Women’s health treatment interventions and outcomes: An evidence and gap map review

This publication can be read in conjunction with the following interactive gap maps 

Evidence and gap map 1: Interventions by health conditions: This map displays interventions as its rows and health conditions as its columns. It illustrates the available evidence on interventions that have been evaluated for all the selected health conditions.

Evidence and gap map 2: Outcomes by interventions: This map presents outcomes as its rows and interventions as its columns. The user is instructed to filter the map by the health condition(s) that they are interested in. The map will then display the outcomes that have been reported in the corresponding interventions within the filtered health condition(s).

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In 2022, the Department of Health launched the first national Women’s Health Action Plan 2022–2023, which seeks to improve health outcomes and experiences for women in Ireland and to address specific health issues that women, clinicians, and other stakeholders have identified as priorities.

The Women’s Health Action Plan 2024-2025: Phase 2: An Evolution in Women’s Health sets out the next steps to address these issues. Action 6 of the 2024–2025 Action Plan is dedicated to increasing the evidence base for women’s health in Ireland by supporting clinical, academic, and applied research. It acknowledges that there are significant gaps in our knowledge of women’s health and of the impact of sex and gender on women’s health outcomes and experiences.

The Department of Health requested this evidence review to identify the existing evidence base and gaps on the effectiveness of interventions to improve women’s health outcomes in selected conditions in Organisation for Economic Co-operation and Development (OECD) member countries, and to guide future research in this area.

To answer these questions, we conducted an evidence and gap map review. An evidence and gap map review is a type of evidence review designed to answer broad, big-picture research questions by identifying and illustrating existing evidence and any evidence gaps relevant to the review question.

Studies were eligible for inclusion if they were English-language randomised controlled trials, non-randomised trials, full economic evaluations, systematic reviews including any of these study designs, and protocols of same. The population of interest was biological females of any age who were diagnosed with one or more specific conditions within the following health condition categories:

• abnormal menses/symptoms
• cancers of the female reproductive tract
• gynaecological-related conditions/pain
• menopausal symptoms
• pelvic floor disorders
• pelvic organ prolapse
• pelvic and vulvar vaginosis
• female infertility
• early pregnancy loss (<20 weeks)
• postpartum mental health.

We included 2,279 studies that were published between January 2019 and February 2024, and used these to create two evidence and gap maps. The first evidence and gap map illustrates interventions by health conditions, and the second illustrates outcomes reported by interventions.

Evidence and gap map 1: Interventions by health conditions identifies the number of included studies that evaluated interventions in each health condition category. The categories with the most evidence from across mainly OECD member countries, starting with the category with the highest number of studies, are: gynaecological-related conditions/pain; cancers of the female reproductive tract; female infertility; pelvic floor disorders; and menopausal symptoms.

The health condition categories with the least evidence (and the specific conditions within each category with the least evidence) from across mainly OECD member countries, starting with the category with the fewest studies, are:

• Abnormal menses/symptoms (n=45 studies): absence of period/abnormally reduced pattern or flow (n=9 studies) and premenstrual dysphoric disorder (n=9 studies)
• Pelvic and vulvar vaginosis (n=55 studies): vulvitis (n=0 studies)
• Postpartum mental health (n=85 studies): postpartum post-traumatic stress disorder (n=13 studies)
• Pelvic organ prolapse (n=92 studies): cystourethrocele, enterocele, and urethrocele (n=0 studies)
• Early pregnancy loss (< 20 weeks) (n=108 studies): septic abortion (n=0 studies).

Filtering the evidence and gap map to only display studies that were ongoing or completed in Ireland revealed that no eligible Irish studies exist on the health condition categories of menopausal symptoms, pelvic organ prolapse, pelvic and vulvar vaginosis, early pregnancy loss (<20 weeks), and postpartum mental health. With the exception of cancers of the female reproductive tract (n=21 studies), 4 or fewer studies have been conducted in Ireland on each of the remaining health condition categories.

Four of the health condition categories on which there are no included studies conducted in Ireland also have the least evidence from across OECD member countries:

1. pelvic and vulvar vaginosis
2. pelvic organ prolapse
3. early pregnancy loss (<20 weeks)
4. postpartum mental health.

Evidence and gap map 2: Outcomes by interventions displays the evidence for general and condition-specific core outcomes. Core outcomes are agreed, standardised outcomes that should be measured and reported in any clinical trials conducted on a particular condition. Where there is research on a particular condition but the research does not report on core outcomes, this represents an evidence gap in outcomes. Most core outcomes have been reported in the included studies on each respective health condition; however, the following core outcomes are not reported in the included studies:

• menstrual regularity in adenomyosis
• chronic anovulation in polycystic ovary syndrome
• mortality in ectopic pregnancy and in spontaneous abortion/miscarriage
• suicidal thoughts, attempted suicide, and thoughts of harming the baby in postpartum depression.

This evidence and gap map review reveals that there are several evidence gaps in women’s health research that need to be addressed in order to improve women’s health outcomes on a national and international level.

Future research on the included health conditions should measure and report core outcomes to generate a consistent body of evidence for women’s health research, which is fundamental to informing decision-making. In addition, conducting consultations with multidisciplinary experts, specialists, and women representatives would help to interpret the evidence gaps identified and to inform future research.

Evidence and gap map 1: Interventions by health conditions: This map displays interventions as its rows and health conditions as its columns. It illustrates the available evidence on interventions that have been evaluated for all the selected health conditions.

Evidence and gap map 2: Outcomes by interventions: This map presents outcomes as its rows and interventions as its columns. The user is instructed to filter the map by the health condition(s) that they are interested in. The map will then display the outcomes that have been reported in the corresponding interventions within the filtered health condition(s).