Occupational health challenges faced by female anaesthesiologists: a scoping review.

Institutional review board (IRB) approval was not required for this scoping review as it was considered IRB exempt. No patient care was required. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were strictly adhered to throughout the conduct of this scoping review, ensuring comprehensive and transparent reporting of the review process, including literature search, selection, data extraction, and synthesis. The five-stage framework used to structure the Methods section of the scoping review is known as the Arksey and O’Malley framework. It provides the methodological foundation for modern scoping reviews. Additionally, the authors acknowledge that gender is non-binary and distinct from biological sex, although many studies reviewed in this manuscript use these terms interchangeably. Furthermore, we recognise that the lived experiences of individuals across the gender spectrum are diverse and uniquely shaped by sociocultural and physiological factors. For the purposes of this review, we focused on individuals born with a uterus and ovaries, as they encounter specific physiological and occupational health challenges throughout their lifespan—from menstruation to menopause. In the manuscript, we use the terms ‘women/woman’ and ‘female/females’ to reflect the language of the included literature, while recognising that these terms may not encompass the full spectrum of gender identities. We also acknowledge that some individuals who identify as transgender women or non-binary may experience overlapping or distinct challenges, although these populations are outside the defined scope of this review. The primary research question was to identify what female-specific health issues impact female anaesthesiologists in the workplace and what practice management techniques have been identified to support them in the workplace. The search was designed to yield all articles that address female-specific health issues that female anaesthesiologists can be impacted by in the workplace including but not limited to menstruation, infertility, pregnancy, lactation, postpartum mood disorders, chronic pain conditions, and menopause. Conditions that are either exclusive to biologic females or exhibit significantly higher prevalence, morbidity, or impact among females, especially in the context of occupational functioning, were included. Although chronic pain is not a sex-specific condition, it was included because women experience a higher prevalence and greater occupational burden of chronic pain compared with men, particularly in the context of physically demanding clinical work such as in anaesthesiology. Although our primary focus was on physician anaesthesiologists, studies involving nurse anaesthetists were included if they addressed occupational or physiological health issues directly relevant to the conceptual scope of this review, particularly when findings were transferable to the broader anaesthesia workforce. A list of inclusion and exclusion criteria was established before initiation of publication screening. Studies were included if they met the following inclusion criteria: 1) If the publication addressed female health issues in anaesthesiologists including but not limited to menstruation, infertility, pregnancy, lactation, postpartum mood disorder, chronic pain conditions, menopause, and more. 2) If the publication discussed actionable, practice management techniques and steps to address female health issues in the workplace. If the publication addressed female health issues in anaesthesiologists including but not limited to menstruation, infertility, pregnancy, lactation, postpartum mood disorder, chronic pain conditions, menopause, and more. If the publication discussed actionable, practice management techniques and steps to address female health issues in the workplace. Articles were excluded if they did not include discussion of actionable practice management strategies, as this was a key criterion for inclusion. This review followed a comprehensive search strategy, created in collaboration with librarian support, using keywords and index terms in the PubMed, EMBASE, Google Scholar, and SCOPUS databases. The last search was completed in March 2025. We used a broad search strategy, with the terms ‘female’, ‘women’, ‘anesthes-’, and ‘anaesthes-’ and numerous other iterations. The complete search strategy is available in Supplementary material 2 . No limits were set on the date to allow a comprehensive initial screening of publications. All available publications, including Non-English publications, newsletters, and conference abstracts, were included. Three included publications were not in English. Translation services were used to translate the article to English. Finally, we reviewed the bibliographies of the articles to identify any additional relevant publications. All search results were screened for inclusion by two dual board-certified anaesthesiologists (AMP: Pain Medicine and AS: Critical Care Medicine). Screening was executed in parallel and independently by each physician to find all publications that met the inclusion criteria using Covidence, a web-based tool primarily used to streamline and manage the process of conducting systematic and scoping reviews. Conflicts that occurred during the independent review were screened again by the same reviewers, and if there was no resolution, the publication was discussed with a third reviewer serving as the tiebreaker. This was not required as all conflicts were resolved by the two reviewers. After the screening was completed, a third reviewer read through the full publications to document specific qualitative and quantitative variables of interest ( Fig. 1 ). During the charting process, authors discussed progress, and data collection forms were adapted to capture emerging trends. The two variables of interest were the types of health issues female anaesthesiologists face and the practice management suggestions in the publications. Fig 1 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram. Fig 1 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram. The authors included all publications including grey literature meeting the inclusion criteria to ensure a comprehensive assessment of the topic. Grey literature refers to research that is produced on all levels of government, academics, business, and industry, but which is not controlled by commercial publishers. Titles, abstracts, and full texts were independently reviewed by two authors (AMP and AS). Two studies had to be excluded as the full text was not available. Discrepancies were resolved by consensus among the authors at the completion of the review stage. After initial review by all authors, it was determined to exclude articles before the year 2000 for two reasons. First, all of the publications before 2000 were on pregnancy complications from waste anaesthetic gas (WAG) exposures before scavenging systems. Since then, scavenging systems, WAG monitoring, and compliance measures for OR ventilation have been implemented across most anaesthetic work environments. Second, the authors wanted to focus the review on recent and up-to-date recommendations. For each study, we extracted author names, year of publication, journal, country of origin, study title, article type, sample size, female health condition, and actionable steps for the workplace. Studies were assessed for actionable strategies and methods suggested for addressing female health issues in the workplace. Only studies providing actionable steps to improve workplace conditions related to female health were included. Studies merely identifying a ‘need for improvement’ or presenting similarly vague recommendations were excluded. Studies were then analysed qualitatively. The authors frame their findings to help guide future research in the discussion section of this paper.

