Systematic review of the literature: estimation of the most common gynecological disorders and associated factors among Kazakhstani adolescents

ABSTRACT

Background. Gynecological disorders (GD) represent a major noncommunicable disease burden among women of reproductive age worldwide, yet remain under-researched among young women in Central Asia, particularly in Kazakhstan. This systematic review aims to identify the most common gynecological disorders among young women in Kazakhstan, assess associated risk factors, and explore barriers to healthcare access.

Research design and methods. A systematic review was conducted according to PRISMA 2020 guidelines and registered with PROSPERO (CRD420251085283). Electronic databases were searched for English- language studies reporting on GD in Kazakhstani adolescents, with no restriction on publication start date. Eligible studies included original epidemiological research on reproductive health in Kazakhstani youth.

Results. Of 60 identified records, eight met the inclusion criteria. The most commonly reported non- infectious gynecological disorders included polycystic ovary syndrome (PCOS), uterine fibroids, endometriosis, menstrual disorders (especially dysmenorrhea), infertility, and reproductive cancers such as ovarian and cervical cancer. Risk factors included obesity, limited health literacy, and sociocultural stigma.

Conclusions. Gynecological disorders are highly prevalent among young women in Kazakhstan, yet remain underdiagnosed and underreported due to cultural, educational, and systemic barriers. There is a critical need for robust epidemiological research, and targeted public health interventions to address these gaps.

PLAIN LANGUAGE SUMMARY

Gynecological disorders—such as menstrual problems, polycystic ovary syndrome (PCOS), infertility, and reproductive cancers—affect many young women around the world. However, very little is known about how common these conditions are among young women in Kazakhstan. To understand the situation better, we reviewed all published studies that looked at noninfectious gynecological disorders in Kazakhstani adolescents and young women. Out of 60 available papers, only eight met the criteria for inclusion. These studies showed that conditions like PCOS, uterine fibroids, endometriosis, painful periods, and infertility are frequently reported in this population.

Several factors may increase the risk of these disorders, including obesity, low awareness about reproductive health, and cultural stigma that makes many young women feel uncomfortable discussing gynecological symptoms. These barriers also make it harder for girls and young women to seek timely medical care. Overall, our review shows that gynecological disorders among young women in Kazakhstan are common but often overlooked, underdiagnosed, and underreported. There is a strong need for better health education, more supportive healthcare services, and high-quality research to understand and address these problems early.

ARTICLE HIGHLIGHTS

• Gynecological disorders are a major but under-recognized health burden among young women in Kazakhstan and remain significantly under-studied in the region.

• The most frequently reported noninfectious disorders included PCOS, uterine fibroids, endometriosis, menstrual disorders (particularly dysmenorrhea), infertility, and reproductive cancers.

• Key risk factors involved obesity, low reproductive health literacy, and persistent sociocultural stigma surrounding gynecological symptoms.

• Major barriers to timely care included limited awareness, delayed help-seeking, and structural gaps in youth-friendly reproductive health services.

• Findings highlight an urgent need for comprehensive epidemiological research and targeted public health strategies to improve early detection, education, and access to gynecological care among young women in Kazakhstan.

1. Introduction

Gynecological disorders (GD) represent a major public health concern among women of reproductive age. Excluding sexually transmitted infections, GD encompasses female infertility, endometriosis, pelvic organ prolapse, polycystic ovary syndrome (PCOS), uterine fibroids, and premenstrual syndrome [1]. Globally, GD listed as one of the leading causes of noncommunicable diseases (NCD) in terms of incident rate, and the highest number of disability-adjusted life years (DALYs) [1,2]. However, the burden of GD remains significantly high compared to other NCDs. Recently, the WHO reported that the progress toward meeting the goal of improving women health has been insufficient, or in some instances showed no improvement [3].

GD can have profound and multifaceted effects on young women, who transitioned from adolescence to adulthood, affecting their physical health, emotional well-being, social life, and overall quality of life [2]. While a number of GD are commonly reported among young women, some go unnoticed, as many young women are unaware of what constitutes normal versus abnormal reproductive health [4]. In addition, factors such as cultural practices, where discussing menstruation or sexual health is taboo, discourages young women from reporting GD [5]. Cultural stigma around gynecological consultations, limited sexual education, and inadequate youth- friendly clinics contribute to a lack of early intervention and diagnosis [4–6]. These factors are particularly concerning for young women, where traditional beliefs often discourage young, unmarried women from seeking reproductive health services [5].

