Association Between Mental Health and Reproductive System Disorders in Women: A Systematic Review and Meta-analysis

The Association Between Medically Assisted Reproduction and Postpartum Depression: A Register-Based Cohort Study

OBJECTIVE

Undergoing medically assisted reproduction (MAR) has been linked to mixed mental health outcomes in women. We investigated the risk of postpartum depression (PPD) among mothers conceiving with MAR compared to mothers conceiving spontaneously.

DESIGN

Register-Based Study.

SETTING

Denmark.

POPULATION

125 870 mothers with a PPD screening record who gave birth between 2015 and 2019.

METHODS

We linked mothers' PPD screening records to national health registers and defined MAR conception linking childbirths to MAR treatments.

MAIN OUTCOME MEASURES

We defined PPD as an Edinburgh Postnatal Depression Scale score of ≥ 11. We performed logistic regression on the risk of PPD among mothers who conceived with MAR compared to spontaneous conception and further assessed variations according to duration, type, and indication for MAR.

RESULTS

The study population included 10 977 mothers with MAR conception and 114 893 with spontaneous conception, of which 767 (7%) and 8767 (8%) had PPD. We found a lower risk (adjusted risk ratio 0.87, 95% CI [0.80-0.93]) of PPD among mothers with MAR conception compared to spontaneous conception, with smaller variations according to type, duration and indication for MAR.

CONCLUSIONS

We observed a lower risk of PPD among mothers with MAR conception compared to mothers with spontaneous conception. While it is unlikely that MAR itself is protective of PPD, women who seek MAR may have a strong desire and psychological preparedness for parenthood, which could explain the observed findings. Among mothers conceiving with MAR, PPD risk may vary depending on the type of MAR treatment and underlying reasons for seeking MAR.

The prevalence and risk of anxiety and depression in polycystic ovary syndrome: an overview of systematic reviews with meta-analysis

PURPOSE

To summarize the pooled prevalence rates of anxiety and depression in women with polycystic ovary syndrome.

METHODS

An overview of systematic reviews with meta-analysis was conducted. The CINAHL, Embase, PsycINFO, and PubMed databases were searched up to April 22, 2024. The methodological quality of systematic reviews was assessed using AMSTAR 2. The degree of overlap between reviews was analyzed by calculating the corrected covered area.

RESULTS

Ten systematic reviews were selected. Regarding anxiety disorders, the pooled prevalence of panic disorder, social phobia, and anxiety disorders without specifying the type of disorder were 4%, 5%, and 16.9%, respectively. This prevalence was higher in depressive disorders, reaching 34.8%. Anxiety symptoms were very prevalent in women with PCOS, although the prevalence varied depending on the self-reported questionnaire used: the Hamilton Anxiety Scale 69.4%, the Hospital Anxiety and Depression Scale 41.5%, and the Self-rating Anxiety Scale 32.4%. Additionally, the highest prevalence of depression symptoms was associated with the Beck Depression Inventory 46.0%, followed by the Self-rating Depression Scale 39.2%, and the Hospital Anxiety and Depression Scale, which ranged from 31% to 33.8%.

CONCLUSIONS

Meta-analyses found mainly anxiety and depression symptoms and disorders are prevalent in women with PCOS. Meta-analyses also showed women with PCOS had a higher risk of having anxiety disorders, and depression symptoms than women without PCOS.

HIGHLIGHTS

• Anxiety symptoms were prevalent, although the prevalence varied depending on the self-reported questionnaire. • The highest prevalence of depression symptoms was associated with the Beck Depression Inventory (46.0%). • The pooled prevalence of anxiety disorders without specifying the type of disorder was 16.9%.

Changes in the global burden of polycystic ovary syndrome from 1990 to 2021

BACKGROUND

Polycystic ovary syndrome (PCOS) is a chronic, multifaceted condition influenced by epigenetic and environmental factors that is responsible for a significant proportion of anovulatory infertility cases. Here, we analyzed the global, regional, and national burdens of PCOS from 1990 to 2021 using data from the Global Burden of Disease 2021 (GBD 2021).

