{"paper_id":"ef48d244-555f-447e-884b-ce3855651a16","body_text":"REM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n1 \nTitle: A rapid evidence map of womens health. \n                                                                                                                                           \nAuthors: Deborah Edwards1, Judit Csontos1, Elizabeth Gillen1, Ruth Lewis2, Alison Cooper2, \nAdrian Edwards2  \n \n1 Wales Centre For Evidence Based Care, Cardiff University, United Kingdom \n2 Wales COVID-19 Evidence Centre, Wales, United Kingdom  \n \nAbstract: The rapid evidence map focuses on identifying the nature and extent of published \nliterature on the following topic areas: healthcare professionals communication with women \nabout womens health issues and broader health problems during clinical encounters; access \nto specialist healthcare; endometriosis; menopause; womens health and mental health issues, \nand mental health  issues associated with specific conditions related to menopause or \nmenstrual health (adenomyosis; endometriosis; fibroids; heavy menstrual bleeding, polycystic \novary syndrome and premenstrual dysphoric disorder).  \n \nThe purpose of this rapid evidence map w as to identify research gaps and priorities that will \nbe beneficial to womens health in Wales. The rapid evidence map uses abbreviated \nsystematic mapping or scoping review methods to provide a description of the nature, \ncharacteristics and volume of the available evidence.  \n \nThere is a lack of primary and secondary research that explores communication between \nwomen and healthcare professionals within primary and secondary care settings. Secondary \nresearch evidence exists but there are gaps in the evidence base regarding access to services \nproviding minor gynaecological procedures and pain management, or care for menstrual \nhealth and wellbeing, endometriosis, polycystic ovarian syndrome, menopause, heart \nconditions, autoimmune diseases, hypermobility spectrum disorders, myalgic \nencephalomyelitis, long COVID, fibromyalgia, skin conditions, or palliative and end of life care, \nwhich are priority areas identified by the Womens Health Wales Coalition (2022).  There are \nno active funding calls exploring these topics. \n \nRegarding endomet riosis, there is a lack of review evidence regarding education and \nresources for health care professionals and doctors to reduce diagnostic times and improve \ncare. There is an evidence gap for primary research regarding information, support \ninterventions and tools for women with endometriosis to help them manage their symptoms \nand improve their quality of life. \n \nA substantial amount of secondary evidence exists on menopause along with a plethora of \nresearch priorities around treatment and symptom management. It was beyond the scope of \nthis work to determine if any research had been conducted in these priority a reas since the \nproduction of the guidelines and recommendations.  \n \nThere is a lack of research recommendations and review evidence that address mental health \nissues and specific issues that affect a womens menstrual health such as adenomyosis, \nfibroids, heavy menstrual bleeding and premenstrual dysphoric disorder. \nFunding statement: The Wales Centre for Evidence Based Care was funded for this work \nby the Wales COVID-19 Evidence Centre, itself funded by Health and Care Research Wales \non behalf of Welsh Government.  \n \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \nNOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.\n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n2 \n \n \n \n \nWales COVID-19 Evidence Centre (WCEC) \n \nRapid Evidence Map: Women’s health  \nReport number – REM 00045 (October 2022) \n \nRapid Evidence Map Details \nReview conducted by:  \nWales Centre For Evidence Based Care \nReview Team:  \n▪ Deborah Edwards \n▪ Judit Csontos \n▪ Elizabeth Gillen  \nReview submitted to the WCEC: October 2022 \n \nStakeholder consultation meeting: 24th October 2022 \n \nRapid Evidence Map report issued by the WCEC: November 2022 \n \n \nWCEC Team:  \n▪ Adrian Edwards, Ruth Lewis, Alison Cooper, Micaela Gal  involved in drafting  the \ntopline summary, reviewing, editing, publication process. \nThis review should be cited as:  \nREM00045. Wales COVID -19 Evidence Centre, Rapid Evidence map : Womens health . \nOctober 2022 \n \n \nDisclaimer:  \nThe views expressed in this publication are those of the authors, not necessarily Health and \nCare Research Wales.  The WCEC and authors of this work declare that they have no \nconflict of interest.  \n \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n3 \nRapid Evidence Map: Women’s health  \nReport number – REM00045 (October 2022) \nTOPLINE SUMMARY \nWhat are Rapid Evidence Maps?  \nOur Rapid Evidence Maps (REMs) use abbreviated systematic mapping or scoping review \nmethods to provide a description of the nature, characteristics and volume of the available evidence \nfor a particular policy domain or research question. They are mainly based on the assessment of \nabstracts and incorporate an a priori protocol, systematic search, screening, and minimal data \nextraction. They may sometimes include critical appraisal, but no evidence synthesis is conducted. \nPriority is given, where feasible, to studies representing robust evidence synthesis. They are \ndesigned and used primarily to identify a substantial focus for a rapid review, and key research \ngaps in the evidence-base. (N.B. Evidence maps are not suitable to support evidence-informed \npolicy development, as they do not include a synthesis of the results.) \n \nWho is this summary for?  \nHealth and Care Research Wales  \nBackground / Aim of Rapid Evidence Map (REM) \nThe Welsh Government Research and Development Division intends to run  a commissioned \nfunding call on understanding and tackling gender inequalities in health and social care in Wa les. \nThe purpose of this REM was to identify research gaps and priorities that will be beneficial to \nwomen’s health in Wales to inform the proposed funding call. It was decided, based on a preliminary \nreview of the literature, feedback from an NHS public consultation exercise in Wales, and further \ndiscussion with the stakeholder  group, that the REM would focus on identifying  the nature and \nextent of the literature on the following prioritised topic areas : healthcare professionals’ \ncommunication with women about women’s health issues and broader health problems during \nclinical encounters ; access to specialist healthcare ; endometriosis; menopause; women’s \nhealth and mental health issues,  and mental health issues associated with specific \nconditions related to menopause or menstrual health (adenomyosis; endometriosis; fibroids; \nheavy menstrual bleeding, polycystic ovary syndrome and premenstrual dysphoric disorder).  \nResearch gaps in other areas and health conditions, in which women might also experience \ninequality, were not explored in this REM.  \n \nKey Findings \nExtent of the evidence base \n▪ Communication within health care encounters : The evidence base included one \nsystematic review (of endometriosis) and nine primary studies. The primary studies focused \non breast cancer (n=2), maternal medicine (n=3), perinatal mental health (n=1), \ngynaecological conditions (n=1) , and non-specific conditions (n=2). Three studies focused \non specific populations: urban Africans, Iraqi Muslim refugees, and undocumented migrants. \nPlanned and ongoing NIHR funded projects include clinicians’ perspectives of listening to \nwomen’s health, menstrual and gynaecological conditions, menopause, and women’s \ncancers \n▪ Access to specialist healthcare : The evidence base consisted of 19 reviews and 9 \nprotocols. Conditions covered were maternal medicine (n=8), sexual and reproductive \nhealth (n=5), cancer and cancer s creening (n=4), perinatal mental health (n=4), mental \nhealth (n=2), HIV (n=2), and non-specific conditions (n=3). Specific populations investigated \nwere r efugees or displaced people (n=6), those in differing social, economic, and \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n4 \nenvironmental circumstance s (n=4), physical disabilities (n=3), homeless (n=2), migrants \n(n=2), experiencing intimate partner violence (n=1), and minority ethnicity black (n=1). The \nreviews focused on barriers and facilitators (n=10) , barriers (n=5) , experiences (n=3), \nmapping the evidence (n=3), factors (n=2), management (n=1), facilitators (n=1), predictors \n(n=1), associations (n=1), and prevalence (n=1). \n▪ Endometriosis: The evidence base included 121 systematic reviews covering  different \ntopics including  medical management (n=22),  surgical management (n=15), biology / \nmolecular (n=12), risk factors (n=11), and comorbid conditions (n=9). Research priorities \nwere identified by the James Lind Alliance (JLA), NICE guideline, a Wales-specific primary \nstudy (Boivin et al 2018), and researchers within the field  (n=2). Recent UK funding calls \nwere identified covering laboratory research, aetiology of endometriosis and uterine \ndisorders, and medical and surgical management. \n▪ Menopause: The evidence base included 108 systematic reviews covering different topics \nincluding hormonal therapies (n=17), homeopathic therapies (n=13), non -hormonal \ntherapies (n=10), genitourinary symptoms of menopause (n=7), alternative therapies (n=6), \nand lifestyle interventions (n=6).  Research priorities were identified as part of a NICE \nguideline, by the British Menopause Society, and researchers within the field (n=3). Recent \nUK funding calls were identified covering reproductive and menopausal health, testosterone \nfor the treatment of symptoms, women's reproductive health in the workplace, and women’s \nhealth hub landscape. \n▪ Women’s health and mental health issues : The evidence base included 37 reviews \ncovering: perinatal mental health (n=23), g eneral mental health (n=9) , p olycystic ovar y \nsyndrome (n=3) , and intimate partner violence (n=2). Some reviews focused on specific \npopulations including women in prison, w omen in inpatient mental health services , mental \nhealth of migrants and refugee women, and mental health of women from different minority \ngroups. Recent UK funding calls were identified covering: young women’s mental health, \nwomen and partners who have experienced pregnancy not ending in live births, and \nperimenopause and the risk of psychiatric disorders. \n▪ Mental health issues associated with specific conditions related to menopause or \nmenstrual health: The evidence base included 10 systematic reviews covering: polycystic \novary syndrome (n=4), endometriosis (n=4) menopause (n=1), and menstruation (n=1). The \nreviews focused on prevalence (n=4), associations (n=4), and management (n=2). \n \nRecency of the evidence base \n▪ The review included evidence available (from 2012, 2018, and 2021) up until September \n2022. (Separate searches were conducted for different topics, with variable time limits due \nto the varying volume of research published in certain areas.) \n \nSummary of the evidence gaps \n▪ There is a lack of primary and secondary research  that explores communication \nbetween women and healthcare professionals (HCPs)  within primary and secondary \ncare settings.  \n▪ Secondary research evidence  exists but there are gaps in the evidence base regarding \naccess to services providing minor gynaecological procedures and pain management, or \ncare for menstrual health and wellbeing, endometriosis, polycystic ovarian \nsyndrome, menopause, heart conditions, autoimmune diseases, hypermobility spectrum \ndisorders, myalgic encephalomyelitis, long COVID, fibromyalgia , skin conditions, or \npalliative and end of life care, which are priority areas identified by the Women’s Health \nWales Coalition (2022).  