Dissertation for the degree of Doctor of Philosophy in the field of study 22
Health Care in the specialty 222 Medicine scientific specialty "Obstetrics and
gynecology". – Shupyk National Healthcare University of Ukraine, Kyiv, 2023.
Today, the problem of abnormal uterine bleeding (AUB) in women of
reproductive age is particularly relevant taking into account the existence of
additional social factors that contribute to menstrual cycle (MC) regulation
disorders. Chronic psychoemotional stress is one of such factors, the frequency of
which has been steadily increased among the population in recent years.
The dissertation is devoted to improving the quality of life of women with
AMC who are in a state of chronic psycho-emotional stress, based on the study of:
clinical parameters of the menstrual cycle, stress factors, psycho-emotional state,
features of hormonal homeostasis, vitamin D level, iron deficiency states, vaginal
microbiocenosis, quality of life parameters through development and
implementation of an optimized complex of diagnostic, therapeutic and preventive
measures and proving its effectiveness.
In the structure of etiological factors of AUB, the superiority of organic
causes over functional ones is established. However, in women under 25 years old,
the functional factors were leading, and in the presence of psychoemotional stress,
the main cause of AUB is ovulatory dysfunction, the rate of which was
significantly higher than in patients without chronic stress. An assessment of the
psychoemotional state was carried out, which indicates an increase in the levels of
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psychological, perceived and professional stress, state and trait anxiety and the low
resistance to stressful situations. A further study of the hormonal mechanisms of
AUB in women with chronic psychoemotional stress was obtained, which indicate
a decrease in estradiol, progesterone, follicle-stimulating hormone (FSH) and
luteinizing hormone (LH) concentrations and an increase in prolactin and cortisol
levels. The data about the importance of vitamin D and iron deficiency, the
decrease of which is especially pronounced in the presence of chronic
psychoemotional stress were added. The parameters of the microbiocenosis of the
vagina in persons with AUB were clarified and more frequent conditions
associated with pathological vaginal secretions by chronic psychoemotional stress
were revealed.
The identified additional pathogenetic factors made possible to substantiate
the improvement and implementation of an optimized complex of treatment
measures in women of reproductive age with AUB and chronic psychoemotional
stress, taking into account an individual approach and improvement of the patient’s
quality of life.
The dissertation research was conducted in three stages. The results of the
first stage, which included a retrospective analysis of 336 women of reproductive
age with AUB and 50 healthy women, indicate that the frequency of structural
causes of AUB relative to functional ones is 66.90 % and 33.10 %, respectively.
The most frequently reasons were uterine leiomyoma (37.50 %), ovulatory
dysfunction (24.11 %), adenomyosis (20.83 %). It was established that in women
under 25 years old the main factor of AUB is ovulatory dysfunction (67.85 %), and
with age, the frequency of structural factors increases and adenomyosis is most
often detected in patients 26-40 years old, endometrial changes – 31-35 years, after
40 years – leiomyoma and endometrial polyp.
During the second stage of the study, in addition to determination of the
leading gynecological causes of AUB in women of reproductive age depending on
the stress load, the study of social factors, psychofunctional state, hormonal
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characteristics, vitamin D concentration, iron deficiency states, vaginal microbiota
and quality of life was planned. For this purpose, 100 women of reproductive age
with AUB and chronic psychoemotional stress (main group), 50 patients with AUB
without chronic stress (comparison group) and 30 women of reproductive age
without AUB and chronic psychoemotional stress (control group) were examined
