Оцінка адаптаційно-компенсаторних можливостей дівчат із розладами менструальної функції

Abstract

The duration and regularity of the menstrual cycle are influenced by many factors, including psychosocial stress, which can lead to activation of the hypothalamic-pituitary-adrenal system. Purpose - to assess the levels of stress hormones cortisol, insulin (IRI), prolactin, and the cortisol/insulin (K/In) index in adolescent girls with menstrual disorders. Materials and methods. 177 adolescent girls aged 12–17 years with menstrual disorders were examined (87 with abnormal uterine bleeding (АUB), 90 - with oligomenorrhea (OM)). The comparison group consisted of 57 girls of the same age with normal menstrual cycles examined in the early follicular phase. The level of cortisol, insulin, prolactin (PRL) was measured in blood serum on an empty stomach using the immunoenzyme method to determine the level of organism’s adaptive capabilities. All hormones were defined according to the instructions for the kits. The ratio of K/In was calculated. Results. In girls with menstrual disorders, three types of reaction from the adrenal glands were found, which were expressed in increased levels of cortisol above 75 and 90 percentile, a decrease (below 10 percentile) and its fluctuations within physiological values. At cortisol values above the 90 percentile, the average level of glucose, IRI, and HOMA in teenage girls with OM did not differ from the normative values, and in patients with AUB these indicators were significantly higher than in adolescents with OM. The K/In ratio in girls with OM by 1.8 times exceeded the similar indicator of adolescents with AUB (p<0.04) and was slightly higher than in the comparison group, which indicates a satisfactory reaction of stress tolerance. With AUB, this coefficient decreased, which may indicate exhaustion of the body’s adaptive capabilities. The same situation was observed when cortisol increased above the 75 percentile. When the cortisol level was within physiological values, the content of glucose and IRI also did not go beyond the limits of normative fluctuations. The stress ratio (K/In) had no significant difference depending on the type of violations and was significantly reduced. The absence of changes in the content of cortisol and IRI in the blood serum in response to the onset of menstrual disorders may indicate a certain instability in the development of the body's protective reactions in teenage girls with menstrual disorders. Conclusions. The revealed changes in the content of cortisol, insulin, K/In and PRL as markers of a non-specific stress reaction in the structure of the adaptive response in disorders of menstrual function carry additional information about impaired adaptation to stress and the state of compensatory capabilities of the girl's body, expand the understanding of pathogenetic mechanisms these disorders and can be used both in the assessment of the state of adaptation and in the development of appropriate preventive strategies. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.