Thirty-three articles were identified to be included in this scoping review. These articles included 13 review articles, 10 surveys, three retrospective studies, two cross-sectional studies, one qualitative study, one guideline, two newsletters, and one editorial ( Supplementary material 1 ). The categories evaluated included pregnancy/postpartum (22 articles), lactation (16 articles), menopause (two articles), chronic pain conditions (two articles), infertility (two articles), menstruation (zero articles), and postpartum mood disorders (zero articles). Bias assessments are individually detailed for each study in Supplementary material 3 . Publications were summarised by health condition and practice management techniques implemented in Supplementary material 1 . A total of 22 studies in this review addressed the health challenges faced by pregnant anaesthesiologists, with a consistent focus on occupational exposures, workplace accommodations, and institutional policy gaps. Multiple surveys and qualitative studies highlighted that pregnant anaesthesiologists are often exposed to physical and environmental hazards such as ionising radiation, surgical smoke, WAGs, ergonomic strain, and extended working hours. 4 , 5 , 6 , 7 , 8 , 9 Although some clinicians reported receiving education about these risks, the majority described inconsistent or insufficient application of protective policies. Several studies emphasised the lack of structured reintegration plans after maternity leave, and the absence of accommodations for altered clinical duties during pregnancy. 10 Institutional variability in the enforcement of maternity protection laws and the limited flexibility in training schedules further compounded these challenges. Recommendations across the literature included implementing formal occupational health education during residency, reassignment from high-risk environments during early pregnancy, ergonomic and schedule modifications, 11 and establishment of supportive return-to-work protocols post-leave. 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 Additional recommendations included installation of scavenging systems, avoiding assigning pregnant anaesthesiologists to rooms with radiation exposure, keeping noise levels at 455 dBA or less, ensuring proper exhaust ventilation, implementing an exposure limit of a maximum of 2 ppm over a 1-h period for any halogenated agent, implementing exposure limits of a maximum of 25 ppm for N 2 O when it is the sole agent being utilised, and appropriate personal protective equipment (PPE). 9 They also recommend gestational specific ergonomic training, supportive, destigmatised workplace environments that facilitate personal choices around childbearing, clear parental leave policies, providing confidential intradepartmental mentorship regarding pregnancy loss, and facilitating graded return postpartum. Regarding postpartum, the ASA recommends that maternity leave should be at least 6 weeks for vaginal delivery and 8 weeks for Caesarean delivery with the option to extend this time ( Supplementary material 1 ). Sixteen studies addressed the experiences and occupational challenges faced by anaesthesiologists during lactation, highlighting structural, cultural, and policy-related barriers across diverse clinical settings and geographic regions. Commonly reported challenges included insufficient protected time for milk expression, lack of clean and private lactation facilities near ORs, logistical difficulties in taking breaks during clinical duties, and the persistence of stigma and inadequate institutional support. Several studies emphasised the compounded burden experienced by trainees and early-career anaesthesiologists who navigate these demands alongside career advancement pressures. 21 Titler and colleagues 22 and Xu and colleagues 19 quantified the time needed for lactation breaks, confirmed the scarcity of workplace accommodations, and advocated for non-OR assignments, shortened break durations with greater frequency, and designated lactation rooms equipped with refrigeration, privacy, and communication tools. A scoping review by Mergler and colleagues 15 further reinforced these logistical barriers, emphasising the need for structured parental leave policies and gender-equity initiatives that normalise lactation within perioperative care teams. A qualitative study by Allen and colleagues 10 provided insight into the emotional and psychosocial burdens of returning to work while lactating, underscoring the value of pre-return orientation, mentorship, and fostering a departmental culture that supports lactating physicians. Policy-focused reviews stressed the importance of long-term job security, caregiver support systems, and explicit anti-harassment policies that protect lactating physicians from bias and marginalisation. 18 , 23 In international contexts, studies from China 19 and Australia 11 identified similar concerns and recommended national-level interventions to ensure ergonomic protections, flexible leave arrangements, and consistent implementation of lactation-friendly practices across institutions. Collectively, these articles advocate for a cultural and operational shift in anaesthesiology departments—moving from ad hoc support to systemic, policy-driven approaches that safeguard the physical and emotional well-being of lactating clinicians. Recommended strategies include structured lactation scheduling, temporary adjustments to clinical duties, peer support networks, education for departmental leadership to reduce stigma and normalise breastfeeding in the clinical environment, and implementation of proper lactation breaks, lactating facilities, education about lactation to all staff members, protection from biological hazards, and clinical assignments that allow for time to pump ( Supplementary material 1 ). Two articles discussed infertility and fertility preservation in anaesthesiologists. Barnett and colleagues 12 conducted a multicentre survey involving 224 anaesthesiologists and 168 obstetrician-gynaecologists to assess pregnancy complications and loss among these specialties. Among respondents who reported at least one pregnancy, 65.1% (67/103) of anaesthesiologists experienced at least one pregnancy complication or loss. Notably, anaesthesiologists were more likely to recall receiving education about occupational pregnancy risks, with 54% reporting such education compared with 23.8% of obstetrician-gynaecologists. Additionally, 11.6% of anaesthesiologists reported reproductive assistance. They recommended improved education and leave policies for physicians who experience pregnancy