance of these loci to women of African ancestry has not been previously studied. We therefore sought to uncover additional menopause loci and investigate the relevance of European menopause loci by performing a GWAS meta-analysis in 6510 women with African ancestry derived from 11 studies across the USA. We did not identify any additional loci significantly associated with age at menopause in African Americans. We replicated the associations between six loci and age at menopause (P-value < 0.05): AMHR2, RHBLD2, PRIM1, HK3/UMC1, BRSK1/TMEM150B and MCM8. In addition, associations of 14 loci are directionally consistent with previous reports. We provide evidence that genetic variants influencing reproductive traits identified in European populations are also important in women of African ancestry residing in USA.

Genomic Markers of Ovarian Reserve

Ovarian reserve and its utilization, over a reproductive life span, are determined by genetic, epigenetic, and environmental factors. The establishment of the primordial follicle pool and the rate of primordial follicle activation have been under intense study to determine genetic factors that affect reproductive lifespan. Much has been learned from transgenic animal models about the developmental origins of the primordial follicle pool and mechanisms that lead to primordial follicle activation, folliculogenesis, and the maturation of a single oocyte with each menstrual cycle. Recent genome-wide association studies on the age of human menopause have identified approximately 20 loci, and shown the importance of factors involved in double-strand break repair and immunology. Studies to date from animal models and humans show that many genes determine ovarian aging, and that there is no single dominant allele yet responsible for depletion of the ovarian reserve. Personalized genomic approaches will need to take into account the high degree of genetic heterogeneity, family pedigree, and functional data of the genes critical at various stages of ovarian development to predict women's reproductive life span.

Contraceptive and sexual health care issues in women with schizophrenia

Schizophrenia is a debilitating mental health disease that currently affects about 1% of the world's population with over 250 000 diagnosed cases in Great Britain. The typical age of onset...

Sibling composition and household room sharing are associated with menarcheal status among rural Bengalee girls of West Bengal, India.

Menarche, the first menstruation, is one of the most important events in a woman's reproductive life. The timing of menarche varies across populations and depends upon social interaction and family environment. It is also associated with several biological as well as social factors. The objective of this study was to explore the relationship between sibling composition and age at menarche (AAM) and to assess the association between the pattern of room sharing with family members of different sexes and menarcheal occurrence among rural Bengalee girls from West Bengal, India. The total sample comprised 577 Bengalee girls, 6-17 years of age, from various schools and madrasas in two blocks of the Nadia District of West Bengal State in India. The effects of room sharing on the occurrence of menarche, and of sibling composition on the menarcheal age, were assessed by analyses of covariance. The room-sharing pattern had a significant effect on menarcheal status (yes÷no): a significantly higher percentage of girls who shared a room with the mother and÷or sisters were postmenarcheal compared with those who shared a room with male family members. AAM did not differ significantly between girls having brothers or sisters. However, sibling order had a significant impact on AAM. Girls who had a younger sibling only (brother or sister) had a higher mean AAM, and girls who had both younger brothers and younger sisters had significantly higher mean AAM, than did the girls who had no younger sibling (singletons or having only elder siblings). There was no difference in AAM between the girls who had younger sister(s) and those who had younger brother(s). These differences were also independent of body mass index. In conclusion, the room sharing characteristics and the sibling sex composition, particularly their order, had significant effect on menarche in adolescent rural Bengalee girls.

