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Purpose To evaluate the acceptance of micronutrient therapy in women with symptoms related to a pathological neurostress profile and to explore its association with patient-reported outcomes such as perceived efficacy, side effects, compliance, and perceived lack of information. Methods This retrospective observational study included women aged ≥ 18 years who underwent neurostress testing followed by micronutrient therapy. The study was conducted at the Department of Obstetrics and Gynecology, University Hospital Bern. Patients were invited to complete the validated ACCEPT© questionnaire to assess their level of treatment acceptance. Descriptive statistics and non-parametric tests were applied, and correlations were analyzed using Spearman’s rho. Results Eighty-one women participated. Overall treatment acceptance was high, with a median ACCEPT© score of 88.9 (Q1 = 66.6, Q3 = 100). Acceptance of drug-related constraints scored high (median = 100), whereas acceptance of treatment duration was lower (median = 66.6). Side effects were well tolerated (median = 100), and perceived efficacy was rated positively (median = 100). General acceptance correlated significantly with perceived efficacy (p < 0.001) and side effects (p < 0.001), but not with compliance (p = 0.084). A negative correlation was found with the perceived lack of information (p = 0.043). Conclusion Micronutrient therapy in women with a pathological neurostress profile was highly accepted, particularly regarding treatment-related constraints and side effects. Acceptance was closely linked to perceived efficacy, highlighting the importance of patient-centered communication and expectation management.

Purpose Pyrroluria is a proposed metabolic condition that remains controversial and insufficiently supported by empirical evidence within conventional medical practice and research. The present study evaluates patient acceptance of micronutrient therapy prescribed for pyrroluria in a clinical setting. The aim is not to validate the condition but to document patient experiences with a therapy commonly used in complementary practice. Methods This retrospective cohort study was conducted in the Department of Gynecology at the University Hospital of Bern in 2022/2023. The study included patients who tested positive for pyrroluria and received micronutrient therapy. The primary outcome was the overall acceptance of therapy, assessed using the validated ACCEPT© questionnaire. Results The mean score for overall therapy acceptance was 74 ± 34 out of a maximum of 100 points, indicating a high level of acceptance. Micronutrient therapy was also well accepted in terms of side effects (85 ± 27), treatment constraints (71 ± 24), long-term use (85 ± 20), and therapy regimen (84 ± 21). The perceived efficacy of the therapy received a score of 63 ± 34, which did not reach statistical significance (p = 0.7). Conclusions Micronutrient therapy was well tolerated and accepted by patients with pyrroluria, underscoring its potential as a low-risk adjunctive intervention. However, the perceived treatment efficacy was modest, and no conclusions about the biological validity of pyrroluria or the effectiveness of the therapy can be drawn. Rigorous, placebo-controlled trials are needed to evaluate the therapeutic value of micronutrients in this context. Furthermore, substantial scientific investigation is required to determine whether pyrroluria constitutes a valid clinical entity within conventional medicine.

Background Cardiovascular diseases (CVD) are the leading cause of death among women, with risk increasing after menopause. Lipid levels are key biomarkers, yet conventional blood tests remain invasive and underutilized. Non-invasive technologies and machine learning (ML) may offer new approaches to lipid monitoring and risk assessment using wearable devices and biosensors. Objective This systematic review investigates the availability, accuracy, and clinical applicability of minimally and non-invasive lipid monitoring methods and ML-based cardiovascular risk estimation in adults. Methods A systematic search was conducted in MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov (2010–2024). Studies in English were included; case reports and animal studies were excluded. Data extraction focused on devices, measurement approach, and predictive utility for cardiovascular outcomes. Methodological heterogeneity was addressed through narrative synthesis and thematic grouping (Thomas in Cochrane Handb Syst Rev Interv, 2024). Results From 14,863 records, 37 studies were included. Near-infrared, saliva-based, and smartphone-enabled fingertip devices showed promising accuracy. ML models using wearable-derived physiological data demonstrated moderate success in predicting cardiovascular risk and lipid levels. Conclusion Minimally and non-invasive lipid monitoring and ML-based risk prediction may support accessible, personalized cardiovascular risk management. Despite encouraging findings, validation in large-scale, long-term studies is essential before clinical adoption. Trial registration Title registration number (on PROSPERO): CRD420251105896

Purpose Lipedema is a chronic disorder that affects the subcutaneous adipose tissue of the lower and upper limbs and results in painful fat accumulations. During the reproductive life span, about 11% of women are affected; however, there are a high number of suspected undiagnosed and thus untreated cases. Methods The aim of this systematic review was to evaluate the association between hormones and the pathophysiological mechanisms of lipedema development. Inclusion criteria were: lipedema, lipoedema, estrogen, estrogen antagonists, female sex hormones, hormones, insulin, puberty, pregnancy, menopause, subcutaneous fat tissue, and subcutaneous adipose connective tissue. Results The literature search yielded 121 hits; after deduplication, 64 records were screened. After abstract and full-text screening 15 publications were suitable for being included in the systematic review. Overall, four different pathophysiological hypotheses were postulated: (1) general hormonal imbalance, (2) changes in growth hormone balance, (3) metabolic imbalance such as changes in adipose stem cells in relation to adipokines or leptin in association with the transcription factor PPARγ, and (4) changes in estrogen metabolism as well as alterations in the function of estrogen receptors. Conclusion Lipedema appears to be a multifactorial condition primarily driven by hormonal dysregulation—especially involving estrogen—alongside metabolic and possible genetic components. The findings support the reclassification of lipedema as a hormonally influenced disorder distinct from obesity, emphasizing the need for further research into diagnostic biomarkers, targeted therapies, and the role of genetic susceptibility.