loss because of physical and mental health consequences. In a newsletter, Sumrak 24 emphasised the disproportionately high rates of infertility among female physicians and the lack of formal education on fertility preservation during medical training. Key recommendations included early education on fertility risks and options beginning in medical school, guaranteed access to reproductive endocrinologists and insurance coverage, and institutional workplace accommodations to reduce stigma and provide time for treatment-related absences. The article underscored the need for cultural and policy shifts within anaesthesiology to support reproductive health equity. Two articles discussed menopause and included practice recommendations. In Binks' 25 survey of 100 female anaesthetists, it was reported that 80% reported symptoms impacting their physical health, mental health, or both owing to the result of menopause transition. Specifically, 64% reported that they had significant symptoms, whereas 40% had an effect on work life pertaining to fatigue, brain fog, and irritability. 25 Forty-four percent of respondents reported that they felt unable to discuss their symptoms. An individualised response to symptom management was suggested, and a need to raise awareness of menopause. Additional suggestions included flexibility in working patterns to help with fatigue management, and avoiding assignments in heated environments such as obstetrics and burn units to help with temperature control. Davies and colleagues 26 published a guideline for the ageing workforce of anaesthetists in which they address menopause. They outline several practical recommendations for supporting clinicians experiencing menopause symptoms. These include ensuring that institutional policies explicitly address the needs of employees undergoing menopausal transitions, with an emphasis on flexibility, workplace adjustments, and educational outreach. The guideline encourages dissemination of menopause-related resources and formal pathways, such as online training for leadership, educational webinars, and support networks, to increase awareness and normalise seeking help. Two cross-sectional studies discussed chronic pain specific to carpal tunnel syndrome (CTS) and multiple sclerosis (MS) in nurse anaesthetists. 27 , 28 CTS and MS were included in the review not by targeted selection, but because they emerged as the only relevant findings during our search using chronic pain-related terms, highlighting both the scarcity and specificity of existing literature on this topic among women anaesthesiologists. In a cross-sectional study of 244 participants, Diaz 27 found that female nurse anaesthetists had a significantly higher prevalence of CTS compared with OR nurses, particularly in the nondominant and bilateral hands, suggesting occupational strain as a contributing factor. Recommendations to prevent CTS included mitigating mechanical exposure to rigid laryngoscopes by replacing them with flexible, fibreoptic laryngoscopes and wearing fitted gloves during airway management. Landtblom and colleagues 28 conducted a Swedish registry-based study evaluating the risk of MS among female nurse anaesthetists. The study found an increased risk compared with the general population, suggesting a potential association with occupational exposures in anaesthesia. Recommendations to prevent MS included minimising exposure to organic solvents or volatile anaesthetic agents. 28 No articles fulfilling the inclusion criteria of this study were found discussing or proposing actionable solutions for the challenges faced by female anaesthesiologists in managing menstruation and postpartum mood disorders.

Third-party reviewer, graphic design, editing of the paper: SC Writing of the manuscript: SC, AS, AMP Creation of search terms, extracted the papers and organised them to be reviewed: LM Initial reviewer of the articles: AS Edited and guided the manuscript: MK, EM Conceived the topic, initiated the scoping review, initial reviewer of the articles: AMP

All anaesthesiologists may face challenging health issues in the workplace; however, there are some unique sex-specific health challenges that females experience compared to males ( Figs 2 and 3 ). A holistic discussion on how menstruation, pregnancy, infertility, childbirth, postpartum, and/or menopause affect a female anaesthesiologist’s career needs occur to enable a better understanding of the issues and to promote practical changes to occur in the workplace( Table 1 ). Fig 2 Traditional life cycle of females and males (universal medical conditions that women assigned female at birth will experience). Fig 2 Fig 3 Challenges of female-specific health issues from residency to retirement. Fig 3 Table 1 Common sex-specific health issues faced by females and males. Table 1 Physiological domain Female-specific Shared (all genders) Male-specific Reproductive and fertility Hormonal contraception; fertility preservation; infertility evaluation/treatment Infertility (general); sexual and reproductive health Fertility evaluation/treatment Pregnancy, postpartum, lactation Pregnancy (including miscarriage), lactation, postpartum physiologic changes – – Hormonal transitions Perimenopause/menopause Endocrine disorders (e.g. thyroid disease, diabetes) Androgen-related disorders Gynaecologic/urologic Endometriosis, fibroids, abnormal uterine bleeding, other gynaecologic disorders Lower urinary tract symptoms Prostate disorders, testicular/scrotal disorders, penile disorders Cancer Breast, ovarian, cervical, endometrial Non-sex-specific cancers (e.g. colorectal, lung, melanoma) Prostate, testicular Pain and headache disorders – Musculoskeletal pain syndromes – Bone and musculoskeletal health Osteoporosis (female-predominant) Musculoskeletal conditions (general) – Cardiometabolic and general health – Obesity, coronary artery disease, hypertension, sleep disorders – Mental health conditions Perinatal mood disorders (postpartum depression/anxiety) Depression/anxiety, substance use disorders – Traditional life cycle of females and males (universal medical conditions that women assigned female at birth will experience). Challenges of female-specific health issues from residency to retirement. Common sex-specific health issues faced by females and males. For context, women make up about 38% of all active physicians in the USA, whereas in the EU, women constitute 52.8% of physicians, although the proportion does vary considerably by country. 