Personalized management strategies for patients with perimenopausal disorders under war-related stress

Authors

DOI:

https://doi.org/10.18370/2309-4117.2025.79.30-38

Keywords:

menopause, women’s health, vasomotor symptoms, menopausal hormone therapy, perimenopause, climacteric syndrome

Abstract

Objective of the study: to investigate the frequency of menopausal transition symptoms in women aged 40–52 years under chronic stress due to the war in Ukraine.
Materials and methods. An online survey of women aged 40–52 years presenting with menstrual cycle disturbances was conducted on the initiative of the Association of Gynecologists-Endocrinologists of Ukraine. Between May and September 2024, 1685 questionnaires were collected, of which 1374 were complete and included in the analysis. The standardized online questionnaire included items on place of residence, clinical profile, menopausal symptoms, and somatic health characteristics. Parametric statistical methods were used for data analysis.
Results. Most respondents were aged 46–52 years (59.6%). Overweight was observed in 45.9% and obesity in 24.2%. Menstrual cycle disturbances persisted for 2–11 months in 87.4% of respondents, with 76.6% attributing these changes to severe stress.
Over 80% of women in both age groups reported fatigue, decreased activity, and irritability; anxiety and panic attacks occurred in 29–52% of cases. Sleep disturbances were present in the majority (73–75%), and cognitive difficulties affected more than half of respondents regardless of age.
Genitourinary menopausal syndrome symptoms were reported by over 50% of women, while sexual disorders (decreased libido and loss of interest in sexual activity) were noted by about two-thirds of respondents.
Conclusions. The study demonstrated a high prevalence and inverted pattern of climacteric symptoms, with the early onset of cognitive dysfunction and manifestations of genitourinary menopausal syndrome already at a young age (40–45 years). This indicates that chronic psycho-emotional stress of war is a significant aggravating factor that potentially accelerates and intensifies the clinical manifestations of the menopausal transition in women in Ukraine. The obtained results justify the need to reconsider management approaches for patients in this age group, with an emphasis on proactive identification of complaints, educational efforts, and timely initiation of therapy to prevent the progression of menopausal disorders.

Author Biographies

T.F. Tatarchuk, SI “All-Ukrainian Center of Motherhood and Childhood of the NAMS of Ukraine”; SSI “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

L.V. Kalugina, SI “All-Ukrainian Center of Motherhood and Childhood of the NAMS of Ukraine”; SSI “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv

Kyiv, MD, professor, leading researcher, Department of Endocrine Gynecology;
chief researcher, Department of Reproductive Health

K.D. Plaksiieva, SSI “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv

PhD, senior researcher, Department of Reproductive Health

T.M. Tutchenko, SI “All-Ukrainian Center of Motherhood and Childhood of the NAMS of Ukraine”; SSI “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv

PhD, senior researcher, Endocrine Gynecology Department;
Department of Reproductive Health

T.I. Yusko, SI “Ukrainian Center of Motherhood and Childhood of the NAMS of Ukraine”, Kyiv

