Вплив чинників військової агресії на перебіг лейоміоми матки у жінок репродуктивного віку

War clearly has a negative impact on the reproductive potential of the population of Ukraine, in particular on the development of uterine leiomyoma (UL), due to a number of factors related to physical and mental health, as well as access to medical care. Severe psychological stress can cause hyperactivation of the hypothalamic-pituitary-adrenal-ovarian axis, which leads to increased secretion of luteinizing hormone by the pituitary gland and progesterone by the adrenal glands, as well as levels and bioavailability of ovarian hormones such as estrogen and progesterone, which promote the proliferation of UL cells. On the other hand, the diagnosis of UL itself can be considered an important psychosocial trigger with significant health impairments associated with physical pain, psychological distress, reduced social functioning and sexual satisfaction.The objective: to study the influence of military intervention factors on the development of UL in women of reproductive age.Materials and methods. We examined 46 women of reproductive age with UL who were exposed to military intervention either directly in the occupation zone or were displaced persons (main group – MG). The obtained results were compared with similar examinations of 48 patients of reproductive age with UL (comparison group – CG), who were examined in 2017–2019. The examination included clinical assessment and determination of blood concentrations of thyroid-stimulating hormone (TSH), cortisol, prolactin (in the I phase of the menstrual cycle) and progesterone – in both phases of the menstrual cycle. The data obtained were compared with the results of the examination of 30 healthy women of reproductive age.Results. It was found that women with UL who were exposed to military intervention factors were on average significantly older than women in the CG – 42.3 ± 0.7 and 38.3 ± 0.3 years, respectively, p < 0.05. Women in both groups reported pain with equal frequency – 45.7% and 52.1%, respectively. Dysmenorrhea occurred in almost every second woman – 45.7% in the MG and 47.9% in the CG without differences between groups. Women in the MG significantly more often reported menstrual disorders (80.4 vs 41.7% in the CG, p < 0.05) and abnormal vaginal secretions (39.1 vs 16.7% in the CG, p < 0.05). The majority of the subjects in both groups had excessive menstruations – 71.7% and 54.1%, including heavy menstrual bleeding – in 50.0% and 39.6% of women, respectively. The frequency of abnormal uterine bleeding (39.1 vs 12.5%, p < 0.05) and early reproductive losses (37.0 vs 18.8%) increased in women with UL during the war due to a fourfold increase in the number of miscarriages (17.4 vs 4.2%). Irregular menstruations were four times more often in women exposed to military intervention (19.6 vs 4.2%, p < 0.05).Blood hormone levels in women of the MG showed significantly higher levels of TSH (2.88 ± 0.37 mIU/L), prolactin (27.83 ± 1.81 ng/ml), cortisol (202.9 ± 19.8 ng/ml) and progesterone in the first phase of the menstrual cycle (5.71 ± 0.27 nmol/L, p < 0.05).Conclusions. In women of reproductive age with UL under the influence of military intervention, the frequency of menstrual disorders doubled to 80.4% due to a threefold increase in the frequency of abnormal uterine bleeding (up to 39.1%) and a fourfold increase in the frequency of irregular menstrual cycle (up to 19.6%). The frequency of abnormal vaginal secretions increased significantly up to 39.1%.The factors of military intervention contributed to an increase in the levels of TSH, prolactin and cortisol, as well as progesterone in the follicular phase of the menstrual cycle. Thus, the inclusion of measures to normalize thyroid and ovarian functions, as well as reduce stress, and, accordingly, prolactin and cortisol levels, will indirectly contribute to the improvement of the course of UL.