The dissertation research is aimed at developing methods of prevention of violations and rehabilitation of reproductive health of female military personnel exposed to the factors of the war environment.
At the first stage of the dissertation work, an anonymous questionnaire survey of 300 military women of reproductive age who served in the zone of operation of the United Forces, and 85 civilian women of a similar age from the front-line region was conducted. The survey focused on reproductive and mental health issues, awareness and use of contraception and STD prevention by female military personnel while in a military environment.
Military personnel reported using different methods of contraception 49.8±5.9% of the time, which is 1.7 times less compared to civilian women: (RR=1.66; 95%CI: 1.2–2.4; p=0.001). Among those who reported the use of contraception, hormonal methods were chosen by 8.8±4.8% of female military personnel in the last 3 months, compared to 12.1 ± 8.4% among non-military women (χ2=0, 53, p=0.47).
The features of the clinical course of menstrual dysfunctions identified for the first time in female military servicemen in the war zone were statistically significantly more often associated with a violation of the duration and regularity of the menstrual cycle on the background of ovulation disorders against an increase in the duration and volume of uterine bleeding: 80,8±9,0% compared to 43,8±11,4% (t=4,99, p<0,001).
According to the assessment of the frequency of post-stress reactions in military personnel with menstrual dysfunction, a high sensitivity to military stress with the formation of anxiety and/or depressive disorders was determined in 45.2% of cases (33/73), among which 57.6% (19/33) had low subclinical anxiety, 42.4% (14/33) - subclinical depression. The analysis of the HADS hospital scale of anxiety and depression demonstrated fairly high average indicators of anxiety and depression in military personnel with a statistically significant predominance of anxiety symptoms in scores: 6.98±0.13 versus 4.76±0.17 in depression (p=0.05).
According to the results of cytological studies, abnormal results of the PAP test were diagnosed in 32.7±10.3% of cases in military personnel with menstrual dysfunction, while the frequency of mild squamous intraepithelial lesions (LSIL), which were mainly accompanied by signs of viral infection, was higher than the frequency of atypia unspecified squamous epithelium (ASCUS): 18.2±10.2% and 14.5±9.3%, respectively.
Cytological smears of the inflammatory type were diagnosed in 44.9±13.9% of military personnel, among whom immunocytochemical studies of cervical intraepithelial structures revealed a high positive expression of proliferation markers, in particular cytokeratin-7, which is a prognostically unfavorable sign of the development of hyperproliferative and tumor processes of the endocervix and probably is associated with the negative impact on women's reproductive health of the factors of military work in the conditions of a military environment.
The obtained results made it possible to substantiate the conceptual model of staged preventive and rehabilitation measures to optimize the protection and restoration of reproductive health and improve the quality of life of female military personnel with stress-associated menstrual dysfunctions that were affected by the factors of the military environment.
At the third stage of the dissertation work, the effectiveness of the developed complex of medical rehabilitation of reproductive health of female patients of this category was investigated, for the assessment of which the International Classification of Functioning, Limitation of Vital Activities and Health (ICF) was applied for the first time. The restorative treatment complex combined drug therapy, psychotherapy with elements of trauma-focused therapy, therapeutic physical factors and methods of physical rehabilitation.
Considering the background of the use of the developed restorative treatment complex in female military servicemen, a probable recovery of menstrual function indicators was noted in 83.3±17.7% of cases (p˂0.01) and an improvement in the quality of life in 76.5±20.8% of women (p˂0.01) in comparison with indicators before treatment.
On the basis of the obtained results, the need to add to the existing Unified clinical protocols of primary, secondary (specialized), tertiary (highly specialized) medical care "Abnormal uterine bleeding" and "Family planning" regarding the use of various methods and regimes of hormonal contraception for the prevention and rehabilitation of reproductive health of female military personnel with menstrual dysfunctions was proven.