PhD, junior researcher, Endocrine Gynecology Department

References

  1. Monteleone P, Mascagni G, Giannini, et al. Symptoms of menopause — global prevalence, physiology and implications. Nat Rev Endocrinol. 2018 Apr 2;14(4):199–215. DOI: 10.1038/nrendo.2017.180
  2. Knight MG, Anekwe C, Washington K, et al. Weight regulation in menopause. Menopause. 2021 Aug;28(8):960–5. DOI: 10.1097/GME.0000000000001792
  3. Brinton RD, Yao J, Yin F, et al. Perimenopause as a neurological transition state. Nat Rev Endocrinol. 2015 Jul 26;11(7):393–405. DOI: 10.1038/nrendo.2015.82
  4. Chou PH, Lin CH, Cheng C, et al. Risk of depressive disorders in women undergoing hysterectomy: A population-based follow-up study. J Psychiatr Res. 2015 Sep;68:186–91. DOI: 10.1016/j.jpsychires.2015.06.017
  5. Thomas HN, Hamm M, Borrero S, et al. Body Image, Attractiveness, and Sexual Satisfaction Among Midlife Women: A Qualitative Study. J Womens Health. 2019 Jan;28(1):100–6. DOI: 10.1089/jwh.2018.7107
  6. Romashchenko OV, Grygorenko VM, Melnykov SM, Biloholovska VV. Formation of urogenital disorders in women at the stage of menopausal transition. Reproductive health of woman. 2024 Nov 25;(7):37–45. DOI:10.30841/2708-8731.7.2024.315435
  7. Meriggiola MC, Villa P, Maffei S, et al. Vulvovaginal atrophy in women with and without a history of breast cancer: Baseline data from the PatiEnt satisfactiON studY (PEONY) in Italy. Maturitas. 2024 May;183:107950. DOI: 10.1016/j.maturitas.2024.107950
  8. El Khoudary SR, Greendale G, Crawford SL, et al. The menopause transition and women’s health at midlife: a progress report from the Study of Women’s Health Across the Nation (SWAN). Menopause. 2019 Oct;26(10):1213–27. DOI: 10.1097/GME.0000000000001424
  9. Waetjen LE, Crawford SL, Chang PY, et al. Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study. Menopause. 2018 Oct;25(10):1094–104. DOI: 10.1097/GME.0000000000001130
  10. Bianchi VE, Bresciani E, Meanti R, et al.The role of androgens in women’s health and wellbeing. Pharmacol Res. 2021 Sep;171:105758. DOI: 10.1016/j.phrs.2021.105758
  11. Cappelletti M, Wallen K. Increasing women’s sexual desire: The comparative effectiveness of estrogens and androgens. Horm Behav. 2016 Feb;78:178–93. DOI: 10.1016/j.yhbeh.2015.11.003
  12. Brzozowska M, Lewiński A. Changes of androgens levels in menopausal women. Prz Menopauzalny. 2020 Dec;19(4):151–4. DOI: 10.5114/pm.2020.101941
  13. Scavello I, Maseroli E, Di Stasi V, et al. Sexual Health in Menopause. Medicina (B Aires). 2019 Sep 2;55(9):559. DOI: 10.3390/medicina55090559
  14. Karaçam Z, Özsoy S, Özer Yurdal NE. The prevalence of urinary incontinence and risk factors in menopausal women in Turkey: A systematic review and meta-analysis. International Journal of Urological Nursing. 2024 Mar 26;18(1). DOI: 10.1111/ijun.12382
  15. Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024 Oct;27(5):466–72. DOI: 10.1080/13697137.2024.2380363
  16. Buckinx F, Aubertin-Leheudre M. Sarcopenia in Menopausal Women: Current Perspectives. Int J Womens Health. 2022 Jun;14:805–19. DOI: 10.2147/IJWH.S340537
  17. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16–31. DOI: 10.1093/ageing/afy169
  18. Hurtado MD, Saadedine M, Kapoor E, et al. Weight Gain in Midlife Women. Curr Obes Rep. 2024 Feb 28;13(2):352–63. DOI: 10.1007/s13679-024-00555-2
  19. Metcalf CA, Duffy KA, Page CE, Novick AM. Cognitive Problems in Perimenopause: A Review of Recent Evidence. Curr Psychiatry Rep. 2023 Oct 27;25(10):501–11. DOI: 10.1007/s11920-023-01447-3
  20. Phumsatitpong C, Wagenmaker ER, Moenter SM. Neuroendocrine interactions of the stress and reproductive axes. Front Neuroendocrinol. 2021 Oct;63:100928. DOI: 10.1016/j.yfrne.2021.100928