Changes in the PCOS phenotype with age

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-age women. The diagnosis of PCOS is mainly based on the following three components: (1) hyperandrogenism, (2) oligo-amenorrhea, and (3) the observation of polycystic ovaries on a sonogram. The comorbidities may include insulin resistance, type II diabetes mellitus, hypertension and cardiovascular disease. Importantly, the diagnostic criteria and complications related to PCOS are age-dependent. Androgen production in women may decrease because of ovarian aging or decreased production by the adrenal glands over time. The prevalence of hirsutism and acne decreases with age. Ovarian volume and follicle number also decrease with age, with the age-related decrease in follicle number seemingly greater than that of ovarian volume. Aging may also be associated with increased risk of insulin resistance and metabolic disturbances. Therefore, these age-related changes may affect the observed incidence and complications of PCOS. In adolescent patients, the criteria described above pose particular diagnostic problems because the characteristics of normal puberty often overlap with the signs and symptoms of PCOS. Hyperandrogenism and chronic anovulation are the primary disturbances in younger women with PCOS; whereas, obesity, insulin resistance, and metabolic disturbances are predominant in older women with PCOS. The deterioration of insulin resistance during the reproductive life of women with PCOS appears to be mainly attributable to the increase in obesity. Therefore, if body weight could be controlled properly, younger hyperandrogenic PCOS women might reduce their risk of insulin resistance and metabolic disturbances later in life.

Consequences of a Primary Elective Cesarean Delivery Across the Reproductive Life

To estimate cumulative risks of morbidity associated with the choice of elective cesarean delivery for a first delivery. A decision analytic model was designed to compare major adverse outcomes across a woman's reproductive life associated with the choice of elective cesarean delivery compared with a trial of labor at a first delivery. Maternal outcomes assessed included maternal transfusion, hysterectomy, thromboembolism, operative injury, and death. Neonatal outcomes assessed included cerebral palsy and permanent brachial plexus palsy in the offspring. Choosing an initial cesarean delivery resulted in a 0.3% increased risk of a major adverse maternal outcome in the first pregnancy. In each subsequent pregnancy, the difference in composite maternal morbidity increased such that by the fourth pregnancy, the cumulative risk of a major adverse maternal outcome was nearly 10% in the elective primary cesarean delivery group, three times higher than women who initially underwent a trial of labor. Although the choice of an initial cesarean delivery resulted in 2.4 and 0.41 fewer cases of cerebral palsy and brachial plexus palsy, respectively, per 10,000 women in the first pregnancy, by a fourth pregnancy, the risk of a adverse neonatal outcome was higher among offspring of women who had chosen the initial elective cesarean delivery (0.368% compared with 0.363%). Maternal morbidity associated with the choice of primary elective cesarean delivery increases in each subsequent pregnancy and is greater in magnitude than that associated with the choice of a trial of labor. These increased risks are not offset by a substantive reduction in the risk of neonatal morbidity.

Introduction to “Coping with Environmental Risk and Uncertainty: Individual and Cultural Responses”

The papers in this special issue of Human Nature collectively consider societal and individual responses to a wide variety of environmental and social risks. The first paper considers societal level effects of pathogen risk on collectivism and conformity, avoidance of outsiders, and in-group loyalty in a worldwide cross-cultural sample. The second deals with societal-level effects of resource unpredictability on the nature and conduct of warfare in eastern Africa. The third deals with effects of volcanic eruptions and earthquakes and mediating factors on individual perceptions of risk in Mexico and Ecuador. The final paper deals with effects of various types of father absence on women's reproductive life histories in Bangladesh.

Somatic Stem Cells in the Myometrium and in Myomas

The human uterus mainly consists of two layers: an inner endometrium and an outer layer, the myometrium, made of smooth muscle. The uterus is characterized by its unique capacity for regeneration. This capacity permits cyclical regeneration and remodeling of the tissue over the course of a woman's reproductive life. During each menstrual cycle, the endometrium regenerates, and the uterus enlarges to make room for fetal growth. This cyclic physiologic pattern suggests that myometrial stem/progenitor cells are present in the tissue and play a role in myometrial functions. Our group (and others) recently characterized and isolated putative stem/progenitor cells in the myometrium. These findings are permitting a better understanding of myometrial physiology and pathology. We review current studies of myometrial stem/progenitor cells and suggestions that, in combination with hypoxia, these cells may contribute to uterine remodeling during pregnancy and the formation of myomas.