METHODS

Incidence, prevalence, and Disability-Adjusted Life Years (DALYs) data relevant to PCOS from 204 countries and 21 territories from 1990 to 2021 were obtained from the GBD 2021 study. Here, we considered age-standardized rates (per 100,000 individuals) with 95% uncertainty intervals (95% UIs) obtained from the aforementioned research and presented trends based on age and Socio-demographic Index (SDI) parameters.

RESULTS

In 2021, the global age-standardized incidence and prevalence rates of PCOS were 30.7 per 100,000 and 867.7 per 100,000, respectively, representing an increase of 26.77% and 28.21% since 1990. Additionally, age-standardized disability-adjusted life years stood at 7.6 per 100,000 globally in 2021, marking a 27.58% increase from 1990. Age-standardized prevalence of PCOS varied across countries, ranging from 93.1 to 3978.9 cases per 100,000 women, with Italy (3978.9), Japan (3104.7), and New Zealand (2789.7) having the highest rates. Notably, PCOS prevalence was noted to peak globally among females 15-19 years of age. Regions with a high SDI exhibited the highest age-standardized incidence (70.2), prevalence (1720.7), and DALY (15.2) rates of PCOS. Furthermore, a nonlinear correlation between PCOS burden and SDI was noted, with prevalence rates peaking around an SDI of approximately 0.9.

CONCLUSION

Our findings highlight the growing global impact of PCOS and underscore the need for concerted efforts to attenuate the increasing global prevalence of this condition. Significantly divergent PCOS disease burdens were observed across different age groups and SDI regions, with high SDI regions bearing heavier burdens. The increased disease burden among younger age groups and regional disparities underscore urgency for targeted intervention and formulation of policies to effectively address this public health issue.

The Neuroendocrine Regulation of Reproductive Behavior and Emotional Control by Kisspeptin

Reproductive success and ultimately species survival at a population level is contingent on a plethora of neuroendocrine signals working in concert to regulate gonadal function and reproductive behavior. Among these, the neuropeptide kisspeptin (encoded by the KISS1/Kiss1 gene) has emerged as the master regulator of the hypothalamic-pituitary-gonadal axis. Besides the hypothalamus, both kisspeptin and its cognate receptor are extensively expressed throughout cortico-limbic brain structures in rodents and humans, which are regions traditionally implicated in behavioral and emotional responses. Thus, there exists a neuroanatomical framework through which kisspeptin can integrate reproductive behavior and emotional regulation with the reproductive axis. Accordingly, this sets the scene for recent findings derived from an assortment of species, including humans, unveiling kisspeptin as an important gatekeeper of reproductive behavior and emotional control. Herein, we summarize the major preclinical animal and human experimental evidence identifying kisspeptin as a key neuromodulator of reproductive behavior and emotional state. Such findings have laid the foundations for clinical applications of kisspeptin-based therapies for patients with related reproductive and psychosexual disorders.

Characterizing the description of pelvic congestion syndrome pain: A latent class analysis

ObjectivesChronic pelvic pain from pelvic congestion syndrome (PCS) is a complex condition disproportionately affecting women. PCS pain has been described as dull and achy, but emerging research indicates variances in the historical pain depictions. We aimed to identify the groups of pain characteristics experienced by women living with PCS using a latent class analysis and examine their predictive validity on quality of life, pain intensity, and pain management indicators.MethodsA secondary data analysis of cross-sectional survey data collected from 160 participants on a Facebook PCS support group was conducted. After evaluating the original 86 unique pain descriptors endorsed on the McGill Pain Questionnaire, descriptors endorsed by more than 30 participants were retained for analysis (n = 34).ResultsResults from the latent class analysis identified two latent classes: mild but consistent (44.4%) and intense and debilitating (55.6%). Between the two latent classes, there were clear patterns of pain endorsement to indicate that women in the two groups experience PCS pain differently. Compared to the second latent class (intense and debilitating), women in the first latent class (mild but consistent) experienced milder PCS associated pain and reported a significantly higher quality of life, satisfaction with their health, and less interference with sleep quality and sexual desire. Unfortunately, everyday activities (i.e., exercising, urinating, moving, standing, and working) were more likely to increase pain for women in the second latent class.ConclusionsDiagnosis and treatment of pelvic venous disorders are hindered by outdated evidence on the expected pain depictions. A comprehensive pain profile of PCS is needed to establish the effect on women's lifestyles, quality of life, and mental health.