In Kazakhstan, an upper-middle-income Central Asian country [7], healthcare system has undergone substantial reforms since its independence in 1991. According to governmental data, more than 50% of the 19 million people, identified as female with a median age of 31 years [7,8]. The government has taken steps to prioritize maternal and reproductive health, including the development of national programs aimed at youth health. However, like other countries in the region, access to gynecological care among youth remains variable, with significant regional and socio-economic disparities in access to specialized gynecological services.

Thus, identifying and addressing common reproductive health concerns is an important step forward. This review aims to synthesize available evidence on the most prevalent gynecological disorders among young women in Kazakhstan, discuss underlying risk factors, barriers to healthcare access, and suggest pathways for improved care and research.

2. Methods

This systematic review was conducted following the recommendations outlined in “The PRISMA 2020 statement: an updated guideline for reporting systematic reviews” by Page and colleagues [9]. Registered as PROSPERO ID: CRD420251085283.

2.1. Search strategy

Three major electronic databases; PubMed, Scopus, ScienceDirect and EMBASE via Elsevier were searched for studies focusing on gynecological disorders among adolescents in Kazakhstan. Due to the limited availability of publications on this topic in English, no restrictions were placed on the start date of publication; however, the search was limited to articles published up to March 30^th, 2025.

The following key words were used for the search: (gynecological disorders among adolescent females in Kazakhstan OR Reproductive health issues affecting teenage girls in Kazakhstan OR Female teen reproductive problems in Kazakhstan.

2.2. Eligibility criteria

For articles selection several inclusion and exclusion criteria were established. Inclusion criteria are as follows:

1. Original research studies addressing gynecological conditions in Kazakhstani adolescents.

2. Epidemiological research.

3. Publications available in the English language only.

2.3. Exclusion criteria included

1. Articles written in languages other than English.

2. Review papers and meta-analyses.

3. Studies unrelated to gynecology

4. Studies not focused on Kazakhstani youths.

2.4. Data collection process

S.K., R.N. and A.A. independently carried out the processes of literature search, article selection, and quality evaluation. Selected articles were compared, and discrepancies resolved through team discussion involving S.K., S.K. and R.K. The quality of the included studies evaluated based on the GRADE approach, which assesses the strength of the body of evidence. Initially, titles and abstracts assessed for inclusion eligibility, and then a full-text evaluation was carried out to according to the set criteria.

2.5. Types of outcome

The primary outcome of interest is the types and prevalence of reproductive issues among adolescents in Kazakhstan.

2.6. Data extraction

The extracted data included the name of the first author; publication year; methodology; and findings.

2.7. Publication bias and limitations

This study aims to analyze the most commonly reported gynecological issues among adolescent girls in Kazakhstan, therefore, only studies with epidemiological or relevant analyses were included. These conditions do not necessarily reflect all reported conditions. A number of manuscripts excluded from the current review due to subject duplication, language, article type (book chapter, abstracts, presentations and clinical trials), and articles with no or limited access.

3. Results

A total of 60 records were retrieved from the three databases. After excluding 10 non-English publications, 50 records remained for the screening process. Following a review of titles and abstracts, 14 articles were excluded due to lack of relevance either because they did not address gynecological conditions in Kazakhstan or failed to mention young patients. The full texts of the remaining 38 articles were then assessed, leading to the exclusion of 23 more: eight were review articles, and 15 were other types such as conference abstracts or presentations. Of the 15 remaining articles, five were excluded due to irrelevance or duplication. Consequently, eight articles met the inclusion criteria and were incorporated into the systematic review (Figure 1). A summary of the main findings from these eight studies is provided in Table 1. Of note, prevalence data in the included studies were reported inconsistently, with some studies presenting percentages, others reporting rates per 100,000 population, and several providing only qualitative descriptions, which limited direct comparisons across disorders and populations. However, despite these differences in reporting formats, all prevalence data were standardized where possible, and carefully interpreted in context, ensuring that the overall conclusion of the review remain robust.

Figure 1.