29 , 30 As of 2020, women comprised 38% of consultant anaesthetists in the UK. 29 According to the Association of American Medical Colleges (AAMC), women represent approximately 37% of all full-time faculty in academic anaesthesiology in the USA 30 ; however, this does not include those outside of academic hospitals. Although regional studies provide insights into the representation of women in anaesthesiology, there is a lack of comprehensive global data on the number of female anaesthesiologists worldwide. Available studies suggest that women are underrepresented in both clinical and academic anaesthesiology roles which can be for a variety of reasons. Our report summarises existing literature on the sex-specific health struggles faced by women in anaesthesiology with regard to menstruation, infertility, pregnancy, lactation, postpartum mood disorders, menopause, and chronic pain conditions. Although a total of 33 studies were included in this scoping review, it is worth noting that before the year 2000, there were only eight publications on these topics, most of which focused on occupational hazards of anaesthetic gases. Female anaesthesiologists experience the highest rates of discrimination related to motherhood among medical specialties, with 60% of anaesthesiologists expressing concerns about the stigma when pregnant or having children during training. 16 Half of female anaesthesiologists feel discouraged from starting a family during these critical career stages. In a 2017 survey-based study of 5782 women physicians, anaesthesiologists had the highest rate of maternal discrimination at 47.1% of respondents, with obstetrics and gynaecology at 43.8% and surgery at 42.1%. 31 These pressures may contribute to the increased infertility rates and may propagate emotional distress amongst these professionals. The increased strain to maintain this balance negatively impacts their health, exacerbating higher dissatisfaction and increasing burnout rates. 14 It is no surprise that work demands would profoundly affect having children, thus presenting a challenge for female anaesthesiologists who feel the need to choose between having a career and having a family. 14 Cultivating a supportive workplace environment that respects personal decisions about childbearing and implementing comprehensive policies pertaining to parental leave is imperative to address these issues. Furthermore, complications with pregnancy are documented amongst anaesthesiologists, with some studies noting higher rates of spontaneous miscarriages and abortions compared with the general population. 32 This finding may be pronounced amongst paediatric anaesthesiologists. 33 Institutional efforts to mitigate exposure to anaesthetic gases and other teratogens have improved since the 1980s and 1990s; evidence continues to show that pregnant anaesthesiologists remain at risk for workplace exposures, particularly in settings where adherence to safety protocols may be inconsistent or outdated. These outcomes may be attributed to occupational exposures such as ionising and non-ionising radiation, noise, vibration, temperature, droplet infection, and needle stick injuries. 4 Recommended actionable measures from the literature include standardised safety measures including proper installation of scavenging systems, acceptable guidelines of dosing and duration of exposure, PPE, and protection against radiation. 5 Hospitals should maintain noise levels at no more than 455 dBA and ensure proper exhaust ventilation. 4 Of the 22 pregnancy and postpartum studies included in the scoping review, we prioritise the following recommendations for workplaces regarding pregnancy and postpartum support in clinical environments: workplace hazard reduction, physical safety measures for women, policy enforcement, and development of standardised policies and support systems ( Table 2 ). Table 2 Summary of practice management tips. NIOSH, National Institute for Occupational Safety and Health; OSHA, Occupational Safety and Health Administration. Table 2 Health conditions addressed in literature Proposed actionable steps Lactation 1. Insufficient lactation breaks 2. Lack of proper structural lactation facility 3. Fear of judgement of breast pumping in the workplace 4. Common lactation-related health issues, such as engorgement, mastitis, or premature cessation because of work-related barriers Policy development - Implement reasonable parental leave policies - Offer flexible scheduling options - Establish lactation support policies - Create guidelines for training adjustments regarding missed time for residents - Develop fair hospital coverage systems - Implement nontraditional scheduling and leave policies with long-term job security - Value citizenship tasks for promotion - Establish zero tolerance for harassment and discrimination Infrastructure - Create lactation spaces near operating rooms for quick access - Provide clean, private rooms with locks and ‘in-use’ signage - Include refrigeration for milk storage - Install computers and phones to allow continued patient monitoring - Add hospital-grade breast pumps to minimise equipment transport - Consider converting call rooms for daytime lactation use Scheduling and time management - Allow for pumping breaks every 2–3 h (more frequent for infants <6 months) - Account for 15–20 min minimum per session, plus setup/cleanup time - Consider limiting assignments in remote locations - Create reliable break coverage systems - Incorporate lactation needs into daily case assignments - Limit supervising anaesthesiologists who are lactating to overseeing no more than two operating rooms simultaneously Compliance - Follow American College of Graduate Medical Education (ACGME) requirements for clean, private facilities with refrigeration - Adhere to federal law requiring reasonable break time for milk expression - Consider state-specific lactation laws that may provide additional protections - Ensure facilities meet federal requirements (not bathrooms, private, shielded from view) Training programme adjustments - Account for pregnancy/maternity needs in training requirements - Create flexible rotation schedules - Develop fair call distribution systems - Provide clear guidelines for leave duration - Allow flexibility in training schedules - Establish coverage systems for parental leave Peer and mentorship programmes - Enhance peer support networks - Develop supportive return-to-work protocols - Establish clear communication channels Workplace environment - Encourage supportive workplace behaviours - Improve education about breastfeeding needs - Change perspectives around workplace lactation - Reduce stigma associated with breastfeeding Pregnancy Occupational exposures that include but are not limited to ionising and