There are no active funding calls exploring these topics. \n▪ Regarding endometriosis, there is a lack of review evidence  regarding education and \nresources for HCPs and doctors  to reduce diagnostic times and improve care. There \nis an evidence gap  for primary research regarding information, support interventions \nand tools  for women with endometriosis to help them manage their symptoms and \nimprove their quality of life. \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n5 \n \n \n \n▪ A substantial amount of secondary evidence exists on menopause along with a plethora \nof research priorities around treatment and symptom management. It was beyond the \nscope of this REM to determine if any research had been conducted in these priority \nareas since the production of the guidelines and recommendations. Researchers in the field \nwould like to see primary research conducted in the area of quality of life. \n▪ There is a lack of research  recommendations and review evidence that address mental \nhealth issues and specific issues that affect a women’s menstrual health such as \nadenomyosis, fibroids, heavy menstrual bleeding and premenstrual dysphoric \ndisorder. \n \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n6 \nTABLE OF CONTENTS \nTABLE OF CONTENTS ............................................................................................................. 6 \n1. BACKGROUND ................................................................................................................. 9 \n1.1 Communication within healthcare encounters .......................................................... 9 \n1.2 Women’s access to specialist healthcare.................................................................. 9 \n1.3 Endometriosis .......................................................................................................... 10 \n1.4 Menopause .............................................................................................................. 10 \n1.5 Mental health............................................................................................................ 11 \n1.5.1 Adenomyosis.................................................................................................... 11 \n1.5.2 Fibroids............................................................................................................. 11 \n1.5.3 Polycystic Ovary Syndrome ............................................................................. 11 \n1.5.4 Heavy menstrual bleeding ............................................................................... 12 \n1.5.5 Premenstrual Dysphoric Disorder.................................................................... 12 \n2. FINDINGS ........................................................................................................................ 12 \n2.1 Summary of the evidence for communication within healthcare encounters ......... 12 \n2.1.1 Bottom line summary ....................................................................................... 12 \n2.2 Summary of the evidence for access to specialist healthcare ................................ 13 \n2.2.1 Bottom line summary ....................................................................................... 13 \n2.3 Summary of the evidence for endometriosis ........................................................... 13 \n2.3.1 Bottom line summary ....................................................................................... 15 \n2.4 Summary of the evidence for menopause .............................................................. 15 \n2.4.1 Bottom line summary ....................................................................................... 16 \n2.5 Summary of the evidence for women’s health and mental health issues ............... 16 \n2.5.1 Bottom line summary for women’s health and mental health issues .............. 17 \n2.6 Summary tables ....................................................................................................... 18 \n3. STRENGTHS AND LIMITATIONS OF THIS REM ......................................................... 29 \n4. REFERENCES ................................................................................................................ 30 \n5. RAPID EVIDENCE MAP METHODS .............................................................................. 33 \n5.1 Eligibility criteria ....................................................................................................... 33 \n5.2 Evidence sources ..................................................................................................... 34 \n5.3 Search strategy ........................................................................................................ 34 \n5.3.1 Reference management .................................................................................. 34 \n5.4 Study selection process ........................................................................................... 34 \n5.5 Data extraction and coding/charting ........................................................................ 34 \n5.6 Assessment of methodological quality .................................................................... 34 \n5.7 Data summary .......................................................................................................... 35 \n5.8 Further information available ................................................................................... 35 \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n7 \n6. ADDITIONAL INFORMATION ......................................................................................... 35 \n6.1 Conflicts of interest .................................................................................................. 35 \n6.2 Acknowledgements .................................................................................................. 35 \n7. ABOUT THE WALES COVID-19 EVIDENCE CENTRE (WCEC) .................................. 36 \n8. APPENDICES .................................................................................................................. 37 \n8.1 Appendix 1: JLA Top 10 endometriosis research priority areas ............................. 37 \n8.2 Appendix 2: NICE recommendations for research: endometriosis ......................... 37 \n8.3 Appendix 3: NICE recommendations for research: menopause ............................ 38 \n8.4 Appendix 4: The BMS recommendations for research: menopause ...................... 38 \n8.5 Appendix 5: NICE recommendations for research: adenomyosis .......................... 38 \n8.6 Appendix 6: NICE recommendations for research: uterine fibroids........................ 39 \n8.7 Appendix 7: NICE recommendations for research: heavy menstrual bleeding ...... 39 \n8.8 Appendix 8: The National Association for Premenstrual Syndrome: Guidelines on \nPremenstrual Syndrome: ..................................................................................................... 39 \n8.9 Appendix 9: NICE recommendations for research: Fertility problems (PCOS) ...... 39 \n \n \n  \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n8 \nAbbreviations: \nAcronym Full Description \nBMA British Medical Association  \nDHEA Dehydroepiandrosterone \nDHSC Department of health and Social Care \nFTWW Fair Treatment for The Women of Wales \nGSM Genitourinary syndrome of menopause \nHCP Health care professionals  \nHCRW Heath and Care Research Wales  \nHIC High income countries \nHRT Hormone replacement therapy \nHMB Heavy menstrual bleeding \nIPV Intimate partner violence \nNICE National Institute of Clinical Excellence  \nNIHR National Institute for Health and Care Research \nOECD Organisation for Economic Co-operation and Development \nPCOS Polycystic ovary syndrome \nPMDD Premenstrual dysphoric disorder \nPMS Premenstrual syndrome  \nREM Rapid Evidence Map \nVMS Vasomotor symptoms \nVTE Venous thromboembolism \nLNG-IUS Levonorgestrel-releasing intra-uterine system \n \n \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n9 \n1. BACKGROUND \nThis Rapid Evidence Map  (REM) was conducted as part of the Wales COVID -19 Evidence \nCentre Work Programme. The initial request to explore women’s health came from Health and \nCare Research Wales  (HCRW) to inform the development of a proposed commissioned \nfunding call by the Welsh Government Research and Development Division .  The research \nteam conducted a preliminary search of the evidence and presented the  findings to the \nstakeholder group  in order to identify research priorities that will be beneficial to women’s \nhealth in Wales.  As a result of the stakeholder meeting and further discussion afterwards the \nfocus for the REM  was to explore the nature and extent of the literature on healthcare \nprofessionals’ communication  with women about women’s health issues and broader \nhealth prob lems during clinical encounters , and their access to specialist healthcare . \nAdditionally, the nature and extent of the evidence in relation to endometriosis, menopause \nand mental health will also be investigated  as the preliminary search identified that th ese \nareas have been shown to be a priority area  (Scottish Government 2021, Department of \nHealth and Social Care 2021). The focus of the REM was also informed by the priority areas \nidentified during an  NHS public prioritisation exercise  conducted in Wales and led by a \nmember of the stakeholder group. \n \n1.1 Communication within healthcare encounters  \nWhile women’s life expectancy is on average longer than men’s in the UK, evidence suggests \nthat women  experience more ill health and disability  throughout the life course  (Office of \nNational Statistics 2022). The reasons for this include women’s underrepresentation in clinical \ntrials and research  (Duma et al. 2018)  and that healthcare professionals’ education and the \nhealthcare system is designed for men (Department of Health and Social Care 2022, Women’s \nHealth Wales Coalition 2022). Moreover, communication with women in the healthcare system \ncould also pose barriers to seeking help for certain condition s (Scottish Government 2021, \nDepartment of Health and Social Care 2021). Women often feel that healthcare professionals \ndo not take their symptoms seriously, or they do not receive support after events, such as a \nmiscarriage (Scottish Government 2021, Depart ment of Health and Social Care 2021) . In \naddition, deaf women , women with disabilities, and refugees often face further barriers to \ncommunication, as healthcare professionals often do not know sign language or translation to \nother languages is not directly available (Allen & Sesti 2018, British Medical Assocation 2021). \nThe English, Scottish and Welsh Governments have all recently published or started working \non Women’s Health Strategies to support women’s health and wellbeing  (Scottish \nGovernment 2021, Dep artment of Health and Social Care 2022, Welsh Government 2022) . \nImproved communication is part of this commitment, with professional bodies recommending \ntraining on women’s health and practice -based skills, such as communication, to be part of \nthe medical curricula (Allen & Sesti 2018, British Medical Assocation 2021) . While Women’s \nHealth Strategies are based on national consultations and surveys, little is known abou t \nwomen’s experiences of communication during clinical encounters throughout the life course. \n1.2 Women’s access to specialist healthcare \nIn addition to communication issues  the Women’s Health  Wales Coalition (2022) have \nidentified four key themes which are co mmon reported as being of concern around women’s \nhealth.  These are access to specialist services, improved data collection, support for \nsustainable co -production and training for health and care professionals. Access to \nappropriate specialist healthcare can pose an issue to many women (Women’s Health Wales \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n10 \nCoalition 2022). Due to the development and management of health services in England and \nWales, boundaries exist between different health boards and NHS Trusts which often leads to \nwomen living in one area being unable to access specialist care in another  (Women’s Health \nWales Coalition 2022).   \n1.3 Endometriosis \nEndometriosis affects 10% of women and those assigned female at birth (Royal College of \nObstretricians & Gynaecologists 2019). It occurs where cells similar to those lining the womb \nare found elsewhere in the body  and such cells can cause inflammation, pain and the \nformation of scar tissue. Symptoms that are commonly reported include chronic pelvic pain, \npainful periods, pain during or afte r sex, painful urination and bowel movements, fatigue or \ntiredness, and difficulties getting pregnant and can vary considerably in severity from mild or \nno symptoms to being chronic and debilitating  (Women’s Health Wales Coalition 20 22). In \nWales it takes an average of nine years before women receive a diagnosis (a year longer than \nin England) and can involve the distress of repeated medical appointments that fail to identify \na cause for symptoms (Women’s Health Wales Coalition 2022).  