PRISMA 2020 flow diagram illustrating the study selection process for the systematic review, including identification, screening, eligibility assessment, and final inclusion of studies.

Table 1.

Summary of the included articles, which incorporates the name of article, author name, study design and main findings.

Title	Author	Publication year	Study method	Finding
Knowledge, attitude and practice of adolescent girls toward reproductive health: a cross- sectional study in Turkistan region, Kazakhstan	Ryskeldiyeva et al. [11]	2023	A survey based cross-sectional study	More than 85% of the 1250 young Kazakhstani female participants (average age of 17 year olds), reported a gynecological disorder. The majority have poor knowledge and practice of reproductive health, with BMI, alcohol consumption identified as influencing factors.
Evaluation of Biochemical Serum Markers for the Diagnosis of Polycystic Ovary Syndrome (PCOS) in Obese Women in Kazakhstan: Is Anti- Müllerian Hormone a Potential Marker?	Madikyzy et al. [13]	2024	Case-control observational study	PCOS is stringly associated with BMI. The increase in the prevalence of obese Kazakhstani women led to increase in the prevalence of PCOS
National and regional trends in the prevalence of polycystic ovary syndrome since 1990 within Europe: the modeled estimates from the Global Burden of Disease Study 2016	Miazgowski et al. [14]	2019	A modeling based approach using a Global Burden of Disease Study of PCOS	High prevalence of PCOS among Kazakhstani women in the age range of 15 to 49 years.
The Prevalence, Indications, Outcomes of the Most Common Major Gynecological Surgeries in Kazakhstan and Recommendations for Potential Improvements into Public Health and Clinical Practice: Analysis of the National Electronic Healthcare System (2014–2019)	Sakko et al. [16]	2022	Descriptive population based study using Unified Nationwide Electronic Health System	The most common gynecological disorders that required surgical interventions among 18-34 year olds Kazakhstani women are ectopic pregnancy, and uterine fibroids (leiomyomas).
Epidemiology of endometriosis in Kazakhstan: a national population-based cohort analysis (2014– 2019) using data from the national electronic healthcare system.	Aimagambetova et al. [17]	2025	A population based descriptive study	They estimated the prevalence of endometriosis among Kazakhstani females (25-44 years old) to approximately 0.12%, divided into 50% endometriosis of the uterus, more than 34% with ovarian endometriosis, and approximately 10% suffer endometriosis of pelvic peritoneum.
Estimation of the Change of Ovarian Cancer Incidence in Kazakhstan: Component Analysis of Its Dynamics with the Consideration of Ethnic Features	Kuanyshkaliyev a et al. [18]	2016	Retrospective analyses based study	There is an increase in prevalence of ovarian cancer. The prevalence differ between various ethnic groups.
Cervical cancer trend in the Republic of Kazakhstan and attitudes toward cervical cancer screening in urban and rural areas	Zhetpisbayeva et al. [19]	2024	Retrospective and survey-based cross sectional study	In Kazakhstan, the incidence rate of cervical cancer remained unchanged over the study period with a decrease in mortality. A difference in disease prevalence observed between regional and metropolitan areas.
The impact of primary dysmenorrhea on adolescents’ activities and school attendance	Donayeva et al. [20]	2023	A comparative cross- sectional study	Dysmenorrhea is strongly associated with quality of life of young women, and that there is a strong relationship between dysmenorrhea and BMI.