non-ionising radiation, noise and vibration, temperature, droplet infections, needle stick injuries, and exposure to halogenated agents increase risk for pregnancy loss, low birth weight, congenital abnormalities, and complications. Physical safety measures Temperature and humidity - Maintain room temperature at 21°C with 40–70% humidity Radiation protection - Use proper protective equipment (lead jackets, thyroid collars) - Monitor dosimeter and fetal dosimeter regularly (at least monthly) - Maintain safe distance (90 cm) from radiation sources Noise reduction - Keep levels below 115 dBA - Avoid low-frequency sounds - Minimise exposure to sudden loud noises - Adhere to NIOSH recommendations: time-weighted average of 85 dB for 8-h workday, using 3-dBA time/intensity exchange rate - Follow OSHA limits: 90 dBA for 8-h workday - Aim for average noise level of 45 dBA or less within hospitals Surgical smoke protection - Adhere to NIOSH and OSHA recommendations for exhaust ventilation and exposure reduction - Use properly fitting N95 mask when working with known transmissible diseases, especially in areas lacking proper ventilation Waste anaesthetic gas (WAG) management Exposure limits - Follow NIOSH recommendations: 25 ppm for nitrous oxide, 2 ppm for halogenated anaesthetic gases Prevention strategies - Handle facemasks, vaporisers, and flowmeters carefully - Regularly identify leaks in high-pressure and low-pressure systems - Implement effective air renewal systems - Use scavenging systems and ensure adequate exhaust ventilation - Consider TIVA to minimise volatile anaesthetic exposure - Reduce exposure to 10–15% or less through proper scavenging - Restrict assignment of doctors planning pregnancy to operating rooms without excessive volatile anaesthetic exposure—install scavenging devices - Reduce exposure to 10–15% or less through proper scavenging - Restrict assignment of doctors planning pregnancy to operating rooms without volatile anaesthetics - Consider reassignment of pregnant women during early pregnancy Workplace accommodations - Consider ergonomic adjustments for pregnant workers - Modify schedules during pregnancy, preferably posting in radiation-free areas - Ensure adequate break times - Allow protected time for medical appointments Policy recommendations - Implement comprehensive maternity leave policies - Establish clear workplace safety guidelines - Develop formal radiation exposure protocols - Offer flexible scheduling options Institutional responsibilities - Implement annual surveys to monitor miscarriage rates - Develop clear protocols and policies - Notify female staff about WAG risks - Establish clear reporting mechanisms - Provide workplace accommodations during pregnancy - Regularly monitor and assess exposure levels Infertility/family planning Negative stigma surrounding being pregnant during training therefore contributing to higher infertility rates - Cultivating a supportive workplace environment that facilitates personal choices around childbearing and implementing parental leave policies - Allow non-punitive, flexible sick leave options for fertility treatments Menopause - Flexible clinical assignments allowing for breaks for symptoms (i.e. hot flashes, cognitive disturbances) - Destigmatise workplace culture by discussing the impact of menopause on a female’s physical and mental well-being Health conditions not addressed in literature Suggested actionable steps by authors Menstruation, postpartum mood disorders, chronic pain conditions - Flexible clinical assignments allowing for breaks for symptoms (i.e. debilitating menstrual pain, bloating, anxiety) - Destigmatise workplace culture - Allow non-punitive, flexible sick leave options for debilitating symptoms - Allow work from home (WFH) for special circumstances, if feasible (i.e. non-clinical time allotted for administrative duties, research, academic time, pre-anaesthesia clearance responsibilities, etc.) Summary of practice management tips. NIOSH, National Institute for Occupational Safety and Health; OSHA, Occupational Safety and Health Administration. Insufficient lactation breaks Lack of proper structural lactation facility Fear of judgement of breast pumping in the workplace Common lactation-related health issues, such as engorgement, mastitis, or premature cessation because of work-related barriers Policy development Implement reasonable parental leave policies Offer flexible scheduling options Establish lactation support policies Create guidelines for training adjustments regarding missed time for residents Develop fair hospital coverage systems Implement nontraditional scheduling and leave policies with long-term job security Value citizenship tasks for promotion Establish zero tolerance for harassment and discrimination Infrastructure Create lactation spaces near operating rooms for quick access Provide clean, private rooms with locks and ‘in-use’ signage Include refrigeration for milk storage Install computers and phones to allow continued patient monitoring Add hospital-grade breast pumps to minimise equipment transport Consider converting call rooms for daytime lactation use Scheduling and time management Allow for pumping breaks every 2–3 h (more frequent for infants <6 months) Account for 15–20 min minimum per session, plus setup/cleanup time Consider limiting assignments in remote locations Create reliable break coverage systems Incorporate lactation needs into daily case assignments Limit supervising anaesthesiologists who are lactating to overseeing no more than two operating rooms simultaneously Compliance Follow American College of Graduate Medical Education (ACGME) requirements for clean, private facilities with refrigeration Adhere to federal law requiring reasonable break time for milk expression Consider state-specific lactation laws that may provide additional protections Ensure facilities meet federal requirements (not bathrooms, private, shielded from view) Training programme adjustments Account for pregnancy/maternity needs in training requirements Create flexible rotation schedules Develop fair call distribution systems Provide clear guidelines for leave duration Allow flexibility in training schedules Establish coverage systems for parental leave Peer and mentorship programmes Enhance peer support networks Develop supportive return-to-work protocols Establish clear communication channels Workplace environment Encourage supportive workplace behaviours Improve education about breastfeeding needs Change perspectives around workplace lactation Reduce stigma associated with breastfeeding Physical safety measures Temperature and humidity Maintain