Research has shown that on \naverage in Wales , a women will visit the doctor 26 visits to the doctor before receiving a \ndiagnosis (Boivin et al. 2018) , resulting in delays in accessing treatment . The chronic and \ncomplex nature of endometriosis requires specialist, multi-disciplinary, long-term management \nand the Women’s Health Wales Coalition (2022) reported that this is severely lacking across \nWales with problems identified at all levels of care. NICE guidance (NICE 2017) outlines that \naccess to specialist gynaecologists with expertise in diagnosing and managing endometriosis \nshould be available  (Boivin et al. 2018) , including those sufficiently skilled and trained to \nundertake diagnostic laparoscopy. However, long waiting times for gynaecology appointments \nand surgery and a lack of access to gynaecologists with expertise in endometriosis  within \nWales have been reported ( Women’s Health Wales Coalition 2022) .  With regard to  mental \nhealth, anxiety and depression are commonly reported mental health outcomes (Wang et al. \n2021, Delanerolle et al. 2021) along with a decreased mental and physical quality of life (Wang \net al. 2021). \n \n1.4 Menopause \nWomen and those assigned female at birth account for 52% of the population of Wales and at \nsome point in their lives, the majority of them will experience menopause  (Women’s Health \nWales Coalition 2022). There is often little recognition, appreciation or support for symptoms \nwhich for some can be severely debilitating (FTWW 2019) and women are expected to carry \non working regardless and may having to leave employment often requiring interventions from \nhealthcare professionals (Women’s Health Wales Coalition 2022).  \nInterventions for menopausal symptoms must be considered based on the person’s \ncircumstances, preferences, and the short - and long-term benefits and risks of treatments \n(NICE 2022a). Treatments, such as hormone replacement therapy (HRT), are highly effective \nin reducing menopausal symptoms and health risks associated with untreated menopause, \nincluding heart disease and osteoporosis (FTWW 2019). However, both primary and \nsecondary ca re professionals can have limited knowledge on HRT, and they often rely on \ndated evidence which only focuses on the negative effects of using such treatment (FTWW \n2019). This can lead to a lack of consideration for or access to timely treatment (FTWW 2019). \nOne of the reasons for insufficient access to treatment or specialist services are the lack of \neducation provided for both healthcare professionals (HCPs) and women about peri -\nmenopause, menopause, and HRT throughout the life-course. Awareness about menopause \nand treatments could be raised in different settings, such as GP surgeries, sexual and \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n11 \nreproductive health clinics, hospitals or screening appointments, although this has not been \nthe case (FTWW 2019). Furthermore, people experience a lack of availab ility of specialist \nservices for menopause, which could be traced back to women’s health not being a priority for \nfunding bodies and policy (FTWW 2019).  \n \nAs women’s health groups are becoming more vocal about their needs, the British Menopause \nSociety (BMS) recommends that access to information should be provided to women about \nmenopause, transition, and post -menopausal life to prepare them  for health changes  \n(Hamoda et al. 2020). Moreover, holistic assessment of the individ ual person going through \nmenopause should be conducted, and tailored lifestyle and treatment advice, including \ninformation on HRT risks and benefits, and complimentary therapies, should be provided \n(Hamoda et al. 2020). \n1.5 Mental health \nRecent survey evidence has reported associations  between time to diagnosis for a \ngynaecological health problem and mental health  (BMI Healthcare 2021c, BMI Healthcare \n2021b, BMI Healthcare 2021a).  Delayed diagnosis if often caused by dismissal by healthcare \nprofessionals, which can originate from the lack of awareness and education on women’s \nhealth and gynaecological conditions (BMI Healthcare 2021a). Particular conditions, such as \nadenomyosis, polycy stic ovary syndrome (PCOS)  and uterine fibroids, can be \ndisproportionately affected by long waiting times and mental health problems.  \n1.5.1 Adenomyosis \nAdenomyosis is a benign gynaecological condition caused by endometrial tissue growing in \nthe myometrium which is the muscle layer of the womb (NICE 2013) that can affect one in 10 \nwomen in the UK (BMI Healthcare 2021a) . While some people might not experience \nsymptoms, others report heavy, painful, prolonged, and irregular menstrual bleeding, and \npelvic pain (NICE 2013, BMI Healthcare 2021a) . Receiving an adenomyosis diagnosis can \ntake several years and results of a recent survey found that 42% women waited over five years \nfor a diagnosis and 26% experienced a wait longer than 10 years (BMI Healthcare 2021a). As \na result of prolonged diagnosis and living with symptoms, such as chronic pain, adenomyosis \ncan have a severe impact on a women’s health related quality of life, mental health (anxiety \nand depression) and work productivity (Alcalde et al. 2021, BMI Healthcare 2021a).  \n1.5.2 Fibroids \nFibroids (leiomyomas, polyps) are benign tumours in the myometrium, which can be varying \nin size and number, round and hard in appearance, consisting of smooth muscle cells and \nfibroblasts. Fibroids are usually symptom free, and a high number of women will develop them \nthrough the life course (NICE 2022) . However, people who experience symptoms, describe \nback and stomach pain, painful sexual intercourse, heavy periods, constipation, and more \nfrequent urination (BMI Healthcare 2021b). Fibroids are fairly quick to be diagnosed, with \nmajority of people diagnosed within a year, although some people report diagnosis took over \na year from the start of symptoms (BMI Healthcare 2021b). Although the incidence of \ndepression and anxiety are lower than for other gynaecological conditions (Li et al. 2022) the \nimpact of uterine fibroids on a women’s psychological health is still significant (BMI Healthcare \n2021c, Ghant et al. 2015).  \n1.5.3 Polycystic Ovary Syndrome \nPolycystic ovary syndrome (PCOS) is an endocrine disorder, which can present as ovulation \ndisorders, hyperandrogenism, and polycystic ovarian morphology, meaning that follicles filled \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n12 \nwith fluid are contained in the ovaries (NICE 2022b, BMI Healthcare 2021b) . Getting a \ndiagnosis has been reported to take between one to five years or even longer (BMI Healthcare \n2021b). Regarding mental health, women affected by PCOS suffer from depression, anxiety \n(BMI Healthcare 2021b)  and experience a lower quality of life compared to healthy women \n(Yin et al. 2021). \n1.5.4 Heavy menstrual bleeding \nMenstrual bleeding that is heavier than normal or lasts longer than seven days is often referred \nto as heavy menstrual bleeding or menorrhagia (NICE 2018b) . Heavy menstrual bleeding can \nbe a symptom of fibroids and adenomyosis, among other health conditions, and can severely \nimpact on women’s quality of life (NICE 2018a) . Symptom fluctuations over the menstrual \ncycle in anxiety disorders, post-traumatic stress disorders and obsessive compulsive \ndisorders have been reported by women with regular periods (Green & Graham 2022) . \nHowever, there is a lack of research on how women who do not have regular periods \nexperience mental health symptom fluctuation (Green & Graham 2022). \n1.5.5 Premenstrual Dysphoric Disorder  \nPremenstrual dysphoric disorder is distinct from the above, as its primary symptoms are \npsychological. Premenstrual syndrome (PMS) is the presence of psychological, physical, and \nbehavioural symptoms between ov ulation and the start of menstruation (luteal phase of \nmenstrual cycle) (NICE 2019). Premenstrual dysphoric disorder (PMDD) is characterised as \na more severe form of PMS, which results in women experiencing at least five from 11 \nidentified psychological symptoms of PMS (NICE 2019).  \n2. FINDINGS \n2.1 Summary of the evidence for communication within healthcare encounters  \nThe evidence base consisted of nine primary studies (conducted in USA (n=2), UK (n=2), Italy \n(n=1), Sweden (n=1), Denmark (n=2) , Europe (n=1) and one systematic review for women’s \ncommunication within healthcare encounters (Table 1).  \n• The conditions covered within the primary studies were breast cancer (n=2); maternal \nmedicine (n=3); perinatal mental health (n=1), gynaecological conditions (n=1) and any \ncondition (n=2). \n \n• The condition covered in the systematic review was endometriosis (n=1) \n \n• The specific populations of women that were investigated and included urban Africans \n(n=1), Iraqi Muslim refugees (n=1) and undocumented migrants (n=1) \n \n• Studies focused on experiences (n=7), management (n=1) or factors associated with \ngender of HCPs and patient communication (n=1).  \nPlanned and ongoing NIHR funded projects \nClinician’s perspectives of listening to women’s health, menstrual and gynaecological \nconditions (such as polycystic ovary syndrome (PCOS)), menopause, and women’s cancers. \n2.1.1 Bottom line summary \nThere is a lack of primary and secondary research that explores or addresses communication \nbetween women and healthcare professionals within primary and secondary care settings with \nthe exception of women with endometriosis and their experiences of healthcare encounters . \nHowever, funded NIHR research focusing on HCPs’ perspectives on communication with \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n13 \nwomen, who have women’s health, menstrual and gynaecological conditions (such as \npolycystic ovary syndrome (PCOS)), menopause, or cancer, are planned or ongoing.  \n2.2 Summary of the evidence for access to specialist healthcare \nThe evidence base consisted of systematic reviews (n=17); systematic review protocols (n=4); \nscoping reviews (n=2); scoping review protocols (n=5)  that focused on women’s access to \nspecialist healthcare (Table 2). \n• The conditions covered within the systematic reviews were maternal medici ne (n=8); \nsexual and reproductive health (n=5); cancer and cancer screening (n=4); perinatal \nmental health (n=4), mental health (n=2) and HIV (n=2). Three systematic reviews did \nnot focus on a specific condition but were on women’s health in general. \n \n• The specific populations of women that were investigated included refugees or \ndisplaced people (n=6); those in differing social, economic, and environmental \ncircumstances (n=4); physical disabilities (n=3); homeless (n=2);  immigrants (n=2), \nexperiencing IPV (n=1) and minority ethnicity black (n=1). \n \n• Additionally, three reviews also included HCPs and/or women’s partners.  \n \n• The reviews focused on barriers and facilitators (n=10); barriers (n=5); experiences \n(n=3); mapping the evidence (n=3); factors (n=2); management (n=1); facilitators \n(n=1); predictors (n=1); associations (n=1) and prevalence (n=1). \n \n \n• Fourteen reviews focused on healthcare access within a specific country or region and \nincluded HICs (n= 5); Canada (n=3); UK (n=2); USA (n=2); OECD (n =1); WHO \nEuropean region (n=1) and Australia (n=1).  \n2.2.1 Bottom line summary \nSubstantial secondary research evidence exists on the topic of women’s access to specialist \nhealthcare services, such as  maternal medicine, sexual and reproductive health, cancer, \nperinatal and general mental health, and HIV. Research populations include women from a \nwide range of backgrounds and with different socioeconomic, health and ethnic \ncharacteristics. No secondary e vidence was found regarding access to services providing \nminor gynecological procedures and pain management, or care for menstrual health and \nwellbeing, endometriosis, pol ycystic ovarian syndrome , menopause, heart conditions, \nautoimmune diseases, hypermobility spectrum disorders, myalgic ence phalomyelitis, long \nCOVID, fibromyalgia, skin conditions, or palliative and end of life care, which are priority areas \nidentified by the  Women’s Health Wales Coalition (2022). We did not find any funding calls \nthat covered this topic. \n2.3 Summary of the evidence for endometriosis \nSearches retrieved 121 English language systematic reviews published bet ween 2021 to \nOctober 2022. Figure 1 shows where the focus of the research lies with most studies being \nmedical and surgical treatments  (some reviews explored more than one area of research). \nBrady et al . (2020) reported that healthcare providers/scientists tend to prioritise research \nquestions about cause/pathology or risk factors for endometriosis, diagnosis and screening, \ntreatment, and fertility . Whereas p atients and family members tend to prioritise questions \nabout education/ awareness, emotional impact, and comorbid conditions (Brady et al. 2020) \n \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n14 \n \nResearch priorities for endometriosis  \n• In 2017 the James Lind Alliance (JLA) published their top 10 priorities for \nendometriosis combining information from an online survey, systematic reviews and \nclinical guidelines and covered the following areas (see Appendix 1). \n \n• The NICE guideline (NICE 2017) for endometriosis was published in 2017 and is \ncurrently being reviewed to consider whether it should be updated (DHSC 2022). The \nrecommendations for research as set out in the current guidance can be found in \nAppendix 2. \n \n• Other areas considered to be important by researchers within (As-Sanie et al. 2019, \nBrosens et al. 2017) and based on research already conducted in Wales (Boivin et \nal. 2018) are shown in Table 3. \nFunding calls \n• A funding call has just closed (June 2022) for jointly funded projects between the \nWellbeing of Women and the Scottish Government in laboratory, health and \ntranslational research that aims to improve access for women to appropriate support, \ndiagnosis and the best treatment for endometriosis. \n \n• The National Institute of Health Research (NIHR) has five active awards that focus on \nmedical or surgical management (n=4) and management of teenagers with \ndysmenorrhea in primary care (n=1) \n \n• The Society of Endometriosis and Uterine Disorders  will fund aetiology, \npathophysiology or treatment of endometriosis, adenomyosis, fibroids or other uterine \ndisorders and its complications. \n \n• The Royal College of Obstetricians and Gynaecologists – Endometriosis Millennium \nFund will fund up to £5,000 in order to stimulate and encourage research (clinical or \nlaboratory based) in the field of endometriosis. \nMapping of research priorities, funding calls and systematic reviews \nTable 3 maps current research priorities against open and recently closed calls for funding \nand systematic reviews conducted in since 2021.  \n22\n15\n12 11 9 8 7 6 5\n3 3 3 3 3 2 2 1 1 1\n0\n5\n10\n15\n20\n25\nNumber of systematic reviews\nResearch Focus \nNumber of systematic reviews conducted\n2021 to Oct 2022 by research focus \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n15 \n2.3.1 Bottom line summary \nA high-volume of secondary research evidence exists on the topic of endometriosis, with most \nsystematic reviews focusing on medical and surgical treatments . Recent funding calls focus \non laboratory research, aetiology of endometriosis and uterine disorders, and medical and  \nsurgical management. There is a lack of review evidence regarding education and resources \nfor HCPs and doctors to reduce diagnostic times and improve care. Furthermore, there is an \nevidence gap for primary research regarding information, support interventions and tools for \nwomen with endometriosis to help them manage their symptoms and improve their quality of \nlife.  \n \n2.4 Summary of the evidence for menopause \nSearches retrieved 108 English language systematic reviews pub lished between 2021 to \nOctober 2022. Figure 2 shows where the focus of the research lies with most studies being \nhormonal therapies, homeopathic therapies, symptom prevalence and management and non-\nhormonal therapies (some reviews explored more than one area of research).  \n \n \nKey: GSM: genitourinary syndrome of menopause; HCP: health care professional  \nResearch priorities for menopause \n• The NICE guideline for menopause was published in 2015 (NICE 2015) and an update \nwill be published in August 2023 (NICE 2022a). The recommendations for research as \nset out in the current guidance all focus on HRT and a broader scope that covers \nmenopause symptoms what is being considered within the update (see Appendix 3). \n \n• The British Menopause Society & Women’s Health Concern (Hamoda et al. 2020) have \nproduced recommendations on hormone replacement therapy in menopausal women \nwith breast cancer or dementia (see Appendix 4). \n \n• Other areas considered to be important by researchers within the field (Woods & \nUtian 2018, El Khoudary 2017, Stuckey et al. 2020) are shown in Table 4. \n17\n13 13\n10\n7 6 6 5 4 4 3 3 2 2 2 1 1 1 1\n0\n2\n4\n6\n8\n10\n12\n14\n16\n18\nNumber of systematic reviews\nResearch Focus\nFigure 2: Number of systematic reviews conducted 2021 to Oct \n2022 for menopause by research focus \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n16 \nFunding calls \n• Reproductive Health Policy Research Unit (RH PRU) (closed call August 2022) which \nwill have menstrual and menopausal health as part of its remit. \n \n• Health Technology Assessment:  Testosterone for the treatment of menopause \nsymptoms beyond altered sexual function Call opens December 2022.  \n \n• British Menopause Society:  BMS Education fund offers u p to five grants will be \nawarded between £500 and £2,000 each year, normally to those und ergoing training, \nbut applicants not undergoing training will also be considered. Part funding or matching \nfunding towards larger projects will be considered. \n \n• Department of Health & Social Care : Health and Wellbeing Fund 2022 to 2025: \nwomen’s reproductive wellbeing in the workplace. Call closed 5th August 2022. \nPlanned and ongoing NIHR funded projects \n• NIHR135589: An evaluation of the current Women's Health Hub landscape  \n \nMapping of research priorities, funding calls and systematic reviews \nTable 4 maps current research priorities against open and recently closed calls for funding \nand systematic reviews conducted in since 2021.  \n2.4.1 Bottom line summary \nA substantial amount of secondary evidence exist s on the topic of menopause, with most \nsystematic reviews  focusing on hormone therapy, complimentary or alternative therapies, \nsymptom prevalence, genitourinary syndrome and its management, lifestyle interventions, and \nfactors influencing onset. There are many research priorities set by NICE and the BMS and \ninclude for example further research into HRT and breast cancer or dementia , \ndehydroepiandrosterone (DHEA) and cancer , treatments for vas omotor symptoms  (VMS). \nResearchers in the field would like to see research conducted into different aspects of quality \nof life.  It was beyond the scope of this REM however, to determine if any research had been \nconducted in these areas since the production of the guidelines  and suggestions . Current \nfunding calls are focusing on the menopause as part of the NIHR RH PRU, testosterone \ntreatment, and women’s reproductive wellbeing in the workplace. \n \n2.5 Summary of the evidence for women’s health and mental health issues \nBroad searches retrieved 37 English language systematic reviews published between 2012 to \nOctober 2022 on the topic of women’s health and mental hea lth issues (see Table 5). The \nevidence base is dominated by perinatal mental health (n=23) and there are a plethora of \nfunding calls and active grants in this area. \n \nThere is also a significant amount of evidence for the mental health of women in general and \nwithin this the research focuses specifically on the following populations.  \n• Women in prison. \n \n• Women in inpatient mental health services. \n \n• Mental health of immigrants and refugee women. \n  \n• Mental health of women from different minority groups. \n \nSpecific searches (2018 to 2022)  were conducted for the conditions related to menopause \nand menstrual health and wellbeing using the conditions listed in the Women’s Health Wales \nCoalition document and included a denomyosis; endometriosis; f ibroids; h eavy menstrual \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n17 \nbleeding; PCOS, PMDD. The evidence base consisted of ten systematic reviews (see Table \n6). \n• The conditions covered were PCOS (n=4) , endometriosis (n=4), menstruation (n=1) \nand menopause (n=1). \n \n• One review for PCOS investigated the prevalence of mental health issues in Black, \nAsian and minority ethnic populations.  \n \n• There was no systematic review evidence for mental health and adenomyosis; fibroids; \nheavy menstrual bleeding or PMDD.  \n \n• The reviews focused on prevalence (n=4), associations (n=4) and management (n=2).  \nFunding calls \n \n• The Pilgrim Trust: Young women’s mental health grants. £20,000 to £30,000 per year for \na 3 year project. For 2022 the focus is North East and North West England and Northern \nIreland. \n \n• NIHR Funding call: 22/80 Interventions to promote mental health and wellbeing among \nyoung women . What interventions are effective to promote good mental health and \nwellbeing among young women aged 12 -24? Call opened 28 June 2022 and closes 29 \nNovember 2022. \n \n• NIHR Funding call: 22/82 Improving mental health outcomes for women and partners who \nhave experienced pregnancy not ending in live births . Which interventions are the most \nimpactful in improving mental health outcomes in women or/and partners experiencing a \npregnancy not ending in a li ve birth in the UK? Call opened 28 June 2022 and closes 29 \nNovember 2022. \n \nActive grants \nMedical Research Council : Perimenopause and risk of psychiatric disorders: a longitudinal, \npopulation-based study. Funding period: 2022-2025 \nhttps://gtr.ukri.org/project/0510802D-9354-4182-AA13-59CA915CF45A \nResearch priorities for mental health across a range of conditions  \nAcross the condition specific NICE guidance and the National Association for Premenstrual \nSyndrome guidance there are no specific recommendations that focus on mental health and \nadenomyosis; endometriosis; menopause; fibroids; heavy menstrual bleeding; PCOS  or \nPMDD. \n2.5.1 Bottom line summary for women’s health and mental health issues  \nA high-volume of secondary research evidence exists on the topic of perinatal mental health \nand general mental health issues , especially across seldom heard populatio ns with funding \ncalls also focusing on these areas. There is a lack of research recommendations and review \nevidence that address  mental health issues a nd specific issues that affect a women’s \nmenstrual health such as adenomyosis, fibroids, heavy menstrual bleeding and PMDD.  \n  \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n18 \n2.6 Summary tables \nTable 1: Included evidence for communication within healthcare encounters \nAuthor \nCountry (if a specific focus) \nPopulation  Focus Study design  \nAny condition  \nOtey 2016 \nUSA \nUrban African women  Experiences: \nCommunication during \nmedical encounters  \nMixed methods \n(Interviews) \nPenney 2016 \nUSA \nIraqi Muslim refugee \nwomen \nExperiences: \nPrimary care encounters  \nQualitative study  \n(Interviews) \nBreast cancer \nArmes et al. 2016 \nUK \nWomen Experiences: \nEnd of treatment \nconsultations  \nQualitative study \n(Interviews) \nBuizza et al. 2021 \nItaly \nWomen with and without a \ncompanion \nManagement: \nEffectiveness of a \ncommunication tool during \nthe first consultation with an \noncologist \nRCT \nEndometriosis \nPettersson and Bertero \n2020 \n \nWomen Experiences: \nHealth care encounters \nSR (qualitative) \n14 studies \n2000-2019 \nGynaecological conditions \nMazzi et al. 2014 \nEurope \nWomen Factors: \nAssociated with gender of \nHCP and patient \ncommunication  \nMixed methods study \n(Focus groups and \nrating scale) \nMaternal medicine \nBarkensjo et al. 2018 \nSweden \n \nUndocumented female \nmigrants \nExperiences:  \nPerinatal care  \nQualitative study \n(Interviews) \nFrederiksen et al. 2021 \nDenmark \nPregnant and postpartum \nwomen  \nExperiences: \nKey elements of supportive \ncare practices during \npregnancy and the post-\nnatal period \nQualitative study \n(Ethnography) \nHogh et al. 2020 \nDenmark \nPostpartum women who \nhad experienced a critical \nperinatal event  \nExperiences: \nPostnatal consultation with \nan obstetrician  \nQualitative study  \n(Interviews) \nPerinatal mental health  \nPhillips and Thomas 2015 \nUK \nPregnant women with a \ndiagnosis of mental illness \nExperiences: \nFirst antenatal appointment  \nQualitative study  \n(Interviews) \nKey: HCP: health care professional; RCT – randomised controlled trial; SR: systematic review \n  \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n19 \nTable 2: Included evidence for women’s access to healthcare  \nAuthor \nCountry (if a specific focus) \nPopulation Focus Study design  \nIncluded studies \nDates of search \nAny condition  \nAllen and Vottero 2020 \n \nHomeless women Experiences:  \nAccess to community based \nhealthcare  \nSR (Qualitative) \n24 included studies \nInception to 2018 \nAngus et al. 2013 \nCanada \n \nWomen in differing \nsocial, economic, and \nenvironmental \ncircumstances  \nBarriers:  \nAccess to healthcare in \nCanadian settings  \nSR (Qualitative) \n35 included studies \nDates of search NR \nWhitfield et al. 2022 \nCanada \nWomen living on a \nlow income \nMapping the evidence:  \nAccess to health and social \nservices  \nScR (Mixed methods) \nProtocol \nDates of search NR \nCancer and cancer screening \nConti et al. 2022 \n \nWomen with breast \ncancer from different \nsocioeconomic and \ngeographic locations \nAssociations: \nRelationship between \ngeographical access to \nhealthcare facilities (oncology \nservices, mammography \nscreening) and breast cancer \noutcomes  \nSR (Quantitative) \n25 included studies \nDates of search NR \nKaranth et al. 2019 \nUSA \nWomen with ovarian \ncancer from different \nsocioeconomic and \nethnic backgrounds \nPredictors: \nDisparities in healthcare \naccess  \nSR with MA \n41 included studies \n2000 to 2017 \nKhan-Gates et al. 2015 \n \nWomen Mapping the evidence: \nGeographical access to \nmammography \nSR (Quantitative) \n21 included studies \n2000 to 2013 \nPearson et al. 2021 \n \nWomen with \nsecondary breast \ncancer \nHCPs \nBarriers and facilitators: \nAccess and receipt of \ntreatment to systemic anti-\ncancer therapies \nPerspectives: \nAccess to systemic anti-cancer \ntherapies \nSR (Mixed methods) \nProtocol \n2000 onwards \nHIV  \nKim and Martin 2022 \nUSA (n=23/24) \nWomen experiencing \nIPV \nBarriers:  \nAccessing HIV pre-exposure \nprophylaxis \nSR (Mixed methods) \n24 included studies \n2007 to 2017 \nO’Brien et al. 2018 \nHICs \nWomen  Facilitators: \nAccess to primary care in HICs \nSR (Mixed methods) \n44 included studies \n2000 to 2017 \nMental health  \nDeSa et al. 2022 \nHICs \nRefugee women  Barriers and facilitators: \nAccess to mental health \nservices  \nSR (Qualitative) \n12 included studies \nSearched March 2020 \nWohler and Dantas 2017 \nAustralia \nCulturally and \nlinguistically diverse \nimmigrant women  \nBarriers: \nAccess to mental health \nservices  \nSR  \nFurther details NR \nMaternal medicine  \nBlair et al. 2022 \nHICs \nPregnant women with \nphysical disabilities \nExperiences: \nAccess to maternity care \nScR (Mixed methods) \n27 included studies \n2000 to 2020 \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n20 \nBreckenridge et al. 2014 \n \nPregnant women with \ndisabilities \nexperiencing \ndomestic abuse \nFactors: \nAssociated with access to \nmaternity care \nSR (Not reported) \n11 included studies \nDates of search NR \nHigginbottom et al. 2019 \nUK \nImmigrant pregnant \nwomen \nExperiences: \nAccess to maternity care \nSR (Not reported) \n40 included studies \n1990 to 2017 \nLawler et al. 2013 Pregnant women with \nphysical disabilities \nBarriers and facilitators: \nAccess to maternity services \nSR  \nFurther details NR \nLennon et al. 2015 Pregnant women Management: \nEffectiveness of interventions \nto improve access to and \nutilisation of prenatal care \nSR (Quantitative) \nProtocol \nFurther details NR \nO’Mahony et al. 2022 Perinatal refugee \nwomen \nBarriers and facilitators: \nAccess to mental health \nservices \nSR (Qualitative) \nProtocol \nMcGeough et al. 2020 \n \nPregnant homeless \nwomen \nBarriers and facilitators: \nAccess to antenatal and \npostnatal care \nSR (Qualitative) \nFurther details NR \nSilva et al. 2022 \n \nBlack women  Prevalence: \nAccess to prenatal care during \nfirst trimester \nSR with MA \nFurther details NR \nPerinatal mental health \nMarkey et al. 2022 \nWHO European region \n \nRefugee and asylum-\nseeking pregnant \nwomen  \nBarriers and facilitators: \nAccess to perinatal mental \nhealth care services   \nScR (Not reported) \nProtocol \nDates of search NR \nO’Mahoney et al. 2022 \n \nPregnant refugee \nwomen \nBarriers and facilitators: \nAccess to mental health care \nand social support \nSR (Qualitative) \nProtocol \n2011 to present \nSmith et al. 2019 \nUK \nPregnant women \n(including their \npartners and HCPs) \nBarriers: \nAccess to mental health \nservices  \nSR (Qualitative) \n35 included studies \n2007 to 2018 \nViveiros and Darling 2019 \nHigh resource settings \nPregnant women  \nMidwives \nBarriers:  \nAccess to perinatal mental \nhealth care in  \nScR (Mixed methods) \n26 included studies \nInception to 2000 \nSexual and reproductive health \nDavidson et al. 2022 \n \nRefugees and \ndisplaced women \nBarriers and facilitators: \nAccess to preventive sexual \nand reproductive health care \nSR (Mixed methods) \n28 included studies  \nInception to 2020 \nJarvis et al. 2020 \nCanada \n \nVulnerable women  Factors: \nDetermining access to primary \nsexual reproductive health care  \nScR (Not reported) \nProtocol \n2008 to present \nNguyen 2020 \n \nWomen with physical \ndisabilities \nBarriers and facilitators: \nAccess to reproductive health \ncare \nScR (Qualitative) \nProtocol \n2011 to present \nO’Shea et al. 2020 \nOECD countries \nWomen Barriers and facilitators:  \nAccess to abortion services \nSR (Mixed methods) \n32 included studies \n2001 to 2018 \nStirling et al. 2021 \nHICs \nResettled refugees \nand refugee-claimant \nwomen \nMapping the evidence: \nAccess and use of sexual and \nreproductive health services \nScR (Mixed methods) \nProtocol \nSearch dates NR \nKey: HICs: High income countries; HIV: human immunodeficiency virus; IPV: intimate partner violence; \nMA: meta-analysis; NR: not reported; OCED; ScR:  scoping review; SR: systematic review \n \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n21 \nTable 3: Mapping of current priority areas by research funding awards and existing systematic reviews for endometriosis \nPriority area Funding calls Existing reviews \nJLA 1: Can a cure be developed for endometriosis? Closed funding call (June 2022) \n£250,000 in total over one to three years. \nScottish Government & Wellbeing of Women \nFunding Call for Endometriosis Research \nNot searched  \nPotentially evidence in this area \nJLA 2: What causes endometriosis?  Not searched  \nPotentially evidence in this area \nJLA 3: What are the most effective ways of educating \nhealthcare professionals throughout the healthcare \nsystem resulting in reduced time to diagnosis and \nimproved treatment and care of women with \nendometriosis? \n \nNo systematic reviews and no primary \nresearch studies found* \nJLA 4 Is it possible to develop a non-invasive \nscreening tool to aid the diagnosis of endometriosis? \nClosed funding call (June 2022) \n£250,000 in total over one to three years. \nScottish Government & Wellbeing of Women \nFunding Call for Endometriosis Research \nNot searched  \nPotentially evidence in this area \n \nJLA 5: What are the most effective ways of maximising \nand/or maintaining fertility in women with confirmed or \nsuspected endometriosis? \n Richard et al. 2021. Effect of postoperative \nhormonal suppression on fertility in patients with \nendometriosis after conservative surgery: a \nsystematic review and meta-analysis \nJLA 6: How can the diagnosis of endometriosis be \nimproved? \nBrosens et al. 2017: Better and earlier diagnosis of \nendometriosis  \n Simpson et al. 2021. Combating diagnostic delay \nof endometriosis in adolescents via educational \nawareness: a systematic review  \nLA 7: What is the most effective way of managing the \nemotional and/or psychological and/or fatigue impact of \nliving with endometriosis (including medical, non-\nmedical and self-management methods)? \nClosed funding call (June 2022) \n£250,000 in total over one to three years. \nScottish Government & Wellbeing of Women \nFunding Call for Endometriosis Research \nNot searched  \nPotentially evidence in this area \nJLA 8: What are the outcomes and/or success rates for \nsurgical or medical treatments which aim to cure or treat \nendometriosis, rather than manage it? \n Previous systematic reviews all appear to be \naimed at managing the condition \nJLA 9: What is the most effective way of stopping \nendometriosis progressing and/or spreading to other \norgans (e.g. after surgery)? \n Chiu et al. 2022. Maintenance therapy for \npreventing endometrioma recurrence after \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n22 \nendometriosis resection surgery - a systematic \nreview and network meta-analysis \nZakhari et al. 2021. Endometriosis recurrence \nfollowing post-operative hormonal suppression: a \nsystematic review and meta-analysis \nJLA 10: What are the most effective non-surgical ways \nof managing endometriosis-related pain and/or \nsymptoms (medical/nonmedical)? \n Not searched  \nPotentially evidence in this area \nNICE: Are pain management programmes a clinically \nand cost-effective intervention for women with \nendometriosis? \n Not searched  \nPotentially evidence in this area \nNICE: Is laparoscopic treatment (excision or ablation) \nof peritoneal disease in isolation effective for managing \nendometriosis-related pain? \n Not searched  \nPotentially evidence in this area \nNICE: Are specialist lifestyle interventions (diet and \nexercise) effective, compared with no specialist lifestyle \ninterventions, for women with endometriosis? \n Hanson et al. 2021. Impact of exercise on pain \nperception in women with endometriosis: A \nsystematic review \nNirgianakis et al. 2022. Effectiveness of dietary \ninterventions in the treatment of endometriosis: \na systematic review \nSverrisdóttir et al. 2022. Impact of diet on pain \nperception in women with endometriosis: A \nsystematic review \nTennfjord et al. 2021. Effect of physical activity \nand exercise on endometriosis-associated \nsymptoms: a systematic review \nMardon et al. 2022. The efficacy of self-\nmanagement strategies for females with \nendometriosis: a systematic review \nNICE: What information and support interventions are \neffective to help women with endometriosis deal with \ntheir symptoms and improve their quality of lives? \n No systematic reviews and no primary \nresearch studies found* \nAs-Sanie et al. 2019: Quality of life  Kalfas et al. 2022. Psychosocial factors \nassociated with pain and health-related quality of \nlife in Endometriosis: A systematic review \nAs-Sanie et al. 2019: The biology of endometriosis and \npossible endometriosis subtypes  \n Not searched  \nPotentially evidence in this area \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n23 \nAs-Sanie et al. 2019: Alternatives to hormonal therapy \nsuch as modulating angiogenesis and \nneuroinflammation \n Not searched  \nPotentially evidence in this area \nBrosens et al. 2017: Origins of endometriosis  Not searched  \nPotentially evidence in this area \nBoivin et al. 2018: Further investigation of the care \npathways for endometriosis in Wales  \n Not searched  \nPotentially evidence in this area \nBoivin et al. 2018: Development of educational \nresources for doctors about endometriosis and young \ngirls about menstrual health \n No systematic reviews and no primary \nresearch studies found* \nBoivin et al. 2018: Development of support tools for \nwomen with endometriosis  \n No systematic reviews and no primary \nresearch studies found* \nKey: JLA: James Lind Alliance; NICE: National Institute of Clinical Excellence  \n* only searched since 2021 on one database so primary research studies may have been conducted in this area \n  \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n24 \nTable 4: Mapping of current priority areas by research funding awards and existing systematic reviews for menopause \nPriority area Funding calls Existing reviews \nNICE: What is the safety and effectiveness of \nalternatives to systemic HRT as treatments for \nmenopausal symptoms in women who have had \ntreatment for breast cancer? \n Not searched  \nPotentially evidence in this area \nNICE: What is the impact of systemic HRT usage in \nwomen with a previous diagnosis of breast cancer for \nthe risk of breast cancer reoccurrence, mortality or \ntumour aggression? \n Not searched  \nPotentially evidence in this area \nNICE: How does the preparation of HRT affect the risk \nof VTE \n Not searched  \nPotentially evidence in this area \nNICE: What is the difference in the risk of breast cancer \nin menopausal women on HRT with progesterone, \nprogestogen or selective oestrogen receptor modulators \n Not searched  \nPotentially evidence in this area \nNICE: What is the impact of oestradiol in combination \nwith the levonorgestrel-releasing intra-uterine system on \nthe risk of breast cancer and VTE? \n Not searched  \nPotentially evidence in this area \nNICE: What are the effects of early HRT use on the risk \nof dementia? \n Not searched  \nPotentially evidence in this area \nNICE: What are the main clinical manifestations of \npremature ovarian insufficiency and the short- and \nlong-term impact of the most common therapeutic \ninterventions? \n Not searched  \nPotentially evidence in this area \nNICE: Managing menopausal symptoms.  