3.1. Common gynecological disorders among young women in Kazakhstan

Excluding infectious diseases, the most prevalent gynecological disorders in Kazakhstan are polycystic ovary syndrome (PCOS), uterine fibroids (leiomyomas), endometriosis, menstrual disorders, and female infertility, which are often interrelated and influenced by a range of biological, environmental, and lifestyle factors [10]. In their cross-sectional study of Turkistan’s adolescent girls Knowledge, attitude, and practice toward reproductive health Ryskeldiyeva et al., surveyed 1,250 adolescent girls in the Turkistan region, the mean age was 17.3 ± 1.4 years, the average menarche age 13.2 ± 1.2 years, 85.7% reported menstrual disorders, while only 3.9% correctly identified sexually transmitted infections and 3.2% correctly identified contraceptive methods [11]. One of the most reported GD is PCOS, which is characterized by hyperandrogenism, irregular ovulation, and polycystic ovarian morphology [12]. For example, Madikyzy et al., evaluated a biochemical serum markers for potentially diagnosis PCOS, claimed that almost all of the participated obese women showed signs of PCOS, and is increasingly linked to rising rates of metabolic syndrome and obesity among Kazakhstani women [13]. The study claimed that 25 out of 92 obese women had a PCOS diagnosis, corresponding to a prevalence of approximately 27% in this selected population. This finding is further supported by Ryskeldiyeva et al., that showed adolescent girls with high body mass index (BMI) were likely to have reproductive issues [11]. In agreement with this is Miazgowski and colleagues who investigated the national and regional trends in the prevalence of polycystic ovary syndrome since 1990 within Europe, based on the modeled estimation from the Global Burden of Disease Study for the year 2016. They claimed that Kazakhstan has one of the highest prevalence of PCOS in the world with 417.23 cases per 100,000 for women in the age range of 15 to 49 years, with (95% uncertainty interval 311.2-546.9 per 100,000), equating to 0.42% [14].

Similarly, uterine fibroids, a benign tumor of the uterus that are frequently associated with abnormal uterine bleeding, pelvic pain, and is the leading cause for hysterectomy [15]. Based on the analysis of the Kazakhstani National Electronic Healthcare System between the year 2014 and 2019, Sakko et al., claimed that uterine fibroids are the most commonly reported GD leading to a 49.4% of major gynecological surgeries in Kazakhstan. This drove the prevalence of hysterectomy surgeries to be the second most performed procedure after unilateral salpingectomy, 66.4% of whom are in the productive age (18-34 years) [16]. The authors also claimed that 7,682 women were diagnosed with endometriosis, corresponding to an overall prevalence of 0.12%, with uterine, ovarian, and peritoneal localizations accounting for 50.1%, 34.5%, and 9.5% of cases, respectively.

Aimagambetova and colleagues conducted a population-based epidemiological study using the Kazakhstani National Electronic Healthcare System over a six-year period to investigate the prevalence of women with endometriosis registered in Kazakhstan healthcare system [17]. The research found an overall prevalence of 0.12% among Kazakhstani women, with the majority of cases occurring in reproductive-age women (25-44 years old). The study claimed that the reported number of cases amongst adolescent patients’ group (15–19 years old) was the lowest compared to other investigated age-groups with 0.8%, whereas the early reproductive age group (20–24 years old) was approximately close to 7% of the participants.

Another reported GD in Kazakhstan is ovarian cancer with an approximate increase of more than 14%, as estimated by Kuanyshkaliyeva et al., in their study entitled “Estimation of the Change of Ovarian Cancer Incidence in Kazakhstan: Component Analysis of Its Dynamics with the Consideration of Ethnic Features.” The authors examined the dynamic changes in the incidence of ovarian cancer in women of different ethnicities in Kazakhstan over a ten-year period [18]. While the authors suggested that the increase is proportional to population growth, they also indicated a significant difference in the incident rate between different ethnic groups in Kazakhstan. These differences reportedly due to the differences in life expectancy and risk factors between different groups.

Cervical cancer is another commonly reported GD among Kazakhstani women. Although the trend of the disease appears to be decreasing according to Zhetpisbayeva et al., who studied the trends of cervical cancer in Kazakhstan and the difference in patients’ attitudes toward cervical cancer screening between urban and rural areas, the incidence rate remains unchanged over the study period at approximately 19.38 per 100,000 women [19]. However, the authors reported significant differences in the screening participation and awareness between urban and rural areas (p < 0.001).

Global reports show that primary dysmenorrhea is the most frequently experienced menstrual problem in adolescents, which is true for Kazakhstan as well. Donayeva and colleagues investigated the impact of primary dysmenorrhea on adolescents’ activities in Kazakhstan through a cross-sectional comparative study involving 180 adolescents aged 12 to 18 [20]. The study showed a clear and statistically significant positive correlation between the severity of dysmenorrhea and its adverse effects on adolescents’ quality of life.

