MRC Centre for Reproductive Health

Menstruation can negatively impact quality of life (QoL), particularly during adolescence. The stigma surrounding menstruation and lack of support and education, can have detrimental effects on physical, social, emotional and mental wellbeing. This study aims to (1) determine how adolescent girls from schools across England feel that periods affect their wellbeing, (2) understand the menstrual support and education that adolescents receive and (3) suggest improvements to menstrual health education and support in schools. Eight focus groups were carried out in four schools, two in each school, with year 10 girls. Four questions were asked in each focus group relating to the participants’ attitudes to having a period, how their period affected their wellbeing, the support they need and how could education be improved. A total of 49 girls participated, with most reporting negative attitudes about periods. Most stated that their periods negatively impacted their physical, emotional, and social QoL, affecting areas such as friendships, schoolwork, and socialising. They expressed a need for improved menstrual education and for boys to be included. They wanted improved menstrual support, especially at school, in the form of access to period products, days off school, and emotional support. This study highlights the negative impact that menstruation can have on the QoL of adolescent girls. It shows a need for improved support and education for all genders from an early age; which may help dissipate period stigma and increase QoL. We recommend improvements in education and support systems by providing training to teachers implementing menstrual policies, improving the curriculum and ensuring appropriate support systems are in place in schools.

To determine the future priorities for ectopic pregnancy research. Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for future ectopic pregnancy research. Healthcare professionals, people with lived experience of ectopic pregnancy, and others were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance. Not applicable. Top 10 research priorities for ectopic pregnancy. The initial survey was completed by 855 participants from 35 countries, and 1,220 potential research questions were submitted. Three clinical practice guidelines and 43 Cochrane systematic reviews identified a further 24 potential research questions. A rationalized list of 49 confirmed research uncertainties was entered into an interim prioritization survey completed by 413 respondents from 20 countries. The top 10 research priorities were identified during a consensus development meeting involving 37 participants from 10 countries. These research priorities are diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of ectopic pregnancy. We anticipate that the identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with lived experience of ectopic pregnancy, and others, will help research funding organizations and researchers to develop their future research agenda.

Glioblastoma (GBM) is an aggressive form of primary brain cancer. Recent efforts to characterize GBM using single-cell or spatially-resolved transcriptomics have revealed a tremendous intra-tumoral heterogeneity between malignant cells and between different tumor areas. However, most efforts have focused on malignant cells, and the spatial and cellular heterogeneity of the tumor microenvironment (TME) remains poorly understood. Moreover, it is unclear how TME compositions and organizations influence clinical outcomes for patients. Integrating spatial transcriptomics, single-cell RNA-seq and histology on 25 tumors, cellular composition of the TME was estimated on over 46,000 55-μm wide spots. Spatial associations were revealed between mesenchymal-like cancer cells and monocyte-derived macrophages. Spots were clustered into six unique classes of TME, exhibiting differential composition of malignant and immune cells, and distinct activation of biological pathways. Spatial transcriptomics-informed deconvolution of large-scale bulk RNA-seq datasets revealed that the niche composition of tumors associated significantly with patient survival and response to immunotherapy. Mesenchymal-like, monocyte-derived macrophages-rich and hypoxic niche N1 associated with lower overall survival while oligodendrogial progenitor-like and microglia-derived macrophages-enriched niche N5 is associated with longer patients' survival. Analysis of data from patients treated with immunotherapy showed that niches N1 and mixed mesenchymal-like and astrocyte-like niche N3 associated with response to PD-1 inhibitors. Our results show that GBM exhibits a strong spatial heterogeneity of TMEs, with distinct categories of niche. The niche composition of tumors associated with survival and immunotherapy response. Our results suggest incorporation of TME niches as biomarkers for risk stratification and therapeutic decisions for patients.

Perinatal depression is an important cause of maternal and infant morbidity. Rates of perinatal depression amongst pregnant and postpartum women in Botswana are not well-documented. We examined the prevalence of symptoms of depression and potential associated factors among pregnant and postpartum women participating in a sexually transmitted infection screening study. We conducted a repeated time-point cross-sectional analysis of the Maduo study, a non-randomized clinic-controlled trial evaluating the benefit of antenatal Chlamydia trachomatis and Neisseria gonorrhoeae screening in Gaborone, Botswana. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for symptoms of depression at the first antenatal care and 6–8 week postnatal care visit. Prevalence of depression was assessed using EPDS cut-off scores of ≥11 and ≥13. Participants with an EPDS score of ≥13 were referred to local mental health services. We used multivariate logistic regression to identify potential associations with symptoms of perinatal depression (EPDS score ≥13) at first antenatal care visit, 6–8 week postnatal visit and overall, including socioeconomic, pregnancy-related and relationship factors. We also conducted a sensitivity analysis with EPDS score specified as a continuous variable. All 500 enrolled women completed at least one EPDS questionnaire during the study: 495 (99%) at first antenatal care and 428 (86%) at the postnatal visit. Median EPDS score was 3 (IQR 1–6) at the first antenatal visit and 2 (IQR 0–5) at the postnatal visit. Similar proportions of women had EPDS scores suggestive of depression at first antenatal (EPDS ≥13, 5% (95% CI 3–7%); EPDS ≥11, 7% (95% CI 5–10%)) and postnatal visits (EPDS ≥13, 3% (95% CI 1–5%); EPDS ≥11, 7% (95% CI 5–10%)), however there was minimal overlap in women with antenatal and postnatal symptoms of depression. Symptoms of depression were strongly associated with experience of intimate partner violence both antenatally (aOR 5.41, 95% CI 1.94–15.10, p = 0.001) and postnatally (aOR 5.18, 95% CI 3.35–8.02, p = < 0.001); whilst symptoms of depression at the first antenatal care visit were also associated with unintended pregnancy (aOR 29.44, 95% CI 2.75–314.6, p = 0.005). Rates of perinatal depression in this study were lower than estimated rates in Southern Africa. Nonetheless, screening pregnant women for depression as part of routine antenatal care in Botswana provides an opportunity to identify those most in need of support and specialist services.