  21. Beroukhim G, Esencan E, Seifer DB. Impact of sleep patterns upon female neuroendocrinology and reproductive outcomes: a comprehensive review. Reproductive Biology and Endocrinology. 2022 Jan 18;20(1):16. DOI: 10.1186/s12958-022-00889-3
  22. Dong Y zhi, Zhou F jing, Sun Y pu. Psychological stress is related to a decrease of serum anti-müllerian hormone level in infertile women. Reproductive Biology and Endocrinology. 2017 Dec 11;15(1):51. DOI: 10.1186/s12958-017-0271-4
  23. Gambacciani M, Biglia N, Cagnacci A, et al. Menopause and hormone replacement therapy: the 2017 Recommendations of the Italian Menopause Society. Minerva Obstetrics and Gynecology. 2018 Jan;70(1). DOI: 10.23736/S0026-4784.17.04151-X
  24. Lumsden MA, Davies M, Sarri G. Diagnosis and Management of Menopause. JAMA Intern Med. 2016 Aug 1;176(8):1205–6. DOI: 10.1001/jamainternmed.2016.2761
  25. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015 Nov;100(11):3975–4011. DOI: 10.1210/jc.2015-2236
  26. Baber RJ, Panay N, Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016 Mar 3;19(2):109–50. DOI: 10.3109/13697137.2015.1129166
  27. Louw-du Toit R, Perkins MS, Hapgood JP, Africander D. Comparing the androgenic and estrogenic properties of progestins used in contraception and hormone therapy. Biochem Biophys Res Commun. 2017 Sep;491(1):140–6. DOI: 10.1016/j.bbrc.2017.07.063
  28. Cartwright M, Toit RL du, Africander D. The transcriptional activity of progestins used in contraception and menopausal hormone therapy via progesterone receptor A is dependent on the density of the receptor. Biochem Biophys Res Commun. 2023 Jan;639:70–6. DOI: 10.1016/j.bbrc.2022.11.077
  29. Vatrasresth J, Suwan A, Panyakhamlerd K. Effects of early estradiol valerate administration on bone turnover markers in surgically induced menopausal women. BMC Womens Health. 2021 Dec 13;21(1):363. DOI: 10.1186/s12905-021-01508-w
  30. Georgiev DB. Endometrial safety during administration of the combined estrogen-progestogen hormone replacement drug Klimonorm® in perimenopausal women. Drugs of Today. 2001 Jun;37:31–5.
  31. Rudolph I, Zimmermann T, Kaminski K, et al. Changes in psychic and somatic well-being and cognitive capabilities of peri- and postmenopausal women after the use of a hormone replacement drug containing estradiol valerate and levonorgestrel. Methods Find Exp Clin Pharmacol. 2000;22(1):51. DOI: 10.1358/mf.2000.22.1.795841
  32. NICE guideline. Managing genitourinary symptoms (network meta-analyses): Menopause: identification and management [Internet]. 12 November 2015 [Last updated: 07 November 2024]. Available from: https://www.nice.org.uk/guidance/ng23/chapter/recommendations
  33. Koebele SV, Hiroi R, Plumley ZMT, et al. Clinically Used Hormone Formulations Differentially Impact Memory, Anxiety-Like, and Depressive-Like Behaviors in a Rat Model of Transitional Menopause. Front Behav Neurosci. 2021 Jul 21;15. DOI: 10.3389/fnbeh.2021.696838
  34. Geraci A, Calvani R, Ferri E, et al. Sarcopenia and Menopause: The Role of Estradiol. Front Endocrinol (Lausanne). 2021 May 19;12. DOI: 10.3389/fendo.2021.682012
  35. Cockrum RH, Soo J, Ham SA, et al. Association of Progestogens and Venous Thromboembolism Among Women of Reproductive Age. Obstetrics & Gynecology. 2022 Sep;140(3):477–87. DOI: 10.1097/AOG.0000000000004896

Downloads

Published

2025-09-18

How to Cite

Tatarchuk, T., Kalugina, L., Plaksiieva, K., Tutchenko, T., & Yusko, T. (2025). Personalized management strategies for patients with perimenopausal disorders under war-related stress. REPRODUCTIVE ENDOCRINOLOGY, (79), 30–38. https://doi.org/10.18370/2309-4117.2025.79.30-38

Issue

No. 79 (2025)

Section

Management of menopause

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.