Pitfalls and Strategies for Measuring Menopausal Stage in Eating Disorder Studies of Women in Midlife

OBJECTIVE

Researchers are increasingly interested in exploring the role of the menopausal transition in eating disorder risk. We recently embarked on studies of this critical life phase and encountered significant challenges in assessing menopausal status that limited our ability to test study hypotheses. This Research Forum describes these challenges and presents descriptive data on staging accuracy as well as recommendations for improving assessments that can advance research in this critical area of women's health.

METHOD

Data come from 207 women (ages 40-58) assessed in an ongoing study from the MSU Twin Registry. Menopausal status (premenopause, perimenopause, postmenopause) was measured with the Perimenopause Evaluation Questionnaire assessing women's self-identified stage as well as the regularity of menstrual cycles and medical history. Staging accuracy was evaluated by comparing the self-identified stage with results from individual case analyses of questionnaire responses.

RESULTS

Many more women self-identified as premenopausal (62%), perimenopausal (27%), and postmenopausal (11%) than we identified in case analyses (20%, 7%, 8%, respectively). These discrepancies appeared to be due to women failing to account for medications or medical conditions that would cause premature cessation of menses and/or insufficient questionnaire items and information for staging women with complicated reproductive histories.

DISCUSSION

Findings highlight significant limitations of self-identified status or questionnaire responses alone in determining menopausal status. We provide recommendations for improving stage assessments, drawn from the challenges and lessons learned in our own studies, thereby allowing others to better explore this critical stage and advance women's health in our field.

Familial confounding in the associations between maternal health and autism

Evidence suggests that maternal health in pregnancy is associated with autism in the offspring. However, most diagnoses in pregnant women have not been examined, and the role of familial confounding remains unknown. Our cohort included all children born in Denmark between 1998 and 2015 (n = 1,131,899) and their parents. We fitted Cox proportional hazard regression models to estimate the likelihood of autism associated with each maternal prenatal ICD-10 diagnosis, accounting for disease chronicity and comorbidity, familial correlations and sociodemographic factors. We examined the evidence for familial confounding using discordant sibling and paternal negative control designs. Among the 1,131,899 individuals in our sample, 18,374 (1.6%) were diagnosed with autism by the end of follow-up. Across 236 maternal diagnoses we tested (prevalence ≥0.1%), 30 were significantly associated with autism after accounting for sociodemographic factors, disorder chronicity and comorbidity, and correction for multiple testing. This included obstetric, cardiometabolic and psychiatric disorders (for example, diabetes in pregnancy (hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.08-1.31) and depression (HR 1.49, 95% CI 1.27-1.75)), previously shown to be associated with autism. Family-based analyses provided strong evidence for familial confounding in most of the observed associations. Our findings indicate pervasive associations between maternal health in pregnancy and offspring autism and underscore that these associations are largely attributable to familial confounding.

