Consequences of wartime stress on women’s reproductive health

Authors

  • T.F. Tatarchuk SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; State Scientific Institution “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0002-5498-4143
  • O.О. Yefimenkoa SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; State Scientific Institution “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0003-1228-0911
  • O.S. Myronenko yiv City Clinical Endocrinological Center, Kyiv, Ukraine https://orcid.org/0009-0009-8419-6963
  • R.O. Mnevets ESC “Institute of Biology and Medicine”, Taras Shevchenko National University of Kyiv; SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0001-9614-5762

DOI:

https://doi.org/10.18370/2309-4117.2024.72.28-34

Keywords:

war stress, Ukraine, Ukrainian women, women, reproductive health

Abstract

Background. Experts observe that Russia’s war against Ukraine led to a significant decline in the demographic situation and caused a severe impact on the reproductive health of women.
Objective of the review: to assess and predict the consequences of war-related stress on the reproductive health of women residing in various zones - war zones, adjacent areas, remote territories, and even abroad; managing menopausal disorders in women with premature menopause and perimenopause remotely becomes crucial due to the existing limitations of
in-person gynecological consultations.
Analysis of literary data. The findings indicate a detrimental influence of wartime stress on the reproductive health of women across different categories - those experiencing active combat in adjacent regions, in remote areas, and even overseas.
There is an increase in the frequency of diseases of the female reproductive system, namely: menstrual cycle disorders, abnormal uterine bleeding, premature menopause, hyperandrogenism, severe climacteric disorders. Due to severe negative stressor consequences caused by the war in Ukraine, the number of younger women with premature ovarian failure syndrome has increased, as well as the number of perimenopausal women with severe manifestations of menopause.
Taking into account the difficult social and domestic conditions of some Ukrainian women and the impossibility of seeing a doctor, it is important to prescribe initial therapy for stress-induced consequences of reproductive disorders. The drugs of choice in treatment are modern estrogen-progestagen preparations, the effectiveness and safety of which has been proven by numerous scientific studies. Patients who complain of manifestations of concomitant pathology should be referred to the relevant specialists.
Conclusion: The impact of war-related stress on the female reproductive health system poses a considerable challenge for gynecologists and healthcare professionals in preventing and managing these issues.

Author Biographies

T.F. Tatarchuk, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; State Scientific Institution “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv

MD, professor, corresponding member of the NAMS of Ukraine;
deputy director for research work, head of the Endocrine Gynecology Department;
chief researcher, Department of Reproductive Health

O.О. Yefimenkoa, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; State Scientific Institution “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv

PhD, senior researcher at the Endocrine Gynecology Department;

Department of Reproductive Health

 

O.S. Myronenko, yiv City Clinical Endocrinological Center, Kyiv

obstetrician-gynecologist, Department of Endocrine Gynecology

R.O. Mnevets, ESC “Institute of Biology and Medicine”, Taras Shevchenko National University of Kyiv; SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Kyiv