4. Discussion

This literature review identified few studies that reported the most gynecological disorders in Kazakhstan. To the best of our knowledge, this is the first systematic review to investigate and consolidate the prevalence of gynecological disorders among young women in Kazakhstan. There is insufficient literature that investigated or reported on the prevalence of gynecological disorders amongst young Kazakhstani women. Thus, no date was set in the inclusion criteria in order to capture as many relevant studies as possible, while ensuring the inclusion of good quality studies only. The search revealed a variable prevalence of various gynecological disorders among young women including, PCOS, endometriosis, pelvic inflammatory disorders such as uterine fibroids, ovarian and cervical cancers, and dysmenorrhea.

PCOS, an endocrine disorder affecting women of reproductive age is one of the most common disorders globally with an estimated prevalence between 5 and 10% of this population [9,10]. For instance, the prevalence of PCOS in Oman was estimated to be approximately 7%, whereas in the United Arab Emirates was found to be more than 27% [21]. In Europe, Miazgowski et al., claimed that the average prevalence of PCOS is 276.4 cases per 100,000, with the highest rates in the Czech Republic, approximately 460.6 and the lowest in Sweden 34.10 [14]. In Kazakhstan, the prevalence is not really known due to the limited population-based data that quantifies the prevalence of PCOS in country.

However, observations and international epidemiological trends suggest that PCOS is likely to be underdiagnosed and undertreated in Kazakhstani women suggesting that the prevalence in Kazakhstan is likely to be more than the global average [13]. This shows the gap in literature that investigates the epidemiological situation of PCOS in Kazakhstan, warranting the need for further studies into this important condition.

Among the reported GD was endometriosis, a chronic, estrogen-dependent inflammatory disorder characterized by the presence of endometrial-like tissue outside the uterine cavity, primarily on the ovaries, pelvic peritoneum, and other pelvic organs [17,22]. In Kazakhstan, the prevalence was estimated to be 0.12% of whom half suffer from endometriosis of the uterus, followed by the ovarian and then pelvic [17]. The WHO estimated that endometriosis to effect around 10% of women of reproductive age globally [23], but it could also affect other age-groups as they were cases of patients with endometriosis reported among adolescent and menopausal women [24]. Interestingly, genetic and epigenetic conditions encourage the development of endometriosis with genetic factors are thought to be responsible for approximately 50% of the predisposition to the disease [25]. For example, black women have the lowest risk of developing endometriosis, and Asian women have the highest risk [26]. A study involving over 13,000 women and ran over two decades in Australia concluded that the prevalence of endometriosis was found to be 11.4% (95% confidence interval [CI] 11.10%–11.70%) [27]. There is an increasing prevalence of ovarian cancer in Kazakhstan with high mortality rate [28]. This could possibly be due to the lack of sensitive and specific early diagnostic methods, resulting in most cases being identified at advanced stages [29,30]. Interestingly, ovarian cancer is not a uniform disease, particularly, malignant non-epithelial subtypes, such as germ-cell tumors that are common in adolescents and young women, whilst epithelial ovarian cancers predominate at older ages [31]. The study by Kuanyshkaliyeva and colleagues suggested that the increase in prevalence is due to population growth may not be very accurate, as disease prevalence likely remains constant regardless of population growth, but case numbers will increase [18]. However, we suggest that the increase of ovarian cancer cases are due to increase in aging as well as improvement in disease reporting. In support of this theory is Kaidarova et al., which reported a stable incidence rate of ovarian cancer over a fifteen-year period (2004-2019), which they attribute it to the aging population [28].

While there is an increase in the number of ovarian cancer patients worldwide, the estimated incidence rate of ovarian cancer in Kazakhstan is 11.1 per 100,000 female population in 2019 [28]. This is significantly higher than the estimated global rate of 6.1 per 100,000 of population as reported by the International Agency of Cancer Research there are nearly [32].

Cervical cancer remains a significant public health concern in Kazakhstan, with the latest estimate of the age-standardized incidence rate (ASIR) of cervical cancer in Kazakhstan is significantly higher than the global average of 13.3 per 100,000 [33]. The relatively high prevalence observed in Kazakhstan is partly due to the suboptimal disease screening. For example, a national disease- screening program for cervical cancer established 2008, however, nearly 50% of cervical cancer cases are diagnosed in women who have never been screened, particularly in rural areas [19], highlighting the need for a better public health outreach, especially among underserved populations. Studies demonstrated that prophylactic HPV vaccination significantly reduce the incidence of cervical cancer and related precancerous lesions [34], as early detection through regular screening programs ensures that precancerous changes are treated before they progress to invasive disease, thus lowering both incidence and mortality [29].