The link between tinnitus and menstrual cycle disorders in premenopausal women

This cross-sectional study aimed to explore the association between tinnitus and menstrual cycle disorders in premenopausal women. A total of 558 participants completed a comprehensive questionnaire covering demographics, tinnitus, and gynecological/obstetric history. The analysis investigated the correlation between tinnitus and various menstrual disorders, including dysmenorrhea (primary, secondary, or premenstrual syndrome), as well as different menstrual cycle patterns (regular, hypomenorrhea, menorrhagia, oligomenorrhea, or polymenorrhea). Among the participants, 33% reported experiencing tinnitus, with 74.4% experiencing dysmenorrhea. The most prevalent pathological menstrual pattern was menorrhagia (20%), followed by hypomenorrhea (11.11%). The results revealed a significant increase in tinnitus among premenopausal women with secondary dysmenorrhea (p value < 0.001) or menorrhagia (p value < 0.002) compared with those without tinnitus. Adjustment for confounding variables such as age, income, and psychological health problems did not alter the significant correlations between tinnitus and secondary dysmenorrhea and menorrhagia. Further research is needed to elucidate the nature of this relationship and its underlying mechanisms. Both tinnitus and menstrual disorders can have substantial impacts on the well-being of affected women, and a deeper understanding of these issues could pave the way for improvements in their health care.

Mental illness and sleep disorders among women with gynecological problems

This retrospective cohort study identifies differences between rates of selected mental illnesses and sleep disorders according to eight gynecological problems. Analyses utilize medical claims data for adult employees of a large corporation during 2017-2021. Women with a gynecological problem (most notably pain, endometriosis, pelvic inflammation and bleeding) are significantly more likely to experience mental illness. Several gynecological problems are also significantly associated with sleep disorders. Women with a gynecological problem (vs. none) are 50% more likely to have a mental health problem and 44% more likely to have a sleep disorder after adjusting for age, marital status, dependent children and year. The largest differences between higher (%) mental illness and sleep disorders appear for hyperplasia (6% vs. 45%), cancer (11% vs. 68%), pelvic inflammation (46% vs. 79%) and pain (79% vs. 43%), respectively. On the other hand, the rate of having one or more gynecological problems ranges from 7.1% for women with no mental illness or sleep disorder to 20.6% for women with schizophrenia. Understanding the association between gynecological problems, mental illness and sleep disorders can help clinicians more effectively identify and treat patients.

The conversation about family planning and desire for children in mental healthcare: Patients' perspective versus Professionals' perspective in a mixed methods study

BACKGROUND

Reproductive health and mental health are intertwined, but studies investigating family planning needs and desire for children in mental healthcare are scarce.

METHODS

We studied the experiences of (former) patients, those with close relationships with the (former) patients (close ones) and mental health professionals (MHP) on discussing family planning and desire for children in mental healthcare. We combined quantitative (two nationwide surveys) and qualitative data (four focus groups) in a mixed-methods approach with sequential analytical design.

RESULTS

Combined data from focus groups (n = 19 participants) and two surveys (n = 139 MHPs and n = 294 (former) patients and close ones) showed that a considerable group of MHPs (64.0%), patients (40.9%) and close ones (50.0%) found that family planning should be discussed by a psychiatrist. However, several obstacles impeded a conversation, such as fear of judgment, lack of time and knowledge and limited opportunity for in-depth exploration of life themes in therapeutic relationships.

CONCLUSIONS

To increase the autonomy of patients in discussing family planning, we suggest MHPs explore the desire to discuss family planning with all patients in the reproductive phase of life, prior to discussing contraceptive care. MHPs should receive education about psychiatric vulnerability in relation to family planning and desire for children, and patients and close ones should be empowered to initiate a conversation themselves.

Psychological impact of neovagina creation and uterus transplantation in the patients affected from Mayer-Rokitanski-Kuster-Hauser syndrome: A narrative review

Mayer-Rokitanski-Kuster-Hauser (MRKH) syndrome consists of a congenital aplasia of the uterus and the upper part of the vagina. It is the most frequent congenital cause of absolute uterine factor infertility, determining psychological disorders due to infertility and reduced quality of sexual activity. Being the necessity of baseline and prolonged assessments, clinicians need evaluation parameters for the monitoring of patients to plan a suitable management strategy and for efficient support before and after interventions, such as neovagina and uterus transplantation. Research of the literature was performed in PubMed and SCOPUS by searching for the terms "Mayer-Rokitanski-Kuster-Hauser" AND "psychological disorders"; from the 60 articles obtained, only 35 articles regarding neovagina creation and uterus transplantation were considered for the present manuscript. Based on the literature, management of MRKH syndrome by neovagina creation, either surgically or not, can restore a satisfactory sexual life and to reduce stress, signs of mental disorder and depression and improve sexual activity and quality of life. A psychological assessment of candidates to UT and of their partners is necessary. Recipients had low levels of anxiety compared to the normal population at baseline but a transiently lowered physical quality of life 1 year after surgery; elevated anxiety scores are associated with childlessness in the long-term evaluation. Further research is necessary to develop suitable evaluation protocols and adequate supportive services, to improve the outcomes of patients who undergo neovagina creation and uterus transplantation.