assistant, Department of Physiology and Anatomy;
intern

References

  1. How the psycho-emotional state of Ukrainians has changed: press release based on the results of the research presentation [Internet]. Ukrainian Іnstitute for the Future. 2023 May 29. – Available from: https://uifuture.org/publications/yak-zminyvsya-psyhoemoczijnyj-stan-ukrayincziv-presreliz-za-rezultatamy-prezentacziyi-doslidzhennya/ .
  2. The birth rate in Ukraine has decreased by 28% since the beginning of the Great War. Opendatabo. 2023 [Internet]. Available from: https://opendatabot.ua/analytics/birth-crisis-2023.
  3. Morina N, Stam K, Pollet TV, Priebe S. Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies. J Affect Disord. 2018 Oct 15;239:328–338. DOI: 10.1016/j.jad.2018.07.027.
  4. Długosz P. War trauma and strategies for coping with stress among Ukrainian refugees staying in Poland. J Migr Health. 2023 Jul 7;8:100196. DOI: 10.1016/j.jmh.2023.100196.
  5. Kurapov A, Danyliuk I, Loboda A, et al. Six months into the war: a first-wave study of stress, anxiety, and depression among in Ukraine. Front Psychiatry. 2023 May 10;14:1190465. DOI: 10.3389/fpsyt.2023.1190465.
  6. Psychological health and attitude of Ukrainians to psychological help [Internet]. Gradus Research. 2022 Oct. Available from: https://gradus.app/uk/open-reports/gradus-research-_-mental-health-report-eng/
  7. Clinical guidance Managing menopausal symptoms [Internet]. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). 2020. Available from: https://ranzcog.edu.au/wp-content/uploads/2022/05/Managing-menopausal-symptoms.pdf.
  8. Nishimi K, Thurston RC, Chibnik LB, et al. Posttraumatic stress disorder symptoms and timing of menopause and gynecological surgery in the Nurses’ Health Study II. J Psychosom Res. Volume. 2022 Aug:159:110947. DOI: 10.1016/j.jpsychores.2022.110947
  9. Grevtsova RY, Kuzmichova MV. Ethical and legal aspects of protection of women’s reproductive health under the conditions of martial law. [Internet]. Juridical scientific electronic journal. 2023;11 Available from: http://www.lsej.org.ua/11_2023/77.pdf
  10. Zakharenko N, Pyliagina G, Pedachenko N, et al. Mental disturbances concerned with Syndrome of chronic pelvic pain in endometriosis. Interdisciplinary approach in diagnostic and therapy Psychiatry. Psychotherapy and Clinical Psychology. 2018;9(3);372–383.
  11. Vigil P, Meléndez J, Soto H et al. Chronic Stress and Ovulatory Dysfunction: Implications in Times of COVID-19. Front Glob Womens Health. 2022 May 23:3:866104. DOI: 10.3389/fgwh.2022.866104
  12. Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care “Menopausal disorders and other disorders in the perimenopausal period” [Internet]. State Expert Center of the Ministry of Health of Ukraine Available from: https://www.dec.gov.ua/wp-content/uploads/2022/06/37474-dn_1039_17_06_2022_dod.pdf
  13. Tutchenko TM, Burka OA, Sidorova IV, et al. Practical approaches to the use of markers of biochemical hyperandrogenism in women Literature review. Reproductive Endocrinology. 2022;63–64;25–33. DOI:10.18370/2309-4117.2022.63.25-33
  14. Antypkin YG, Vdovychenko YP, Graziottin A, et al. Uterine bleedings and quality of woman’s life: Resolution of advisory board. Reproductive Endocrinology. 2019 Jun 11(47);13–18. DOI: 10.18370/2309-4117.2019.47.8-12
  15. Hamoda H, Panay N, Pedder H. The British Menopause Society & Women’s Health Concern recommendations on hormone replacement therapy in menopausal women. Post Reprod Health. 2020 Dec;26(4):181–209. DOI: 10.1177/2053369120957514
  16. Harlow SD, Gass M, Hall JE, et al. Executive Summary of the Stages of Reproductive Aging Workshop + 10. Menopause. 2012 Apr;19(4);387–39. DOI: 10.1097/gme.0b013e31824d8f40
  17. de Kruif M, Spijker AT, Molendjak ML. Depression during the perimenopause: A meta-analysis. J of Affective Disorders. 2016;206:174–80. DOI: 10.1016/j.jad.2016.07.040
  18. Zasiekina L, Zasiekin S, Kuperman VJ. Post-traumatic Stress Disorder and Moral Injury Among Ukrainian Civilians During the Ongoing War. Community Health. 2023 Oct;48(5):784–92. DOI: 10.1007/s10900-023-01225-5.
  19. Kuh D, Cooper R, Moore A, et al. Age at menopause and lifetime cognition: Findings from a British birth cohort study. Neurology 90.19 (2018): e1673–e1681. DOI:10.1212/WNL.0000000000005486
  20. Management of Endometrial Hyperplasia Green-top Guideline. [Internet]. RCOG/BSGE Joint Guideline 2016 Feb;67. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/management-of-endometrial-hyperplasia-green-top-guideline-no-67/