room temperature at 21°C with 40–70% humidity Radiation protection Use proper protective equipment (lead jackets, thyroid collars) Monitor dosimeter and fetal dosimeter regularly (at least monthly) Maintain safe distance (90 cm) from radiation sources Noise reduction Keep levels below 115 dBA Avoid low-frequency sounds Minimise exposure to sudden loud noises Adhere to NIOSH recommendations: time-weighted average of 85 dB for 8-h workday, using 3-dBA time/intensity exchange rate Follow OSHA limits: 90 dBA for 8-h workday Aim for average noise level of 45 dBA or less within hospitals Surgical smoke protection Adhere to NIOSH and OSHA recommendations for exhaust ventilation and exposure reduction Use properly fitting N95 mask when working with known transmissible diseases, especially in areas lacking proper ventilation Waste anaesthetic gas (WAG) management Exposure limits Follow NIOSH recommendations: 25 ppm for nitrous oxide, 2 ppm for halogenated anaesthetic gases Prevention strategies Handle facemasks, vaporisers, and flowmeters carefully Regularly identify leaks in high-pressure and low-pressure systems Implement effective air renewal systems Use scavenging systems and ensure adequate exhaust ventilation Consider TIVA to minimise volatile anaesthetic exposure Reduce exposure to 10–15% or less through proper scavenging Restrict assignment of doctors planning pregnancy to operating rooms without excessive volatile anaesthetic exposure—install scavenging devices Reduce exposure to 10–15% or less through proper scavenging Restrict assignment of doctors planning pregnancy to operating rooms without volatile anaesthetics Consider reassignment of pregnant women during early pregnancy Workplace accommodations Consider ergonomic adjustments for pregnant workers Modify schedules during pregnancy, preferably posting in radiation-free areas Ensure adequate break times Allow protected time for medical appointments Policy recommendations Implement comprehensive maternity leave policies Establish clear workplace safety guidelines Develop formal radiation exposure protocols Offer flexible scheduling options Institutional responsibilities Implement annual surveys to monitor miscarriage rates Develop clear protocols and policies Notify female staff about WAG risks Establish clear reporting mechanisms Provide workplace accommodations during pregnancy Regularly monitor and assess exposure levels Cultivating a supportive workplace environment that facilitates personal choices around childbearing and implementing parental leave policies Allow non-punitive, flexible sick leave options for fertility treatments Flexible clinical assignments allowing for breaks for symptoms (i.e. hot flashes, cognitive disturbances) Destigmatise workplace culture by discussing the impact of menopause on a female’s physical and mental well-being Flexible clinical assignments allowing for breaks for symptoms (i.e. debilitating menstrual pain, bloating, anxiety) Destigmatise workplace culture Allow non-punitive, flexible sick leave options for debilitating symptoms Allow work from home (WFH) for special circumstances, if feasible (i.e. non-clinical time allotted for administrative duties, research, academic time, pre-anaesthesia clearance responsibilities, etc.) By implementing these recommendations, employers and training programmes can better support individuals in balancing personal and professional responsibilities. Offering reasonable parental leave policies and fostering a supportive work culture will enable individuals to make personal choices regarding childbearing, while ensuring that pregnancy and postpartum needs are normalised and addressed without fear of judgement, retaliation, or career setbacks. With the return to work after maternity leave, lactating anaesthesiologists encounter physiologic issues with lactation. On a typical day in the OR, infrequent pumping contributes significantly to an insufficient milk supply and becomes a prominent risk factor in breastfeeding discontinuation. As a result, the percentage of anaesthesiologists who continue to breastfeed 1 yr after childbirth drops to as low as 35.1%. 34 This is lower compared with the percentage of women in the general population who continue to breastfeed 1 yr after childbirth at 68% from the 2021 Institutional Repository for Information Sharing (IRIS) report. 35 The number of female anaesthesiologists who discontinue breastfeeding before they are ready and have planned to do so is high; the majority stopped lactation before the American Academy of Pediatrics recommendation of exclusive breastfeeding for the first 6 months of life. 36 There is an undisclosed toll on female anaesthesiologists who know the medical recommendations for themselves and their infants but are unable to do so because of the constraints their careers place on them. It is important to note that lactation has numerous health benefits for the mother and the child. Breastfeeding acts as a protection factor for mothers against breast cancer, ovarian cancer, and type 2 diabetes. 22 Mothers who do not breastfeed are not only at higher risk of these ailments but are also at increased risk of maternal postpartum depression. 22 Physically, breastfeeding, rather than pumping, provides unique benefits as it encourages the expression of milk which can decrease plugged ducts, and mastitis, and encourage milk supply. 22 Considering that lactation experiences vary widely among women, with differences in the time required for effective pumping sessions and the unique challenges related to inadequate infrastructures and inadequate rules and regulations, establishing reliable schedules and safe spaces for pumping is challenging. A cross-sectional online survey of female physicians with at least one biological child recruited through the Academy of Breastfeeding Medicine reported that 570 physicians reported intention to breastfeed at least 12 months in 78.1% of cases. Younger participants' age, breastfeeding discontinuation not attributable to work-related demands, and heightened maternal satisfaction with duration of breastfeeding were associated with longer exclusive breastfeeding and duration. Exclusive breastfeeding at birth, less maternal stress, availability of time to express milk, and collegial support were associated with a longer duration of exclusive breastfeeding. Longer maternal breastfeeding duration goals, longer maternity leave, the existence of laws or regulations to support breastfeeding among working mothers, later child order, and lower levels of maternal depression were associated with longer breastfeeding duration. 