Cross-disciplinary working between gynaecologists and mental healthcare professionals: a mixed-methods systematic review protocol

INTRODUCTION

Reproductive hormone transitions (menstrual cycle, post partum and menopause) can trigger mental disorders in a subset of women. Gynaecological diseases, such as endometriosis and polycystic ovary syndrome, can also elevate the risk of mental illness. The link between psychiatrists and obstetricians is already well established in the peripartum period; however, the link between gynaecology and psychiatry is less so. This mixed-methods systematic review aims to synthesise the existing evidence for integrated mental healthcare for gynaecological illnesses or reproductive hormone transitions outside the perinatal period.

METHODS AND ANALYSIS

A systematic search of the MEDLINE, Embase, Scopus, PsycInfo, CINAHL and Web of Science databases will be conducted. All study types will be considered, both quantitative and qualitative. Opinion and expert consensus statements, as well as government and professional body documents, will also be included, but separately analysed and reported. Studies examining the unmet clinical needs and experiences of women experiencing mental disorders related to reproductive hormone transitions (menarche, menstrual, menopause, but not pregnancy or breast feeding) or gynaecological illness will be included. Studies related to the experience or training of professionals caring for them will be included, specifically on the concept of integrated or interdisciplinary work with colleagues outside their specialty. Abstracts of the identified papers will be screened independently by two reviewers. Full texts will be assessed by two reviewers, and data will be extracted using predetermined data extraction tools. Quantitative studies will be synthesised in narrative format. A thematic synthesis of qualitative studies will be conducted and an integrated narrative synthesis will be described.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review, as no primary data will be collected. The results will be disseminated via a peer-reviewed publication in a relevant scientific journal.

PROSPERO REGISTRATION NUMBER

CRD42024523590.

Raphe glucose-sensing serotonergic neurons stimulate KNDy neurons to enhance LH pulses via 5HT2CR: rat and goat studies

Dysfunction of central serotonergic neurons is known to cause depressive disorders in humans, who often show reproductive and/or glucose metabolism disorders. This study examined whether dorsal raphe (DR) serotonergic neurons sense high glucose availability to upregulate reproductive function via activating hypothalamic arcuate (ARC) kisspeptin neurons (= KNDy neurons), a dominant stimulator of gonadotropin-releasing hormone (GnRH)/gonadotropin pulses, using female rats and goats. RNA-seq and histological analysis revealed that stimulatory serotonin-2C receptor (5HT2CR) was mainly expressed in the KNDy neurons in female rats. The serotonergic reuptake inhibitor administration into the mediobasal hypothalamus (MBH), including the ARC, significantly blocked glucoprivic suppression of luteinizing hormone (LH) pulses and hyperglycemia induced by intravenous 2-deoxy-D-glucose (2DG) administration in female rats. A local infusion of glucose into the DR significantly increased in vivo serotonin release in the MBH and partly restored LH pulses and hyperglycemia in the 2DG-treated female rats. Furthermore, central administration of serotonin or a 5HT2CR agonist immediately evoked GnRH pulse generator activity, and central 5HT2CR antagonism blocked the serotonin-induced facilitation of GnRH pulse generator activity in ovariectomized goats. These results suggest that DR serotonergic neurons sense high glucose availability to reduce gluconeogenesis and upregulate reproductive function by activating GnRH/LH pulse generator activity in mammals.

