Features of the course of menopause in women under chronic stress: An observational cohort study

Background. Functional processes in the female organism at the stage of reproductive function failure in menopause attract considerable interest of researchers. The paper presents a study of great medical, biological and social importance into reproductive function failure in women living in the territories with permanent military operations for a long time and, thus, suffering from post-traumatic syndrome, which significantly affects the character of menopause. Objectives . To identify the features of menopausal syndrome in women who have been living under chronic stress (6–8 years) in the zone of ongoing military operations, namely in the Donetsk and Luhansk People’s Republics, and in women from Rostov Oblast — the region free from active military operations. Methods. An observational cohort study involved 60 women (refugees), long-term residents of the territories with ongoing military operations and 60 long-term residents of the territories without military operations, aged 50–65 years, with clinical manifestations of menopausal syndrome; all women were patients of the Research Institute of Obstetrics and Pediatrics, Rostov State Medical University. In accordance with the Stages of Reproductive Aging Workshop (STRAW+10) classification and clinical manifestations of menopause, two clinical groups ( n = 30) were formed from the representatives of each region of residence. Group I included 30 women, aged 50–55, from the Donetsk and Luhansk People’s Republics, who had late menopausal transition (stage -1 of STRAW+10) and menopausal syndrome. Group II involved 30 postmenopausal patients (stages +1 and +2 of STRAW+10), aged 60–65, with menopausal syndrome. Group 1 enrolled 30 residents of Rostov Oblast, aged 50–55, who had late menopausal transition (stage -1 of STRAW+10) and menopausal syndrome, group 2 included 30 postmenopausal patients (stages +1 and +2 of STRAW+10), aged 60–65, with menopausal syndrome. Modified menopausal index was considered as the main indicator of the study. Statistical data processing was carried out by means of Statistica 10.01 (StatSoft, USA), Microsoft Excel 2010 (Microsoft, USA), IBM SPSS 24.0 (IBM, USA), and MedCalc (MedCalc Software, Belgium). Results. Long-term female residents of the territories with ongoing military operations were reported to develop menopausal syndrome more often. Rostov Oblast female residents in the late menopausal transition revealed a statistically significant prevalence of a mild degree of menopausal syndrome in 63.3 % of cases compared to 36.7 % of a similar severity of menopausal syndrome in residents of the Donetsk and Luhansk People’s Republics. Meanwhile, women from the Donetsk and Luhansk People’s Republics were indicated with moderate menopausal syndrome in 50.0 % of cases in late menopausal transition and severe syndrome in 33.3 % in postmenopause versus 23.4 % and 10 % of women from Rostov Oblast, respectively. The intensity of neurovegetative and psycho-emotional disorders in women of both regions increases with the aging process of the reproductive system and appears most pronounced in the postmenopausal period. Conclusion. Residents of the Donetsk and Luhansk People’s Republics, who live in the war zone and are exposed to constant threat to life, develop post-traumatic syndrome which significantly intensifies and modulates the already existing functional and hormonal restructuring in the brain subsystems during perimenopause. Non-uniform functional shifts at different levels of the central nervous system under conditions of chronic stress lead to a significant change in intracerebral processes and to an increase in the occurrence and severity of various dysfunctional deviations.