37 The experiences of physicians vary across specialties, with unique challenges posed for anaesthesiologists in the OR setting. The articles included in the scoping review are consistent with literature across other specialties. Establishing a nearby, clean, and well-equipped lactation facility in operating areas improves lactation feasibility. Furthermore, implementing policies where breastfeeding anaesthesiologists are assigned temporary clinical duties and limit their supervision to no more than two rooms concurrently improves the ability to pump. These changes aim to support lactation in the workplace and cater to lactating mothers' unique individual time needs. 22 Additionally, fostering a workplace culture inclusive of lactating anaesthesiologists should include education surrounding this topic among all department staff members. 23 This initiative would aid in normalising breast pumping in the workplace, reducing fears of judgement amongst female anaesthesiologists, and alleviate concerns around potential career setbacks related to breastfeeding. 22 On the basis of the 16 articles on lactation included in the scoping review, we prioritise the following recommendations for workplaces to enhance lactation support in clinical environments: access to clean, private lactation facilities; adequate break time for lactation; manageable clinical assignments; and promotion of a supportive workplace culture. By adopting these recommendations, workplaces can ensure compliance with both federal law regarding lactation break times and storage and the training safety standards, ultimately promoting a supportive environment for lactating employees. There were two publications found addressing fertility issues in female anaesthesiologists. Fertility and family planning are significant considerations for female anaesthesiology trainees and early-career women, whose peak reproductive years often coincide with this stage of their career as anaesthesiologists. 18 Female physicians, particularly those in surgical specialties, have a significantly greater incidence of miscarriage (two times more), infertility (three times more), and pregnancy complications (two times more) compared with the general population. In a survey-based study of 4533 female physicians, female physicians were older at first pregnancy, more often underwent infertility evaluation and treatment, and had higher rates of miscarriage and preterm birth. During training, only 8% of those surveyed received education on the risks of delaying pregnancy. Those who were educated were significantly less likely to experience miscarriage or seek infertility evaluation or treatment. 38 There is a notable lack of education and research regarding fertility issues in anaesthesiology. Because of limited support and discussions regarding family planning, female anaesthesiologists have inadequate guidance pertaining to the specific risks associated with their specialty. On the basis of our findings, we prioritise the following recommendations for workplaces regarding family planning: facilitating personal choices in childbearing, promoting work-life integration, formal support and leave policies, and minimising workplace influence on family planning decisions. Recommendations for infertility include early education on fertility risks and options beginning in medical school, guaranteed access to reproductive endocrinologists and insurance coverage, and institutional workplace accommodations to reduce stigma and provide time for treatment-related absences. By adopting these recommendations, workplaces can create supportive environments that enable employees to make personal choices regarding fertility and family planning with confidence and without professional consequence. This will ultimately lead to a more inclusive, flexible, and equitable work culture that respects the diverse needs of the workforce. Additionally, although infertility and pregnancy loss can have emotional and psychological impacts on both partners, these conditions were included in this review owing to their direct physiological, clinical, and occupational implications for female anaesthesiologists, particularly in the context of receiving fertility treatments, physical recovery, and time-sensitive work demands. Notably, this review did not identify any studies that evaluated the rates of postpartum mood disorders in not only female anaesthesiologists but also women physicians, representing a future avenue of study. According to the World Health Organization, 17.22% of women who have recently given birth experience a mental disorder, primarily depression. 39 This number is higher for women without adequate support and those who return to work sooner. 40 Alarmingly, there are no known studies evaluating the rates of postpartum mood disorders in physicians or anaesthesiologists. Most healthcare organisations in the USA do not offer paid time off for maternity leave, resulting in female physicians returning to work sooner than recommended, with potential ramifications to their health that should be studied further. This scoping review did not identify any studies that addressed menstruation. The impact of menstruation on women in the workplace has not been well studied across disciplines. 41 In a cross-sectional study of 1987 women, 45.2% of women reported missing work because of menstrual symptoms, with an average of 5.8 days missed per year. 42 Although female anaesthesiologists presumably face menstrual health concerns in the workplace, no studies have assessed the impact of it on anaesthesiologists. Every female born with a uterus and ovaries will undeniably experience menopause, whether surgical or natural. As female anaesthesiologists age, they will be faced with the impact of menopause on their physical and mental health. The average age of menopause is 51 yr. 42 Forty percent of practicing anaesthesiologists are older than 55 yr, which demonstrates that female anaesthesiologists will experience perimenopause and menopause during their working years. 43 In a 2019 questionnaire-based study of 409 women, around one-third of women reported moderate/severe difficulties coping at work because of menopausal symptoms. 