Purpose Cardiovascular diseases are the leading causes of mortality in women worldwide, with hypertension being a major risk factor. While traditional blood pressure monitoring techniques rely on cuff-based measurements, wearable devices offer a promising alternative for continuous and non-invasive blood pressure tracking. This systematic review investigates the extent to which wearable blood pressure measurements can serve as surrogates for traditional sensors to be implemented in risk assessment tools in predicting cardiovascular risk in women. Methods A systematic search was conducted in databases including MEDLINE, Embase, Cochrane Library, Web of Science, Scopus and ClinicalTrials.gov. Studies published between 2010 and 2024 were included. Exclusion criteria were case reports or animal studies. Study selection was performed based on PRISMA guidelines. Data extraction focused on wearable devices, measurement approach, validation against gold-standard BP methods, and their predictive utility for cardiovascular outcomes. Results The systematic literature search revealed 14′863 results after removal of duplicates, of which 245 were selected for extraction. Most included studies used photoplethysmography, with pulse transit time and pulse wave velocity as core parameters, some using machine learning. Accuracy was moderate to high for diastolic blood pressure, but systolic blood pressure showed greater variability. Cardiovascular risk stratification showed promising results, though external validation was rare. Conclusion Wearable blood pressure monitoring technologies are maturing, with growing potential in preventive cardiovascular medicine in women. However, clinical implementation is limited by varying accuracy, need for calibration, and the lack of standardization. Further validation and longitudinal studies are needed to establish their role in cardiovascular risk prediction.

Purpose Polycystic ovary syndrome (PCOS) is recognised as a potential risk factor for chronic non communicable diseases (NCD). Although international guidelines recommend proactive NCD risk prevention, actual practice may be suboptimal. This study aimed to identify unmet clinical needs regarding information, risk assessment and satisfaction with care related to NCD risk factors among women with PCOS. Methods An eight-domain questionnaire was developed based on the 2018 ESHRE guideline, covering demographics, PCOS diagnostic criteria, aesthetics, metabolism, reproduction, mental health and NCD prevention /monitoring. The present analysis focused on metabolic disorders, guideline-recommended risk screenings, patients’ satisfaction with care and overall satisfaction with management by healthcare providers (HCPs). Results Of 2029 respondents, 1943 answered metabolic-related items. 66.3% without known metabolic disease (MD) reported never having undergone screening for MD. 34.3% received advice from gynaecologist, 58.9% from general practitioner (GP) concerning MD. 41.1% (n = 271) did not receive counselling. Among 1839 respondents, 32.5% reported gynaecologist-led risk discussions. Annual screening occurred in 30.5% (body weight), 46.8% (blood pressure), 5.8% (gynaecologist) to 21.4 (GP) for serum cholesterol and 25.4% for diabetes. 1.0% had been consulted on obstructive sleep apnoea (OSA), 17.5% on endometrial cancer. Satisfaction with gynaecologist counselling was low (Mean 34.7), 79.4% expressed a desire for more advice. Conclusion Women with PCOS remain at high risk for NCDs (CVD, diabetes, endometrial cancer, OSA), yet experience substantial gaps in risk awareness, monitoring, and counseling. Addressing these deficiencies through improved clinical practice, education and adopting holistic PCOS management that balances NCD prevention with infertility concerns, is essential for safeguarding long-term health.

Objectives Cognitive behavioral therapy for insomnia (CBT-I) will be compared with hormone replacement therapy (HRT) and sleep hygiene (active control treatment). Background The late menopausal transition is a vulnerable hormonal phase for women, where sleep disorders and vasomotor symptoms affect one out of three women. HRT is probably the most commonly used method to treat menopausal symptoms, including sleep problems. However, CBT-I is considered the treatment of choice for insomnia in adults in general. Despite this fact, there are only a few studies that have examined the effect of CBT-I in peri- and postmenopause and only one observational study comparing CBT-I and HRT for perimenopausal insomnia. Therefore, this study aims to compare the efficacy of HRT and CBT-I on subjective and objective sleep quality. Methods Fifty-four late perimenopausal women will be randomly assigned to receive psychotherapist-led CBT-I, HRT (transdermal estradiol 1.5 mg/d and oral micronized progesterone 200 mg/day), or sleep hygiene (active control). Sleep quality will be continually assessed for 3 months, using validated questionnaires and an in-ear EEG device. Moreover, potential changes in the biofunctional status and age (27) and vasomotor symptoms will be assessed. Discussion The goal is to enable evidence-based treatment decisions for affected women to close the menopausal medical care gap and improve women’s quality of life. Trial registration {2a, 2b} The study has been registered at ClinicalTrials.gov (Identifier: NCT06497894) on 11 July 2024. URL: ( https://clinicaltrials.gov/ct2/show/NCT06497894 ). Protocol version and trial status {3} Protocol version 3.1 (30. April 2024). Recruitment has not started yet (15. August 2024). The recruitment is planned to begin on 01. November 2024, with an estimated completion date of 01. April 2026.