A second possible reason is due to low uptake of HPV vaccination [8]. As demonstrated in countries with established national HPV vaccination and effective screening programs such as Australia, which report a much lower incidence rate of less than seven per 100,000, compared to Kazakhstan [7,8]. Despite the government effort on reducing the burden of cervical cancer in Kazakhstan, the prevalence remains markedly higher than high-income countries. The difference highlights the gap in Kazakhstan’s healthcare sector in early cervical cancer prevention, emphasizing the urgent need to expand vaccination coverage, improve screening outreach, and strengthen health education across all regions, especially in rural and underserved areas.

Dysmenorrhea, painful menstrual period is categorized into two different forms; primary dysmenorrhea involves pain without any identifiable pelvic disease and usually starts around the onset of menstruation (menarche) [35], and secondary dysmenorrhea, which is linked to identifiable causes, such as endometriosis or uterine fibroids [22,25]. The disorder, identified as a pelvic pain, and considered as one of the most common gynecological issues among menstruating females across different races and age groups [36]. While Donayeva et al., suggested that the issue is very common in Kazakhstan, they did not provide an estimate of its reporting frequency [20]. However, the prevalence can significantly vary between different reproductive age women. For example, in a cross-sectional study of 370 female students (aged 18-25 years) in a university in Saudi Arabia study showed more than 85% of the participants suffered from primary dysmenorrhea [37], involves pain without any identifiable pelvic disease and usually starts around the onset of menstruation (menarche) [35,37]. The study indicated that 8.4% of the participants reported severe dysmenorrhea, and more than half (54.5%) mentioned that dysmenorrhea reduced their quality of life [36]. Equally, analysis of nearly 1000 adolescent college girls of age 15 to 20 years in the Indian city of Gwalior showed as high as 80% of the participants suffered from the condition, of whom approximately 38% had a severe form of dysmenorrhea [38].

Overall, contextualizing these findings within the Kazakhstani landscape indicates that, despite global trends, the prevalence of gynecological disorders, such as PCOS, endometriosis, and cervical and ovarian cancers is likely underreported and undertreated. Contributing factors may include limited population-based studies, suboptimal screening programs, and uneven healthcare access, particularly in rural areas. These observations highlight the need for targeted local research, and public health interventions tailored to the specific needs of young women in Kazakhstan.

4.1. Strength and limitations

As far as we know, this is the first study to estimate the prevalence and types of gynecological disorders among young Kazakhstani women. The terms “adolescents” and “young women” were variably defined across the included studies; for consistency, we defined adolescents as 10-19 years and young women as 20-24 years, following WHO guidelines. This variability in age definitions may have influenced the comparability of outcomes. Additionally, the limited literature on this population and the heterogeneity of study populations, settings, and methodologies added further constrain on direct comparisons. Although we applied multiple indicators from best practice reporting guidelines to strengthen quality assessment, the review was restricted to English-language articles, and relevant studies published in Kazakh or Russian languages may have been missed, potentially introducing language bias and limiting the generalizability of our findings. Nevertheless, our results provide insight into the most frequently reported gynecological disorders in Kazakhstan and highlight gaps in the current literature.

5. Conclusion

The current review highlighted various gynecological disorders reported among young Kazakhstani women. Despite the continuous efforts by Kazakhstani scientific committees, there appears to be a big gap in the local literature that address the epidemiological situation that estimates gynecological conditions in the country. Thus, the finding from this review suggest that future research should prioritize large-scale epidemiological studies, improving disease screening programs, and enhancing HPV vaccination coverage, alongside targeted public health interventions to address under-diagnosis and healthcare disparities, especially in rural areas.

Author contributions

Conceptualization, S.K. and A.A.; methodology, R.N. and A.A.; validation, S.K.; formal analysis, S.K.; investigation, D.M. and S.K.; resources, A.A.; data curation, K.R.; writing – original draft preparation, S.K.; writing – review and editing, R.N. and A.A.; visualization, S.K.; supervision, A.A. All authors have read and agreed to the published version of the manuscript.

Disclosure statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.