Lots of systematic reviews in this area  \nNICE: Cognitive behavioural therapy to manage \nsymptoms associated with the menopause. \n Lam et al. 2022. Behavioural interventions for \nimproving sleep outcomes in menopausal women: \na systematic review and meta-analysis \nSamami et al. 2022. The effects of psychological \ninterventions on menopausal hot fl ashes: A \nsystematic review \nYe et al. 2022. Efficacy of cognitive therapy and \nbehavior therapy for menopausal symptoms: a \nsystematic review and meta-analysis \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n25 \nNICE: Interventions to manage genitourinary \nsymptoms associated with the menopause. \n Lots of systematic reviews in this area  \nNICE: Effects of hormone replacement therapy on \noverall health outcomes. \n Lots of systematic reviews in this area  \nNICE: using testosterone treatment of menopause \nsymptoms beyond altered sexual function \nHealth Technology Assessment: Testosterone for \nthe treatment of menop ause symptoms beyond \naltered sexual function  \nCall opens December 2022 \n \nWoods and Utian 2018:  \nFuture studies of treatment effects of QOL will need to \nincorporate measures sensitive to multiple symptoms \nwomen experience in clusters, such as combinations of \nhot flashes, sleep disruption, and anxiety, not only \nVMS \n  \nNot searched  \nPotentially evidence in this area \nWoods and Utian 2018:  \nImpact of women’s experiences of menopause on QOL \nin relation to their overall health as well as in the \nbroader context of their lives \n Not searched  \nPotentially evidence in this area \nStuckley et al. 2020: \nEfficacy and tolerability of bone mediation in CD \nIdentifying CD in postmenopausal women should lead \nto modification of osteoporosis management \n Not searched  \nPotentially evidence in this area \nEl Khoudary 2017:  \nThe role of endogenous estradiol on cardiovascular \nhealth during the menopause transition \n Not searched  \nPotentially evidence in this area \nKey: CD: Coeliac disease; HRT: Hormone replacement therapy; QoL: Quality of life; VMS: Vasomotor symptoms; VTE: venous thromboembolism  \n  \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n26 \nTable 5: Included evidence for women’s health and mental health issues  \nAuthor Population Study design  Focus \nGeneral mental health    \nBartlett et al. 2015 Women offenders SR with MA Therapeutic interventions in forensic health settings, criminal \njustice institutions and in the community \nBeber 2012 Women with intellectual disability in \nsecure settings \nNR (Not reported) Mental health needs and development of secure services in \nthe UK \nHidayati et al. 2021 Female prisoners ScR (Not reported) Identifying mental health problems \nKapadia et al. 2017 \nUK \nPakistani women  SR (Mixed methods) Healthcare usage rates, and the nature of Pakistani women's \nsocial networks and how they may influence mental health \nservice use \nOrshak et al. 2022 Women veterans ScR (Not reported) Interventions of gender-sensitive care  \nScholes et al. 2021 Women in inpatient mental health services  \nHCPs \nSR (Qualitative) Women service users' experiences of inpatient mental health \nservices and staff experiences of providing care \nWohler and Dantas 2017 \nAustralia \nCulturally and linguistically diverse \nimmigrant women  \nSR (Qualitative) Prevalence of mental health disorders  \nStanton et al. 2016 Female prisoners after release from jail or \nprison \nSR (Not reported) Understanding of the mental health issues of women released \nfrom jail or prison \nPatten et al. 2021 Women  SR (Quantitative)  Effectiveness of exercise interventions on mental health \noutcomes \nIntimate partner violence \nPaphitis et al. 2022 Women survivors of IPV Realist review \n \nManagement:  \nEffectiveness of psychosocial interventions to support recovery \nReyes et al. 2021 \nUSA \nHispanic women who are victims of IPV ScR (Mixed methods) \n \nMapping the evidence  \nPerinatal mental health  \nAhmad and Vismara 2021 Pregnant women RR (Not reported) Psychological impact of COVID-19 \nBlack et al. 2019 Postpartum indigenous women SR with MA Prevalence of postpartum MH disorders \nCoates and Foureur 2019 Pregnant women with MH concerns ScR (Mixed methods) Role and competence of midwives in delivering MH care \nDaehn et al. 2022 Pregnant women SR (Quantitative) Perinatal MH literacy  \nde Oliveira et al. 2014 Women who suffer IPV during pregnancy SR (Quantitative) Relationship between IPV and MH disorders  \nDemissie and Bitew 2021 Pregnant or lactating women SR with MA MH effects of COVID-19 \nEveritt et al. 2022 Pregnant women ScR (Not reported) Educational innovations and teaching strategies used to build \nskills and knowledge in HCPs \nGhahremani et al. 2022 Pregnant women SR (Not reported) Prevention, timely diagnosis and treatment, and referral to \nspecialized services \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n27 \nHansotte et al. 2017 Low-income postpartum women in \nWestern countries \nSR (Not reported) Factors that hinder and improve access to postpartum \ndepression treatment in low-income women after screening \nKapetanovic et al. 2014 HIV-seropositive women SR (Not reported) MH-related variables  \nKesim et al. 2019 Pregnant women SR (Quantitative)  Effectiveness of exercise on MH \nLever Taylor et al. 2018 Pregnant women partners SR (Qualitative) Views of perinatal MH care \nLucas et al. 2019 \nOECD \nPregnant women (< 20 years) SR (Qualitative) Perceptions of MH / wellbeing during and after pregnancy \nMegnin-Viggars et al. 2015 Women with (or at risk of developing) \nantenatal or postnatal MH problems)  \nSR (Qualitative) Experience of the care for MH problems \nMukherjee et al. 2014 Pregnant women in correctional facilities SR (Quantitative) Prevalence, determinants of MH problems \nNilaweera et al. 2014 South Asian Pregnant women who have \nmigrated to HICs \nSR (Quantitative) Prevalence, determinants of MH problems \nNoonan et al. 2017 Midwives  NR (Not reported) Experiences: caring for women with MH issues  \nOwais et al. 2020 Indigenous pregnant women  SR with MA Prevalence of MH issues  \nViswanathan et al. 2021 Pregnant women with MH disorders  SR with MA Effectiveness of pharmacotherapy  \nWaqas et al. 2022 Pregnant women SR with MA Effectiveness of screening programmes for perinatal \ndepression and anxiety \nWatson et al. 2019 Ethnic minority pregnant women in Europe SR (Mixed methods) Experiences of perinatal MH services \nYan and Li 2022 Women with or without MH issues SR with MA Effectiveness of mindfulness-based interventions \nYu et al. 2022 High-risk pregnant women SR (Quantitative) Effectiveness of nonpharmacological interventions  \nPolycystic ovary syndrome \nConte et al. 2015 Women NR (Quantitative) Mapping the evidence on physical activity for improving MH \nWarne et al. 2022 Women participating in fertility treatment SR with MA Effectiveness of group psychological interventions in improving \nMH \nYin et al. 2021 Women SR with MA Prevalence of MH problems  \nKey: HPC: health care professionals ; IPV: intimate partner violence ; MA: meta-analysis; MH: mental health ; NR: narrative review; OECD : Organisation for \nEconomic Co-operation and Development; RR: rapid review; ScR: scoping review; SR: systematic review \n \n \n \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n28 \nTable 6: Included evidence for mental health issues across specific conditions  \nAuthor \nCountry  \nPopulation  Focus Study design \nIncluded studies \nDates of search  \nPolycystic Ovary Syndrome \nDelanerolle et al. 2022 \n \nBlack Asian Minority \nEthnic populations \n \nPrevalence: \nMental health issues \nincluding depression \nand anxiety \nSR with MA \n30 included studies  \n1990 to 2021  \nDouglas et al. 2021 \n \nReproductive-aged \nfemales with a \ndiagnosis of Axis I or II \nmental health disorder. \nPrevalence: \nRates of PCOS in \nmental health \ndisorders. \nSR (Quantitative) \n11 included studies \nSearched August 2020 \nPatten et al. 2021 Women with PCOS Management: \nEffectiveness of \nexercise interventions \non mental health and \nHRQoL \nSR (Quantitative) \n11 included studies  \nSearch dates NR \nYin et al. 2020 Women, with and \nwithout PCOS \nAssociations: \nDepression, anxiety, \nemotional distress, \nQoL, binge eating and \nsomatization \nSR with MA \n46 included studies. \nInception to 2018 \n \nEndometriosis \nDelaneroole et al. \n2021 \nWomen with \nendometriosis \nPrevalence \nSymptoms and \npsychiatric disorders \nassociated with \nendometriosis  \nSR (Mixed methods/ \nMA) \n34 includes studies \n15 studies in MA \nSearch dates NR \nGambadauro et al. \n2018 \nWomen with and \nwithout endometriosis, \nand with or without \npelvic pain \nAssociations: \nDepressive symptoms \nand pelvic pain \nSR with MA  \n24 included studies  \nSearched Sept 2017 \n \nVan Barneveld et al. \n2021 \nWomen with \nendometriosis \nAssociations:  \nDepression, anxiety \nand correlating factors \nSR with MA \n47 included studies \n(17 included MA) \nSearch details NR \nWang et al. 2021 Women with \nendometriosis  \nAssociations: \nAnxiety, depression, \nHRQoL \nSR with MA \n44 included studies \nSearch dates NR \nMenstruation  \nGreen and Graham \n2021 \nMenstruating women Prevalence:  \nSymptom fluctuation \nover the menstrual \ncycle: anxiety \ndisorders, PTSD and \nOCD \nSR (NR) \n14 included studies  \nSearched April 2021 \nMenopause \nWang  et al. 2018 Menopausal \ndepression: \nManagement: \nAdjuvant therapy of \noral Chinese herbal \nmedicine combined \nwith pharmacotherapy. \nSR with MA  \n22 studies included  \nInception to 2016 \nKey: HRQoL: health related quality of life; QoL: quality of life  \n \n \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n29 \n3. STRENGTHS AND LIMITATIONS OF THIS REM \nA strength of this REM is that literature searches were conducted by an information specialist \nand an experience d systematic review methodologist across several databases and with \ndifferent search term combinations to cover as many topics and conditions as possible. \nMoreover, grey literature, including clinical guidance, and funding body databases were also \nsearched for research recommendations, planned and ongoing studies  and funding calls , \nenabling the identification of gaps in knowledge. However, due to the rapid nature of REMs \nand certain streamlined process, such as study selection being conducted by one researcher, \nit is possible that available primary and secondary research studies were missed. Moreover, \nas women’s health is a broad topic, this REM had to be limited to certain topics, such as  \naccess to care, communication,  mental health, endometriosis, and menopause . T hus, \nresearch gaps in other areas and health conditions , in which women might experience \ninequality, were not identified.  \n \nWhile performing the searche s, different time limits were used for topics due to the varying \nvolume of research published  in certain areas. For example, time limit of 2012 was set for \nsearches in access and communication, while limits of 2018 or 2021 were used for different \nendometriosis and menopause searches due to the high volume of research identified in these \ntopics (detailed search strategy is presented in the Additional material) . This step was \nnecessary to make the REM manageable, although this might also me an that potentially \nrelevant research published prior to the limits were missed. Furthermore, critical appraisal was \nnot conducted to enable rapid production of this REM. While critical appraisal is an optional \nstep in REMs, it is possible that the quality of included primary and secondary research studies \nmight be low, which could also present further need for research.  \n \n  \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n30 \n4. REFERENCES \nBackground \nAllen J, Sesti F. (2018). Health inequalities and women - addressing unmet needs. British \nMedical Assocation. \nBritish Medical Assocation. (2021). BMA response to the Department of Health and Social \nCare Women’s Health Strategy: call for evidence. British Medical Assocation Available at: \nhttps://www.bma.org.uk/media/4206/bma-response-to-dhsc-women-health-strategy-call-for-\nevidence-june-2021.pdf. [Accessed 17th October 2022]. \nDepartment of Health and Social Care. (2022). Women’s health strategy for England. CP \n736. Department of Health and Social Care. Available at: \nhttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_da\nta/file/1100721/Womens-Health-Strategy-England-web-accessible.pdf. [Accessed 17th \nOctober 2010]. \nDuma N, Vera Aguilera J, Paludo J, et al. (2018). Representation of minorities and women in \noncology clinical trials: review of the past 14 years. Journal of Clinical Oncology. 14(1): e1-\ne10. https://dx.doi.org/10.1200/jop.2017.025288 \nDepartment of Health and Social Care. (2021). Results of the 'Women's Health - Let's talk \nabout it' survey. Department of Health and Social Care. Available at: \nhttps://www.gov.uk/government/consultations/womens-health-strategy-call-for-\nevidence/outcome/results-of-the-womens-health-lets-talk-about-it-survey.  [Accessed 17th \nOctober 2010]. \nOffice of National Statistics. (2022). Health state life expectancies, UK: 2018 to 2020. \nAvailable at: \nhttps://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeex\npectancies/bulletins/healthstatelifeexpectanciesuk/2018to2020. [Accessed 15 September \n2022]. \nRoyal College of Obstretricians & Gynaecologists. (2019). Better for women. Improving the \nhealth and wellbeing of girls and women. Royal College of Obstretricians & Gynaecologists. \nAvailable at: https://www.rcog.org.uk/media/h3smwohw/better-for-women-full-report.pdf.  \n[Accessed 17th October 2022]. \nScottish Government. (2021). Women’s health plan. A plan for 2021-2024. Scottish \nGovernment. Available at: https://www.gov.scot/publications/womens-health-\nplan/documents/.  [Accessed 17th October 2010]. \nWelsh Government. (2022). The quality statement for women and girls’ health. Welsh \nGovernment. Available at: https://gov.wales/sites/default/files/pdf-\nversions/2022/7/2/1657017419/quality-statement-women-and-girls-health.pdf [Accessed \n17th October 2010]. \nWomen’s Health Wales Coalition. (2022). Women’s health Wales: a quality statement for the \nhealth of women, girls and those assigned female at birth. Women’s Health Wales Coalition. \nAvailable at: https://www.ftww.org.uk/2021/wp-content/uploads/2022/05/Womens-Health-\nWales-Quality-Statement-English-FINAL.pdf [Accessed 17th October 2010]. \n  \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n31 \nAdenomyosis \nAlcalde AM, Martínez-Zamora M, Gracia M, et al. (2021). Impact of adenomyosis on \nwomen's psychological health and work productivity: A comparative cross-sectional tudy. \nJournal of Womens Health 30(11): 1653-9. https://dx.doi.org/10.1089/jwh.2020.8789 \nBMI Healthcare. (2021a). Women’s Health Matters: adenomyosis. Circle Health Group. \nAvailable at: https://www.circlehealthgroup.co.uk/womens-health-matters/download-report. \n[Accessed 17th October 2010]. \nLi N, Yuan M, Li Q, et al. (2022). Higher risk of anxiety and depression in women with \nadenomyosis as compared with those with uterine leiomyoma. Journal of Clinical Medicine. \n11(9): 2638. https://dx.doi.org/10.3390/jcm11092638 \nNICE. (2013). Uterine artery embolisation for treating adenomyosis. IPG 473. National \nInstitute for Health and Care Excellence. Available at: \nhttps://www.nice.org.uk/guidance/ipg473. [Accessed 17th October 2022]. \nEndometriosis \nAs-Sanie S, Black R, Giudice LC, et al. (2019). Assessing research gaps and unmet needs \nin endometriosis. American Journal of Obstetrics & Gynecology. 221(2): 86-94. \nhttps://dx.doi.org/10.1016/j.ajog.2019.02.033 \nBoivin JH, Jupp H, Kingwell H. (2018). Endometriosis in Wales: A comparative study on \nsymptom awareness and help-seeking from the patient perspective for women living in \nWales and other regions of the UK.  Working Paper, University of Cardiff. Available at: \nhttps://www.cardiff.ac.uk/__data/assets/pdf_file/0009/1319571/Boivin_Working_paper_Serie\ns_Endometriosis_in_Wales_16APR_2018.pdf.[Accessed 17th October 2010]. \nBrady PC, Horne AW, Saunders PTK, et al. (2020). Research priorities for endometriosis \ndiffer among patients, clinicians, and researchers. American Journal of Obstetrics & \nGynecology. 222(6): 630-2.  https://dx.doi.org/10.1016/j.ajog.2020.02.047 \nBrosens I, Benagiano G, Brosens JJ. (2017). Endometriosis and obstetric syndromes: early \ndiagnosis must become a priority. Fertility & Sterility. 107(1): 66-7. \nhttps://dx.doi.org/10.1016/j.fertnstert.2016.10.010 \nDelanerolle G, Ramakrishnan R, Hapangama D, et al. (2021). A systematic review and \nmeta-analysis of the Endometriosis and Mental-Health Sequelae; The ELEMI Project. \nWomen's Health 17: 17455065211019717. https://dx.doi.org/10.1177/17455065211019717 \nFiboids \nBMI Healthcare. (2021c). Women’s Health Matters: uterine fibroids. Circle Health Group. \nAvailable at: https://www.circlehealthgroup.co.uk/womens-health-matters/download-report. .  \n[Accessed 17th October 2010]. \nGhant MS, Sengoba KS, Recht H, et al. (2015). Beyond the physical: a qualitative \nassessment of the burden of symptomatic uterine fibroids on women's emotional and \npsychosocial health. Journal of Psychosomatic Research. 78(5): 499-503. \nhttps://dx.doi.org/10.1016/j.jpsychores.2014.12.016 \nMenopause \nEl Khoudary SR. (2017). Gaps, limitations and new insights on endogenous estrogen and \nfollicle stimulating hormone as related to risk of cardiovascular disease in women traversing \nthe menopause: A narrative review. Maturitas. 104: 44-53. \nhttps://dx.doi.org/10.1016/j.maturitas.2017.08.003 \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n32 \nFTFWW. (2019). Making the case for better menopause services in Wales. Fair Treatment \nfor the Women of Wales,. Available at: https://www.ftww.org.uk/2021/wp-\ncontent/uploads/2019/07/FTWW-Making-the-Case-for-Better-Menopause-Services-in-\nWales-Report.pdf. [Accessed 17th October 2022]. \nHamoda H, Panay N, Pedder H, et al. (2020). The British Menopause Society & Women's \nHealth Concern 2020 recommendations on hormone replacement therapy in menopausal \nwomen. Post Reproductive Health. 26(4): 181-209. \nhttps://dx.doi.org/10.1177/2053369120957514 \nNICE. (2015). Menopause, diagnosis and management. NG23. National Institute for Health \nand Care Excellence. Available at: https://www-nice-org-\nuk.abc.cardiff.ac.uk/guidance/ng23/evidence/full-guideline-pdf-559549261. [Accessed 17th \nOctober 2022]. \nNICE. (2022a). Guideline scope. Menopause (update). National Institute for Health and Care \nExcellence. Available at: https://www.nice.org.uk/guidance/gid-ng10241/documents/final-\nscope-2.  [Accessed 18th October 2022]. \nStuckey BGA, Mahoney LA, Dragovic S, et al. (2020). Celiac disease and bone health: is \nthere a gap in the management of postmenopausal osteoporosis? Climacteric. 23(6): 559-\n65.  https://dx.doi.org/10.1080/13697137.2020.1816957 \nMenstrual Health  \nGreen SA, Graham BM. (2022). Symptom fluctuation over the menstrual cycle in anxiety \ndisorders, PTSD, and OCD: a systematic review. Archives of women's mental health. 25(1): \n71-85. https://doi.org/10.1007/s00737-021-01187-4 \nNICE. (2018a). Heavy menstrual bleeding: assessment and management. NG88. National \nInstitute for Health and Care Excellence. Available at: \nhttps://www.nice.org.uk/guidance/ng88.  [Accessed 17th October 2022]. \nNICE. (2018b). Menorrhagia. National Institute of Clinical Excellence. Available at: \nhttps://cks.nice.org.uk/topics/menorrhagia/ [Accessed 17th October 2022]. \nNICE. (2019). Premenstrual syndrome. National Institute for Health and Care Excellence. \nAvailable at: https://cks.nice.org.uk/topics/premenstrual-syndrome/#%21diagnosis. \n[Accessed 17th October 2022]. \nWang Y, Li B, Zhou Y, et al. (2021). Does endometriosis disturb mental health and quality of \nlife? A systematic review and meta-nalysis. Gynecologic and obstetric investigation. 86(4): \n315-35.  https://dx.doi.org/10.1159/000516517 \nWoods NF, Utian W. (2018). Quality of life, menopause, and hormone therapy: an update \nand recommendations for future research. Menopause (10723714). 25(7): 713-20. \nhttps://dx.doi.org/10.1097/GME.0000000000001114 \nPolycystic Ovary Syndrome \nBMI Healthcare. (2021b). Women’s Health Matters: polycystic ovarian syndrome. Circle \nHealth Group. Available at: https://www.circlehealthgroup.co.uk/womens-health-\nmatters/download-report.  [Accessed 17th October 2010]. \nNICE. (2022b). Polycystic ovary syndrome. National Institute for Health and Care \nExcellence. Available at: https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/.  \n[Accessed 17th October 2022]. \nYin X, Ji Y, Chan CLW, et al. (2021). The mental health of women with polycystic ovary \nsyndrome: a systematic review and meta-analysis. Archives of women's mental health. \n24(1): 11-27. https://dx.doi.org/10.1007/s00737-020-01043-x \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n33 \n5. RAPID EVIDENCE MAP METHODS  \n5.1 Eligibility criteria \nThe eligibility criteria for the rapid evidence map, based on the Population, Phenomenon of \nInterest, Context, Study design (PiCoS) framework, are presented in Table 7. \n \nTable 7: Eligibility Criteria \n Inclusion criteria Exclusion criteria  \nPopulation Women, girls and those assigned female at birth  Men, boys and those \nassigned male at birth \n \nPhenomenon of \nInterest \n \nHealthcare professionals’ communication with \nwomen during any clinical encounters, \nconsultations, or appointments \n \nAccess to specialist services \n \nContext Women’s health in generala,b \n \nSpecific women’s health needs & conditionsa \nMenstrual health and gynaecological conditions \n- Pre-menstrual syndrome \n- Menstruation \n- Endometriosis \n- Adenomyosis \n- Polycystic ovarian syndrome \n \nMenopause \n \nPregnancy and childbirth \n- Pregnancy loss and miscarriage \n \nSexual and reproductive health  \n- Contraception  \n- Fertility  \n- Assisted conception \n- Abortion  \n \nGynaecological cancers \nConditions not stated by \nNational health strategy \ndocuments (Department of \nHealth and Social Care 2022, \nScottish Government 2021, \nWelsh Government 2022) \nStudy design Primary research (qualitative and quantitative), \nsystematic, rapid, scoping and umbrella reviews  \nNon-research papers \nNarrative reviews \nGeographical \nlocations \nHICs LMICs \nLanguage of \npublication  \nEnglish \nPublication date 2012 to September 2022 \nPublication type  Published  \n \nKey: HICs: High income countries; LMICS: low and middle income countries  \n \na Based on data provided by Department of Health and Social Care 2022, Scottish Government 2021, \nWelsh Government 2022 and Women’s Health Wales Coalition 2022).  \n \nb Anaesthesia; asthma; autism, autoimmune disease; B12 deficiency; behavioural disorders; bowel \nproblems; cardiovascular health (heart disease, stroke); carpal tunnel syndrome; continence; dementia, \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n34 \nAlzheimer’s disease; dental issues; diabetes; eating disor ders; eye health; fibroids; fibromyalgia; \ngastrointestinal issues; headaches, health impacts of violence against women and girls; migraine; \nhealthy behaviours (healthy weight, exercise, smoking); HPV vaccination; mental health (anxiety, \ndepression, stress) ; musculoskeletal issues; neurodiversity; neurological conditions; obesity; \nosteoporosis and bone health; pain; pelvic health; prolapse; respiratory / pulmonary disease, skin \nproblems; sterilisation; thrush; thyroid issues; urinary tract infection, bladder problems, eating disorders, \nself-harm, myalgic encephalomyelitis, hypermobility spectrum disorders, Ehlers -Danlos syndromes, \nlong COVID, palliative and end of life care. \n5.2 Evidence sources \nSeparate searches were conducted for different topics (such as communication, access, \nendometriosis, menopause, and mental health) and combination of topics. The searches \nwere conducted across four databases MEDLINE (on the OVID platform), Embase (on the \nOVID platform), APA PSYCinfo (on the OVID platform) and CINAHL (on the EBSCO \nplatform) with different date limits applied up to September 2022 for English language \ncitations. Different date limits were necessary due to the high volume of records found in \ncertain topic combinations. To make the rapid evidence map manageable, searches were \nlimited for different dates (2012: communication, access; 2018: endometriosis and \nmenopause research gaps, mental health; 2021: endometriosis and menopause reviews) \ndepending on the volume of records found. The complete search strategy is presented in the \nadditional materials \n   \n5.3 Search strategy  \nAn initial key word search (within that title of a publication only) was undertaken on \nMEDLINE. The key words to be used were (women* OR woman* OR female AND health) \nAND access* OR encounter OR communication.  