Is polycystic ovary syndrome a risk factor for depression and anxiety?: a cross-sectional study

OBJECTIVE

The objective of this study was to learn more about the prevalence and pathophysiology of depression and anxiety that may be caused by polycystic ovary syndrome and to make plans for taking necessary precautions for this vulnerable group.

METHODS

This case-control study was conducted between January 2022 and October 2022. A total of 120 women with polycystic ovary syndrome and 143 controls were included in the study. All healthy volunteers and women with polycystic ovary syndrome were evaluated using self-administered questionnaires and physical examination. Anthropometric data such as weight and height and laboratory value were documented.

RESULTS

There was no significant difference between the groups in terms of demographic characteristics. When the Hospital Anxiety and Depression Scale scores of both groups were compared, both depression and anxiety scores were found to be significantly higher in women with polycystic ovary syndrome compared with the control group (OR: 3.319, 95%CI, 1.563-7.047, p<0.001 and OR: 3.238, 95%CI, 1.659-6.315, p<0.001). In the Hospital Anxiety and Depression Scale questionnaire, the rate of irregular menstruation and Ferriman-Gallwey score were statistically significant in women with polycystic ovary syndrome with high depression and anxiety scores. While serum LH levels and LH/FSH ratios were significantly different in women with polycystic ovary syndrome with high depression scores, serum LH, LH:FSH ratios, and serum total testosterone levels were found significant in women with polycystic ovary syndrome with high anxiety scores.

CONCLUSION

It is clear that depression and anxiety are more common in patients with polycystic ovary syndrome than in healthy women. Our findings support previous recommendations regarding routine screening for depression and anxiety in this population.

[Endocrine and psychosomatic disorders in patients with amenorrhea]

The article presents data on the relationship of pathogenetic mechanisms for the development of menstrual disorders of functional and organic origin in connection with mental disturbances from the point of view of the psychosomatic concept. According to the latter, functional disorders of the menstrual cycle are considered as psychosomatic, in which gynecological pathology develops as a result of psychopathological illness. A striking example of such a disorder is functional hypothalamic amenorrhea. At the same time, endocrinopathies, such as polycystic ovary syndrome and premature ovarian insufficiency, can also be considered in the paradigm of psychosomatic illnesses of ovarian function due to the high prevalence of anxiety and depressive disorders in this cohort of patients. This review highlights the importance of interdisciplinary collaboration between a gynecologist and a psychiatrist for the most effective reproductive rehabilitation of patients with amenorrhea. Literature search was carried out in national (eLibrary, CyberLeninka.ru) and international (PubMed, Cochrane Library) databases in Russian and English. The priority was free access to the full text of articles. The choice of sources was prioritized for the period from 2018 to 2023.However, taking into account the insufficient knowledge of the chosen topic, the choice of sources dates back to 1985.

Depression and Anxiety in Patients With Polycystic Ovary Syndrome: A Cross-Sectional Study in Saudi Arabia

INTRODUCTION

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females of childbearing age. It causes irregular menstruation, infertility, acne vulgaris, androgenic alopecia, and hirsutism. It is associated with a higher risk of mental disorders. This study aimed to determine the prevalence of depression and anxiety among females with PCOS and the factors associated with these disorders.

METHODS

This cross-sectional study was conducted between 15th January and 19th November 2023. We invited Saudi women to do an online survey. We sent the survey link privately, got their permission, and explained the research to ensure privacy and reliability. Females with a previous psychiatric history were excluded. Depression, Anxiety, and Stress Scale-21 Items (DASS-21) were used to assess depression, anxiety, and distress. One-way analysis of variance (ANOVA) and two-sample t-tests were used to identify determinants of depression and anxiety.

