Clinical, psychovegetative and hormonal features of stress-dependent menstrual disorders

The aim of the study. To determine the clinical, hormonal and psychological characteristics in women with stress-related menstrual disorders. Subjects and methods. 82 women of reproductive age where stress was defined as the cause of menstrual dysfunction and 20 women of the same age with a regular menstrual cycle were examined. The hormonal and psychological status (Beck depression inventory, state-trait anxiety inventory, social readjustment rating scale, sleep quality assessment, the quality of life questionnaire, questionnaire of vegetative state) was examined. Results. Oligomenorrhoea in the structure of stress-induced impairment was 79.3 %, amenorrhea - 14.6 %, abnormal uterine bleeding - 3.7 % and premenstrual syndrome - 2.4 %. The level of cortisol was significantly higher (p = 0.01) in patients of the main group, whereas the level of androstenedione was significantly lower (p = 0.03). indexes DHEA-S/ cortisol, estradiol/cortisol are significantly lower in the women with menstrual disorders. A high level of stress was associated with an increase in prolactin levels. in women with stress-related menstrual disorders was dominated anxiety. Conclusion. The reaction of the reproductive system to stress is expressed mainly in menstrual irregularities arising from the development of anxiety, prolonged activation of the pituitary-adrenal axis and increased secretion of prolactin.

stress, menstrual disorders, amenorrhea, oligomenorrhea, anxiety, depression, sleep disorders, quality of life

1. Кузнецова И. В., Коновалов В. А. Нарушения менструального цикла и их гормональная коррекция в контексте стрессозависимых психовегетативных расстройств. Медицинский совет. 2014; 9: 12-16.

2. Кузнецова И. В., Хаджиева Н. Х. Функциональные нарушения менструального цикла: происхождение, клинические варианты, возможности терапии. Вопросы гинекологии, акушерства и перинатологии. 2010; 9 (1): 35-44.

3. Sharma R, Biedenharn KR, Fedor JM. Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol 2013; 11: 66-81.

4. Волель Б. А., Рагимова А. А., Бурчаков Д. И., Бурчакова М. Н., Кузнецова И. В. Стресс-зависимые нарушения менструального цикла. Consilium Medicum. 2016; 18 (6): 8-13.

5. Starka L, Duskova M Functional hypothalamic amenorrhea. Vnitr Lek 2015; 61 (10): 882-885.

6. Berga SL Louck TL. Use of cognitive behavior therapy for functional hypothalamic amenorrhea. Ann N У Acad Sci2006; 1092: 114-129.

7. Gordon CM, Ackerman KE, Berga SL et al. Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017; 102 (5): 1413-1439.

8. Meczekalski B, Katulski K Functional Hypothalamic Amenorrhea and its influence on womens health. J Endocrinol Invest 2014; 37: 1049-1056.

9. Podfigurna-Stopa A, Pludowski P. Skeletalstatus and body composition in young women with functional hypothalamic amenorrhea. Gynecol Endocrinol 2012; 28 (4): 299-304.

10. Berz K, McCambridge T. Amenorrhea in the Female Athlete: What to do and When to worry. Pediatr Ann 2016; 45 (3): 97-102.

11. Bradley LD, Gueye NA. The medical management of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol. 2016; 214 (1): 31-44.

12. Heavy menstrual bleeding: assessment and management. NICE guideline, 2018.

13. O’Brien PM, Brown C, Dennerstein L et al. Towards a consensus on diagnostic criteria, measurement and trial design of the pre menstrual disorders: the ISPMD Montreal consensus. Arch Women Ment Health 2011; 14 (1): 13-21.

14. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.) Arlington, VA: American Psychiatric Publishing, 2013, 991.

15. Walsh S., O’Brien P., Backstrom T. et al. Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder Archives of Women’s Mental Health December2016, 19 (6): 953-958.

16. Вейн А. М., Вознесенская Т. Г. Депрессия в неврологической практике, ООО «Медицинское информационное агентство», 2007; 152-154.

17. Rafique N., Al-Sheikh Mona H. Prevalence of menstrual problems and their association with psychological stress in young female students studying health sciences. Saud Med J. 2018; 39 (1): 67-73.

18. Kollipaka R, Arounassalame B, Lakshminarayanan S. Does psychosocial stress influence menstrual abnormalities in medical students? J Obstet Gynaecol. 2013; 33:489-493.

19. yamamoto K, Okazaki A, Sakamoto У, Funatsu M. The relationship between premenstrual symptoms, menstrual pain, irregular menstrual cycles, and psychosocial stress among Japanese college students. J Physiol Anthropol. 2009; 28 (3): 129-136.

20. Родионова Е. Ю., Чутко Л. С., Кротин П. Н. Психовегетативные расстройства у девушек с нарушением менструаль ного цикла. Журнал неврологии и психиатрии им. С. С. Корсакова. 2016; 116 (12): 30-33.

21. Sahin N, Kasap B, Kirli U et al. Assessment of anxiety-depression levels and perceptions of quality of life in adolescents with dysmenorrhea. Reprod Health. 2018; 15 (1): 13.

22. Kayhan F, Alptekin H, Kayhan A. Eur Mood and anxiety disorders in patients with abnormal uterine bleeding J Obstet Gynecol Reprod Biol. 2016; 199: 192-197.

23. Liu X, Chen H, Liu ZZ et al. Early Menarche and Menstrual Problems Are Associated with Sleep Disturbance in a Large Sample of Chinese Adolescent Girls. Sleep. 2017; 40 (9).

24. Woosley JA, Lichstein KL. Dysmenorrhea, the menstrual cycle, and sleep. Behav Med. 2014; 40 (1): 14-21.

25. Toufexis D, Rivarola M, Hernan L, et al. Stress and the reproductive axis. J Neuroendocrinol. 2014; 26 (9): 573-586.

26. Di Blasio A, Izzicupo P, Di Baldassarre A et al. Walking training and cortisol to DHEA-S ratio in postmenopause: An intervention study Women Health. 2017: 1-16.

27. Kamin HS, Kertes DA. Cortisol and DHEA in development and psychopathology. Horm Behav. 2017; 89: 69-85.

28. Grattan David R. 60 years of neuroendocrinology: The hypothalamo-prolactin axis. J Endocrinol. 2015; 226 (2): T101-T122.

29. Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res. 1967; 11 (2): 213-218.