  21. Tsiligiannis S, Wick-Urban BC, van der Stam J, Stevenson JC, et al. Efficacy and safety of a low-dose continuous combined hormonevreplacement therapy with 0.5 mg 17β-estradiol and 2.5 mg dydrogesterone in subgroups ofvpostmenopausal women with vasomotor symptoms. Maturitas. 2020 Sep:139:20–6. DOI: 10.1016/j.maturitas.2020.05.002.
  22. National Osteoporosis Foundation. [Internet]. NOF. January 2017;7. Available from: www. nof.org/about-us/about-nof/
  23. Chlebowski RR, Anderson GG. Changing Concepts: Menopausal Hormone Therapy and Breast Cancer. J Natl Cancer Inst. 2012 Apr 4;104(7):517–27. DOI: 10.1093/jnci/djs014
  24. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases. BMJ. 2020 Oct 28:371:m3873. DOI: 10.1136/bmj.m3873
  25. Crawford SL, Crandall CJ, Derby CA, et al. Menopausal hormone therapy trends before versus after 2002: impact of the Women’s Health Initiative Study Results. Menopause. 2018. Dec 21;26(6):588–97ю DOI: 10.1097/GME.0000000000001282
  26. Katerenchuk IP, Myakinkova LO, Mokhnachov VY, Yermalinskyi FO. Climadinon® in the complex treatment and prevention of cardiology problems of climacteric syndrome. Practitioner. 2013 Mar 20(1):73–78.
  27. Da Y, Niu K, Wang K, et al. A Comparison of the Effects of Estrogen and Cimicifuga racemosa on the Lacrimal Gland and Submandibular Gland in Ovariectomized Rats. PLoS One. 2015;10(3): e0121470. DOI: 10.1371/journal.pone.0121470.
  28. Mohapatra S, Iqubal A, Ansari MJ, et al. Benefits of Black Cohosh (Cimicifuga racemosa) for Women Health: An Up-Close and In-Depth Review. Pharmaceuticals (Basel). 2022 Feb 23;15(3):278. DOI: 10.3390/ph15030278
  29. Wuttke W, Seidlova-Wuttke D. Black cohosh (Cimicifuga racemosa) is a non-estrogenic alternative to hormone replacement therapy Authors: 2019 May 2(46);72–81. DOI: 10.18370/2309-4117.2019.46.72-81
  30. Wuttke W, Raus K, Gorcow C. Efficacy and tolerability of the black cohosh (Acteae racemosa) ethanolic extract BNO 1055 on climacteric complaints: a double-blind, placebo- and conjugated estrogens-controlled study. Maturitas. 2006. Juli 20. DOI: 10.1016/j.maturitas.2006.06.020
  31. Wuttke W, Gorkow C. Effect of Cimicifuga racemosa extract BNO 1055 (KlimadinonВ®) and conjugated estrogens on the manifestations of menopausal syndrome. Pharmateka. 2003; 11:66–74.
  32. The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of the North American Menopause Society. Menopause. 2020 Sep;27(9):976–992. DOI: 10.1097/GME.0000000000001609
  33. Lewiecki EM, Bilezikian JP, Carey JJ, et al. Proceedings of the 2017 Santa Fe Bone Symposium: insights and emerging concepts in the management of osteoporosis. J Clin Densitom. 2018;21(1):3–21. DOI: 10.1016/j.jocd.2017.10.041
  34. Eastell R, Rosen CJ, Black DM, et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1595–622. DOI: 10.1210/jc.2019-00221.
  35. Barrionuevo P, Gionfriddo MR, Castaneda-Guarderas A, et al. Women’s values and preferences regarding osteoporosis treatments: a systematic review. J Clin Endocrinol Metab. 2019;104(5):1631–6. DOI: 10.1210/jc.2019-00193.
  36. Black DM, Rosen CJ. Postmenopausal osteoporosis. N Engl J Med. 2016;374(3):254–62. DOI: 10.1056/NEJMcp1513724.
  37. Sinreih M, Gregorič K, Gajser K, Rižner TL. Physiological Concentrations of Cimicifuga racemosa Extract Do Not Affect Expression of Genes Involved in Estrogen Biosynthesis and Action in Endometrial and Ovarian Cell Lines. Biomolecules. 2022 Apr 5;12(4):545. DOI: 10.3390/biom12040545
  38. Raus K, Brucker C, Gorkow С, Wuttke W. First-time proof of endometrial safety of the special back cohosh extract (Actaea or Cimicifuga racemosa extracs) CR BNO 1055. Menopause. 2006 Jul-Aug;13(4):678-91. DOI: 10.1097/01.gme.0000196813.34247.e2.
  39. Korda-Vidić V, Vasilj I, Babić D. The stress of war and breast cancer incidence. Psychiatr Danub. 2015 Dec;27 Suppl 2:571-7.
  40. Sangalang CC, Vang C, Kim BJ, Harachi TW. Effects of Trauma and Postmigration Stress on Refugee Women’s Health: A Life Course Perspective. Soc Work. 2022 Jun 6:swac026. DOI: 10.1093/sw/swac026
  41. Rodríguez-Muñoz MF, Chrzan-Dętkoś M, Uka A, et al. The impact of the war in Ukraine on the perinatal period: Perinatal mental health for refugee women (pmh-rw) protocol. Front Psychol. 2023 Mar 13;14:1152478. DOI: 10.3389/fpsyg.2023.1152478.
  42. Serbeniuk A, Kaminskiy V, Kumpanenko Y, et al. The impact of the war in Ukraine on the reproductive health of female military personnel. Int J Gynaecol Obstet. 2023 Nov;163(2):409 – 15. DOI: 10.1002/ijgo.14990.

Downloads

Published

2024-06-30

How to Cite

Tatarchuk, T., Yefimenkoa, O., Myronenko, O., & Mnevets, R. (2024). Consequences of wartime stress on women’s reproductive health. REPRODUCTIVE ENDOCRINOLOGY, (72), 28–34. https://doi.org/10.18370/2309-4117.2024.72.28-34

Issue

No. 72 (2024)

Section

Gynecology

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.