RESULTS

About 967 females participated, of whom 474 (49%) were married, and 358 (37%) had a healthy weight. About 367 (37.9%) of participants were diagnosed with PCOS, and it was associated with age (26-35 years), divorce, and family history of PCOS (p < 0.05). About 112 (30.5%) of PCOS patients experienced extremely severe depression, and 144 (39.2%) had extreme anxiety. People in the age range of 15-25 years had a higher risk of depression and stress (p < 0.05). Divorced participants faced a higher risk of depression, anxiety, and stress than singles (p < 0.05). Those advised on diet and healthy lifestyles exhibited a higher risk of depression, anxiety, and stress than those who were not (p < 0.05). Additionally, being overweight was associated with a higher risk of depression (p < 0.05).

CONCLUSION

The prevalence of PCOS was found to be 37.9% in our study, which may seem higher compared to the existing literature on PCOS. It is associated with being in the age group of 26-35 years, being divorced, and having a positive family history. Almost two-thirds of females with PCOS had depression, anxiety, and stress. Factors associated with the three disorders include divorce and management with diet and lifestyle modifications. Depression and stress were associated with young age. High body mass index (BMI) was associated with depression.

Comorbid pathology of the mammary glands and endometriosis: risk factors and prognosis

OBJECTIVE

Aim: based on a retrospective analysis, the relationship between external genital endometriosis and comorbid breast pathology was established and risk factors were identified, their comparison and the formation of a prognostic risk criterion were determined.

PATIENTS AND METHODS

Materials and Methods: to address the objectives of the study, a retrospective analysis of 470 cases of patients treated for external genital endometriosis after surgical treatment and comorbid breast pathology was conducted. The control group included 30 healthy non-pregnant women. Statistical processing was performed on a personal computer using the statistical software package Statistica 10.

RESULTS

Results: As a result of the analysis, the age of the patients ranged from 23 to 40 years. The average age of patients in the study group was (32.2}1.18) years, and in the control group (31.1}1.35) (p>0.05). The groups were homogeneous in terms of age (p>0.05), marital status (p>0.05) and level of education (p>0.05). Close relatives in 208 (44.25}2.18) % (OR=8.86; 95 % CI: (0.68-10.53); p<0.002) cases suffered from benign (hormone-dependent) tumours and tumour-like diseases of the uterus and appendages in isolation or in various combinations (fibroids, adenomyosis, endometrial hyperplasia). It was also found that 102 (21.70}1.67) % of patients had endometriosis, which may indicate a genetic predisposition to this disease. In the closest relatives of EM patients: in 118 (25.10}2.01) % of the examined parents, breast problems were noted, in 66 (14.04}1.12) % - diabetes mellitus, and in 98 (20.85}1.22) % thyroid diseases were detected, which in total amounted to (60.00}2.23) % (OR=9.12; 95 % CI: (0.58-11.54); p<0.002). Early menarche almost tripled the risk of EM (OR=2.72; 95% CI: (1.02-5.11); p<0.002), and menstrual irregularities doubled it (OR=2.04; 95% CI: (1.09-3.14); p<0.05), higher education, urban residents - 2.2 times higher (OR= 2.27; 95 % CI: (1.11-3.63); p<0.05), diseases of the gastrointestinal tract and hepatobiliary complex - 5.2 times higher (OR=5.27; 95 % CI: (1.89-12.03); p<0.05), frequently recurrent inflammatory diseases of the appendages - 3 times higher (OR=3.14; 95 % CI: (0.91-5.14); p<0.05), dysmetabolic manifestations (thyroid dysfunction) - 5 times higher (OR=5.11; 95 % CI: (1.61-9.503); p<0.002).

CONCLUSION

Conclusions: Thus, in endometriosis and dyshormonal diseases of the mammary glands, menstrual and generative function disorders, along with clinical symptoms of pelvic pain, dysmenorrhoea, autonomic nervous system disorders and sexual dysfunction, are significant components of this problem, initiating comorbidity processes in target organs in the setting of hormonal maladaptation. Therefore, these comorbidities become a trigger for the activation of systemic hormonal imbalance and become an urgent interdisciplinary problem that requires further study.