Background Bacterial vaginosis (BV) is a prevalent vaginal condition among reproductive-age women, characterized by off-white, thin vaginal discharge with a fishy odor. It increases susceptibility to sexually transmitted diseases (STDs) and pelvic inflammatory disease (PID). BV involves a shift in vaginal microbiota, with reduced lactobacilli and increased anaerobic bacteria. Standard treatment with oral metronidazole has been shown to have a limited long-term efficacy, possibly due to biofilm persistence. Alternative treatments, such as lactic acid vaginal gel, aim to restore vaginal pH and lactobacilli. This pilot study compares the efficacy and tolerability of lactic acid gel to standard oral metronidazole for acute BV treatment in non-pregnant women. Methods A total of 32 women with acute BV were recruited and assigned to either the treatment group ( n  = 16) where they applied a lactic acid vaginal gel for 12 days, or the control group ( n  = 16) which received 500 mg oral metronidazole twice daily for seven days. A number of objective and subjective parameters including the Amsel score, the Nugent score and a subjective symptom score were recorded at day 0, three weeks, three months, and six months after the study start. Results In the short-term, lactic acid vaginal gel showed inferior clinical (Amsel criteria) and microbiological (Nugent score) cure rates compared to metronidazole. However, it performed equally well regarding subjective symptom improvement and BV recurrence prevention after up to six months. Conclusion Lactic acid vaginal gel was generally very well tolerated and showed mixed but promising results as a stand-alone treatment for acute BV. Trial registration number NCT02042287 (22.01.2014).

Previous research has shown that women aged 45-54 experience a significantly faster rate of biological aging compared to the preceding or following decade. Exactly in this period of life women will experience the menopause. Menopause is defined as the last menstrual period in a women's life and is diagnosed retrospectively after 12 month of amenorrhea. The menopausal transition is associated with a reduced overall well-being. Practicing yoga has demonstrated beneficial effects on cardiovascular risk factors such as BMI, lipid profile, HbA1c, thus contributing to better overall well-being. Therefore, yoga may represent a promising intervention to support healthy aging in postmenopausal women and may positively influence cardiovascular-related biomarkers. The primary objective of this study is to assess the effect of Iyengar Yoga on the biofunctional age (BFA) of postmenopausal women, assessed using the biofunctional status (BFS). The secondary objectives are to evaluate its impact on the frequency of hot flushes, high-sensitivity C-reactive protein (hsCRP) levels, and oxidative stress. This paper describes the study protocol of a monocentric, randomized, controlled, open-labeled, two-arm, interventional study conducted at the University Hospital of Bern, Switzerland. A total of 72 postmenopausal women will be randomly assigned to either an intervention group or a control group. Participants in the intervention group will attend a 90-minute Iyengar yoga class once per week for 12 weeks, guided by a certified instructor. Additionally, they will perform two 45-minute home-based yoga sessions per week, including postures and relaxation techniques. The control group will not receive any intervention during this period. This protocol describes a randomized controlled trial evaluating whether Iyengar Yoga can reduce the biofunctional age (BFA), calculated using the BFS, of postmenopausal women aged 45-54 years in 12 weeks. Furthermore, yoga practice may have a positive impact on cardiovascular risk factors and overall vitality. The study has been registered at Clinicaltrials.gov (Identifier: NCT04705623) on December 30, 2020. https://clinicaltrials.gov/study/NCT04705623.

Purpose Menopause is associated with a decrease in smell discrimination ability. This study assessed the impact of black cohosh on hippocampal (HC) and hypothalamic (HT) gene expression profiles in rats, to understand, if herbal treatment has an impact on neurologic changes due to menopause and whether this could address a decrease in smell discrimination. Methods HC and HT tissues from female Sprague Dawley rats (total n  = 19) were analyzed at three different life stages: intact tissues of the HC ( n  = 4) and the HT ( n  = 4), oophorectomized tissues 3 months after oophorectomy (OVX) of the HC ( n  = 4) and the HT ( n  = 3), and tissues after treatment with an isopropanolic extract (iCR) from the rhizomes of black cohosh (60 mg/kg) for 3 months after OVX of the HC ( n  = 2) and the HT ( n  = 2). Main outcome measures To reveal underlying biological processes a gene set enrichment analysis (GSEA) was performed. Results The GSEA revealed gene ontology terms that were significantly enriched, including several genes associated with the olfactory system, indicating biological processes regulated by treatment with iCR. Six olfactory receptor genes were further analyzed by another GSEA, demonstrating the possibility of iCR treatment to compensate for oophorectomy-induced changes. Conclusion Findings suggest that herbal treatment, such as iCR, has an esteeming impact on HC and HT genes that are changed through menopause. Further studies are needed to suggest black cohosh as a treatment option for decreased smell discrimination.