Pruritus is a common symptom of intrahepatic cholestasis of pregnancy (ICP) and significantly reduces patients' quality of life (QoL). A multinational survey administered through ICP patient support groups was conducted in women with current or previous ICP. In total, 697 women from the UK, USA, Australia, Canada, New Zealand, and Ireland responded to the survey. 94% had ICP in a previous pregnancy. The median worst itch score (0-10) was 9. Pruritus severity was associated with a higher degree of sleep disturbance, fatigue, and mood changes. 59% reported that pruritus led to disruption of daily activities. 33% reported missing school or work. Most patients were taking ≥2 antipruritic medications and achieved only partial resolution of pruritus. The results underscore the negative impact of pruritus on QoL in patients with ICP and substantiate the high unmet need for developing safe and effective antipruritic therapies in ICP. Trial registration is not applicable because this was not an interventional study.

Cervical cancer is predominantly caused by infection with high-risk human papillomavirus (HPV). Prevention efforts rely on vaccination and cervical screening. This study aimed to determine HPV vaccination and in-date cervical screening rates among women seeking abortion to determine whether this care setting could provide an opportunity to deliver catch-up prevention services. Retrospective database study examining HPV vaccination and cervical screening coverage among women accessing abortion in Edinburgh, Scotland, UK from October to December 2024. National Health Service electronic systems recording HPV vaccinations and the Scottish Cervical Call Recall System were examined together with clinical records to determine if an in-person clinical visit was made as part of care. Some 798 individuals presented for abortion over the study period (n=297, ≤25 years and n=501, >25 years). Of those aged ≤25 years reviewed for HPV vaccination, 161/297 (54.2%) were vaccinated, 37 (12.5%) were unvaccinated and 99 (33.3%) had no record of vaccination status. Of the 501 women of cervical screening age >25 years, 289 (57.7%) were up to date, 70 (14%) were overdue and 142 (28.3%) had never been screened. Of the 37 unvaccinated individuals, 29 (78.4%) attended the clinic in person as did 158 (74.5%) of the 212 overdue/never-screened women. A significant proportion of those individuals who present for abortion are not vaccinated against HPV or up to date with cervical screening. Three-quarters of this group made an in-person visit, indicating an opportunity for delivering cervical cancer preventative services in the future. Future research is required to determine the feasibility of HPV vaccination and cervical screening in this setting.

Menstruation—a monthly physiological event—is currently being experienced by half the world’s female population. This equates to roughly 1.8 billion individuals of reproductive age menstruating every month. Yet, this fundamental biological process remains shrouded in stigma and silence globally. This societal discomfort has created a chasm in understanding and research, severely impacting women’s health and wellbeing. But beneath the surface of this seemingly simple shedding of the uterine lining lies a complex dance of hormones, cells, and molecular pathways, the choreography of which we are only now beginning to fully appreciate.

Since 2020, legislation in Britain has allowed both mifepristone and misoprostol to be taken at home for early medical abortion (EMA). In England and Wales, legislation restricts this to 9+6 weeks, but in Scotland this is permitted up to 11+6 weeks. Data on the outcomes of EMA at home >10 weeks' gestation is limited and so we aimed to establish the safety and efficacy of this in comparison with EMA in a hospital setting. We conducted a retrospective review from our abortion service in Edinburgh, Scotland of outcomes of EMA at home versus hospital between 10+0 and 11+6 weeks' gestation over the 5-year period April 2020-March 2025. The primary outcome was complete abortion rate. Secondary outcomes were rates of incomplete abortion, ongoing pregnancy and serious complications. A total of 371 EMAs occurred at this gestation (n=258 home, n=113 hospital). Complete abortion rates were not statistically significantly different between groups: 251/258 (97%) (95% CI: 94% to 99%) at home and 110/113 (97%) (95% CI: 92% to 99%) in hospital. Neither incomplete abortion rates (home: 4/258, 1.6%; hospital: 3/113, 2.6%) nor ongoing pregnancy rates (home: 3/258, 1.2%; hospital: 0/113, 0%) were significantly different between groups. There was one case of haemorrhage requiring transfusion and three cases of infection receiving intravenous antibiotics, all in the at home group. EMA at home between 10+0 and 11+6 weeks has the same high efficacy and safety as when conducted in hospital. Action is needed to extend EMA at home after 10 weeks' gestation to women across the rest of the UK and beyond.