44 Further studies are needed to identify the prevalence of the conditions in anaesthesiology and how they affect female anaesthesiologists’ work lives. On the basis of our findings, we encourage establishing flexible clinical assignments that allow for breaks for symptoms (i.e. debilitating menstrual pain, hot flashes, 9 etc.); destigmatising workplace culture by discussing the impact of menstruation/menopause in the workplace; allowing non-punitive, flexible sick leave options for debilitating symptoms; and allowing work from home if feasible (i.e. non-clinical time allotted for administrative duties, research, academic time, pre-anaesthesia clearance responsibilities, etc.) ( Table 2 ). This scoping review identified two studies that addressed chronic pain in female nurse anaesthetists specific to CTS and MS. However, women are more likely to experience several other chronic pain conditions such as fibromyalgia, pelvic pain, migraines, autoimmune diseases, inflammatory bowel syndrome (IBS), endometriosis, polycystic ovarian syndrome (PCOS), and more. According to the Centers for Disease Control and Prevention (CDC), 25.4% of women in the USA experience chronic pain compared with 23.2% of men. 45 Chronic pain conditions result in significant paid time lost from work and decreased work productivity and are known to impact women disproportionately. 46 The fact that this review found only two studies on the prevalence or effects of these conditions in female nurse anaesthetists, suggests a potential future field of study. The authors suggest flexible clinical assignments allowing for breaks for chronic pain symptoms; destigmatising workplace culture by discussing the impact of pain conditions in the workplace; allowing non-punitive, flexible sick leave options for debilitating symptoms; and allowing work from home if feasible (i.e. non-clinical time allotted for administrative duties, research, academic time, pre-anaesthesia clearance responsibilities, etc.) ( Table 2 ). There are several limitations to our scoping review. First, the final number of studies included in the scoping review was limited as a result of our two inclusion criteria, which were based on an “AND” strategy rather than “OR”. The authors chose to implement stringent “AND” inclusion criteria to demonstrate that although there may be literature addressing certain topics, there are limited articles addressing actionable strategies to implement in the workplace that are vital to create effective change. These search criteria resulted in a few studies, but this demonstrates the need for more research with implementable strategies to actively support female anaesthesiologists. Furthermore, as most of the included studies were surveys, there is a strong presence of selection and recall bias. There were no prospective studies that met inclusion criteria. Recognising the significant barriers faced by females should not preclude but rather inspire a broader commitment to inclusive occupational health research. It is also worth acknowledging the need for similar investigations into male anaesthesiologists' health and occupational risks. We also discuss men’s and women’s health in a ‘traditional’ timeline. This is not representative of all anaesthesiologists as some may retire before hitting menopause and some may still be in medical school while experiencing infertility. Lastly, we acknowledge that the inclusion of studies involving nurse anaesthetists introduces some heterogeneity in the study population. However, these studies were retained when their findings were conceptually aligned with the health challenges experienced by women anaesthesiologists. There is an absence of publications on topics such as menstruation and postpartum mood disorders, and a lack of studies on menopause and infertility. This gap is concerning, as it may indicate a longstanding oversight of the impact that reproductive health has on career development, workplace culture, and employee well-being. However, the recent increase in publications on these topics is both promising and reflective of shifting societal attitudes toward women’s health and workplace equity. It is likely that this increase in scholarly attention is driven by growing recognition of the need to address reproductive health challenges in the workplace, especially as more women are pursuing demanding careers in fields such as medicine, academia, and corporate leadership. The timing of this shift may also reflect evolving policy changes, such as those around parental leave, workplace accommodations, and gender equality, which have helped to bring these issues into sharper focus. Although this review focuses on select health issues commonly addressed in existing anaesthesiology literature, it does not encompass all sex-specific conditions such as osteoporosis, breast cancer, endometriosis, or PCOS, which merit further investigation because of their prevalence and potential impact on the well-being and practice of female anaesthesiologists. It is essential that further research continue to build on these recent publications, exploring not only the biological and medical aspects of reproductive health but also the social, cultural, and organisational factors that influence women’s career trajectories during key life stages. This will ensure that workplaces are not only compliant with emerging policies but are also actively fostering environments that support reproductive health and family planning decisions. In sum, the historical lack of focus on these issues highlights the need for continued advocacy, research, and policy development to ensure that women’s reproductive health is prioritised in workplace health initiatives and that systemic barriers are removed to allow for greater career success and personal fulfilment. This scoping review highlights significant gaps in the literature addressing the unique health challenges experienced by female anaesthesiologists across their professional lifespan—from menstruation and infertility to pregnancy, lactation, postpartum mood disorders, menopause, and chronic pain. Although existing studies provide insight into select areas such as lactation and pregnancy, there is a conspicuous lack of peer-reviewed research offering actionable strategies for workplace accommodation in other domains. Institutional barriers, cultural stigma, and inconsistent policies continue to exacerbate these challenges, impacting retention, well-being, and career progression for women in anaesthesiology. To advance equity and sustain a diverse anaesthesiology workforce, it is imperative that future research and policy initiatives explicitly address the physiologic realities of women providers. The development of structured support systems, informed scheduling practices, and inclusive workplace policies is not just beneficial—they are essential. Addressing these health issues is not only a matter of professional equity but also one of patient safety, institutional integrity, and long-term workforce sustainability.

The authors declare that they have no conflicts of interest.