ISSUE: Performance and image-enhancing drug (PIED) use among women is a growing phenomenon, particularly within weight-training populations. Despite increasing prevalence, research on the psychosocial factors involved in women's PIED use remains emergent and fragmented.

APPROACH: This systematic review of mixed methods studies uses an integrative approach to explore perspectives, motivations and psycho-social factors associated with women's use of PIEDs within weight-training populations. The review also investigates gendered experiences that may exist among women who use PIEDs.

KEY FINDINGS: Following screening, 22 articles were included in the review and five key themes emerged from the analysis. Women's experiences with PIEDs were found to be significantly shaped by pressures to conform to societal beauty standards and gendered expectations. Unlike men, who often receive guidance from peer-driven "bro-science", women navigate PIED use largely in isolation, which increases potential risks. The stigma surrounding PIED use in women, particularly related to side-effects such as virilisation, further deters open discussions and engagement with healthcare services.

IMPLICATIONS: These findings highlight the importance of developing gender-specific educational materials and harm-reduction initiatives to address the unique challenges faced by women using PIEDs. Additionally, health services should be equipped to engage with this population in a non-judgmental manner and offer tailored support.

CONCLUSIONS: There is a clear need for further research into women's experiences with PIEDs. Gender-sensitive approaches to education, prevention, and healthcare are essential to mitigating the risks associated with PIED use among women in weight-training communities.