Based on the initial search findings, an \nanalysis of the text words contained in the title and abstract and of the index terms used to \ndescribe each article was conducted to inform the development of a search strategy. A \nseries of search strategies were developed for different topics presented in this review, such \nas communication, access, endometriosis, menopause, and mental health. Detailed search \nstrategies and results are presented in the additional materials. The search strategies were \ntailored for each information source.  \n5.3.1 Reference management \nAll reports retrieved from the database searches were imported or entered manually into \nreference management software EndNote TM and duplicates removed. At the end of this \nprocess the remaining reports were imported into web-based application RayyanTM.  \n5.4 Study selection process \nOne reviewer screened the reports using the information provided in the title and abstract \nusing the web passed application Rayyan TM.  For reports that appear to meet the inclusion \ncriteria, or in cases in which a definite decision cannot be made based on the title and/or \nabstract alone, the full texts of all r eports were retrieved. The full texts were screened for \ninclusion by one reviewer. The flow of citations through each stage of the review process were \ndisplayed in a PRISMA flowchart. \n5.5 Data extraction and coding/charting \nThe data extracted was extracted fro m the abstract only and included specific details about \nthe populations, the focus of the research, study design and methodology, by one reviewer. \nNo outcome data was extracted. \n5.6 Assessment of methodological quality  \nAn assessment of methodological quality was not conducted. \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n35 \n5.7 Data summary \nThe evidence was presented both narratively and in the form of tables and graphical evidence \nmaps populated by information describing the number and types of studies and reviews by \nthe women’s health conditions and also noted if any interventions had been conducted.  \n \n5.8 Further information available  \n• The Protocol is available on request \n• Search strategies \n   \n6. ADDITIONAL INFORMATION \n6.1 Conflicts of interest \nNone \n \n6.2 Acknowledgements  \nMichael Bowdery (Health and Care Research Wales); Richard Chivers (Women & Children's \nHealth Division); Lisa Daniels-Griffiths (Welsh Treasury), and Professor Jo Peden (Consultant \nin Public Health). \n \n  \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n36 \n7. ABOUT THE WALES COVID-19 EVIDENCE CENTRE (WCEC) \nThe WCEC integrates with worldwide efforts to synthesise and mobilise knowledge from \nresearch.  \n \nWe operate with a core team as part of Health and Care Research Wales , are hosted in the \nWales Centre for Primary and Emergency Care Research (PRIME), and are led by Professor \nAdrian Edwards of Cardiff University.  \n \nThe core team of the centre works closely with collaborating partners in  Health Technology \nWales, Wales Centre for Evidence -Based Care , Specialist Unit for Review \nEvidence centre, SAIL Databank,  Bangor Institute for Health & Medical Research/ Health and \nCare Economics Cymru, and the Public Health Wales Observatory.  \n \nTogether we aim to provide around 50 reviews per year, answering the priority questions for \npolicy and practice in Wales as we meet the demands of the pandemic and its impacts.  \n \nDirector:  \nProfessor Adrian Edwards \n \nContact Email:  \nWC19EC@cardiff.ac.uk \n \nWebsite:  \nhttps://healthandcareresearchwales.org/about-research-community/wales-covid-19-\nevidence-centre  \n \n \n  \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n37 \n8. APPENDICES \n8.1 Appendix 1: JLA Top 10 endometriosis research priority areas  \n1. Can a cure be developed for endometriosis? \n \n• What causes endometriosis? \n \n• What are the most effective ways of educating healthcare professionals throughout the \nhealthcare system resulting in reduced time to diagnosis and improved treatment and \ncare of women with endometriosis? \n \n• Is it possible to develop a non -invasive screening tool to aid the diagnosis of \nendometriosis? \n \n• What are the most effective ways of maxim ising and/or maintaining fertility in women \nwith confirmed or suspected endometriosis? \n \n• How can the diagnosis of endometriosis be improved? \n \n• What is the most effective way of managing the emotional and/or psychological and/or \nfatigue impact of living with endometriosis (including medical, non -medical and self -\nmanagement methods)? \n \n• What are the outcomes and/or success rates for surgical or medical treatments which \naim to cure or treat endometriosis, rather than manage it? \n \n• What is the most effective way of stopping endometriosis progressing and/or spreading \nto other organs (e.g. after surgery)? \n \n• What are the most effective non-surgical ways of managing endometriosis-related pain \nand/or symptoms (medical/nonmedical)? \n \n8.2 Appendix 2: NICE recommendations for research: endometriosis  \n1. Are pain management programmes a clinically and cost -effective intervention for women \nwith endometriosis? \n \n2. Is laparoscopic treatment (excision or ablation) of peritoneal disease in isolation effective \nfor managing endometriosis-related pain? \n \n3. Are specialist lifestyle interventions (diet and exercise) effective, compared with no \nspecialist lifestyle interventions, for women with endometriosis? \nStudies should aim to provide evidence -based options to support self -management of \nendometriosis. This would improve the quality of life of women with endometriosis, enabling \nthem to manage pain and fatigue, and reducing the negative impact on their career, \nrelationships, sex lives, fertility, and physical and emotional wellbeing. \n \n4. What information and support interventions are effective to help women with endometriosis \ndeal with their symptoms and improve their quality of lives? \nThe direct effectiveness of different types or formats of information and support interventions \non me asurable outcomes such as health -related quality of life and level of function (for \nexample, activities of daily living) have not been tested. \n  \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n38 \n8.3 Appendix 3: NICE recommendations for research: menopause   \nOriginal guidance  \n• What is the safety and effectiveness of alternatives to systemic HRT as treatments for \nmenopausal symptoms in women who have had treatment for breast cancer? \n \n• What is the impact of systemic HRT usage in women with a previous diagnosis of \nbreast cancer for the risk of breast cancer reoccurrence, mortality or tumour \naggression? \n \n• How does the preparation of HRT affect the risk of venous thromboembolism (VTE)? \n \n• What is the difference in the risk of breast cancer in menopausal women on HRT with \nprogesterone, progestogen or selective oestrogen receptor modulators? \n \n• What is the impact of oestradiol in combination with the levonorgestrel-releasing intra-\nuterine system (LNG-IUS) on the risk of breast cancer and VTE? \n \n• What are the effects of early HRT use on the risk of dementia? \n \n• .What are the main clinical manifestations of premature ovarian insufficiency and the \nshort- and long-term impact of the most common therapeutic interventions? \n \nUpdated guidance \nThe following areas have been identified for inclusion in the scope: \n• Managing menopausal symptoms. \n \n• Cognitive behavioural therapy to manage symptoms associated with the menopause. \n \n• Interventions to manage genitourinary symptoms associated with the menopause. \n \n• Effects of hormone replacement therapy on overall health outcomes. \n \nThe surveillance and scoping process did not identify any substantive new evidence on using \ntestosterone beyond the current recommendations in the NICE  guideline for using \ntestosterone for altered sexual function. NICE discussed the need for evidence in this area \nwith the NIHR who have agreed to scope new research. \n8.4 Appendix 4: The BMS recommendations for research: menopause \n• Vaginal DHEA use in cancer survivors. \n \n• The effects of acupuncture on  VMS before it can be considered a more effective \ntherapy than placebo. \n \n• Efficacy and safety of oral DHEA \n \n• DHEA pessaries have recently been licensed for the treatment of vulvovaginal atrophy \nand may have som e benefits for low libido. However, this requires further evaluation \nin adequately powered randomised studies. \n \n• St John’s wort and some isoflavone preparations may be effective for VMS but more \nresearch is required to confirm efficacy. \n \n• Head-to-head comparisons of safety and efficacy of vaginal DHEA to topical vaginal \noestrogens are not available and further research is required to assess this. \n \n8.5 Appendix 5: NICE recommendations for research: adenomyosis  \n• The effects of uterine artery embolisation compared with other procedures to treat \nadenomyosis, particularly for patients wishing to maintain or improve their fertility. \n \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint \n\n \nREM00045. WCEC. Rapid Evidence Map: Womens health. October 2022 \n \n39 \n8.6 Appendix 6: NICE recommendations for research: uterine fibroids \n• No recommendations for research within the guidance. \n \n8.7 Appendix 7: NICE recommendations for research: heavy menstrual bleeding  \n• Hysteroscopy compared with ultrasound or empiric pharmacological treatment in the \ndiagnosis and management of heavy menstrual bleeding (HMB). \n \n• Effectiveness of the progestogen-only pill, injectable progestogens, or progestogen \nimplants in alleviating HMB. \n \n• Long-term outcomes of pharmacological and uterine -sparing surgical treatments for \nHMB associated with adenomyosis. \n \n• Hysteroscopic removal of submucosal fibroids co mpared with other uterine -sparing \ntreatments for HMB. \n \n• Are outcomes after second -generation endometrial ablation for women with HMB \nassociated with myometrial pathology (adenomyosis and/or uterine fibroids) equivalent \nto those for women without myometrial pathology? \n \n8.8 Appendix 8: The National Association for Premenstrual Syndrome: Guidelines on \nPremenstrual Syndrome: \nThis guidance did not include specific recommendations for research into premenstrual \nsyndrome (PMS) but did highlight some areas where there is insufficient data.   \n \n• Insufficient evidence of efficacy is available to give a recommendation for using Vitamin \nB6 in the treatment of PMS. \n \n• Given that calcium and Vitamin D may also reduce the risk of osteoporosis and some \ncancers, clinicians may consider recommending these nutrients even for women with \nPMS, but more data are required to determine efficacy and to optimise regimens. \n \n• More data are required before a clear recommendation can be made for isoflavone \nusage, but preliminary data are encouraging. \n \n• Agnus Castus is the best researched complimentary therap y for PMS, but a lack of \nstandardised quality controlled preparations is a problem. \n \n• Initial data appear encouraging but larger studies are required before St J ohn’s Wort \ncan be recommended for use in PMS. \n \n• There are insufficient data to recommend the routine use of progestogens or natural \nprogesterone in the treatment of PMS. \n \n8.9 Appendix 9: NICE recommendations for research: Fertility problems (PCOS) \n• No recommendations for research included within the guidance.   \n \n \n . CC-BY-ND 4.0 International licenseIt is made available under a \nperpetuity. \n is the author/funder, who has granted medRxiv a license to display the preprint in(which was not certified by peer review)preprint \nThe copyright holder for thisthis version posted November 11, 2022. ; https://doi.org/10.1101/2022.11.09.22282129doi: medRxiv preprint","source_license":"CC0","license_restricted":false}