A Common Genetic Factor Underlies Genetic Risk for Gynaecological and Reproductive Disorders and Is Correlated with Risk to Depression

INTRODUCTION

Sex steroid hormone fluctuations may underlie both reproductive disorders and sex differences in lifetime depression prevalence. Previous studies report high comorbidity among reproductive disorders and between reproductive disorders and depression. This study sought to assess the multivariate genetic architecture of reproductive disorders and their loading onto a common genetic factor and investigated whether this latent factor shares a common genetic architecture with female depression, including perinatal depression (PND).

METHOD

Using UK Biobank and FinnGen data, genome-wide association meta-analyses were conducted for nine reproductive disorders, and genetic correlation between disorders was estimated. Genomic Structural Equation Modelling identified a latent genetic factor underlying disorders, accounting for their significant genetic correlations. SNPs significantly associated with both latent factor and depression were identified.

RESULTS

Excellent model fit existed between a latent factor underlying five reproductive disorders (χ2 (5) = 6.4; AIC = 26.4; CFI = 1.00; SRMR = 0.03) with high standardised loadings for menorrhagia (0.96, SE = 0.05); ovarian cysts (0.94, SE = 0.05); endometriosis (0.83, SE = 0.05); menopausal symptoms (0.77, SE = 0.10); and uterine fibroids (0.65, SE = 0.05). This latent factor was genetically correlated with PND (rG = 0.37, SE = 0.15, p = 1.4e-03), depression in females only (rG = 0.48, SE = 0.06, p = 7.2e-11), and depression in both males and females (MD) (rG = 0.35, SE = 0.03, p = 1.8e-30), with its top locus associated with FSHB/ARL14EP (rs11031006; p = 9.1e-33). SNPs intronic to ESR1, significantly associated with the latent factor, were also associated with PND, female depression, and MD.

CONCLUSION

A common genetic factor, correlated with depression, underlies risk of reproductive disorders, with implications for aetiology and treatment. Genetic variation in ESR1 is associated with reproductive disorders and depression, highlighting the importance of oestrogen signalling for both reproductive and mental health.

Endovascular treatment of acute basilar artery occlusion: A systematic review and meta-analysis of first-line stent retriever versus direct aspiration

BACKGROUND

The best choice between first-line aspiration and stent retriever for acute basilar artery occlusion remains controversial. This study aims to perform a systematic review and meta-analysis comparing the stent retriever and direct aspiration about reported recanalization rates and periprocedural complications.

METHOD

PubMed, Embase, Web of Science, Cochrane, and Clinical Trials were searched for the studies evaluating the efficacy and safety of first-line aspiration versus stent retriever for acute basilar artery occlusion. A standard software program (Stata Corporation) was used for end-point analyses. Statistical significance was defined as a p-value less than .05.

RESULTS

A total of 11 studies were involved in the current study, including 1014 patients. Regarding postoperative recanalization, the pooled analysis identified a significant difference in successful recanalization (odds ratio [OR] = 1.642; 95% confidence interval (95% CI): 1.099-2.453; p = .015) and complete recanalization (OR = 3.525; 95% CI: 1.306-2.872; p = .001) between the two groups in favor of the first-line aspiration. Concerning the complications, the first-line aspiration could achieve a lower rate of total complication (OR = .359; 95% CI: .229-.563; p < .001) and hemorrhagic complication (OR = .446, 95% CI: .259-.769; p = .004) than stent retriever. No significant difference was observed in postoperative mortality (OR = .966; p = .880), subarachnoid hematoma (OR = .171; p = .094), and parenchymal hematoma (OR = .799; p = .720). In addition, the pooled results revealed a significant difference in procedure duration between the two groups in favor of aspiration (WMD = -27.630, 95% CI: -50.958 to -4.302; p = .020). However, there was no significant difference in favorable outcome (OR = 1.149; p = .352) and rescue therapy (OR = 1.440; p = .409) between the two groups.

CONCLUSION

Given that the first-line aspiration was associated with a higher rate of postoperative recanalization, a lower risk of postoperative complication, and a faster duration of the procedure, these findings support the aspiration may be more secure than a stent retriever.