Characteristics of the clinical course and psycho-emotional condition of women with uterine leiomyoma and adenomyosis affected by military intervention

Abstract

On the one side, in the conditions of war, strong psychological stress leads to the disorders of the reproductive system of women, the increased number of inflammatory diseases and neoplasms of the reproductive system. On the other hand, pre-existing conditions such as leiomyoma and endometriosis of the uterus are the factor that deepens stress, causes distress and leads to a decrease in quality of life.The objective: to study the characteristics of the clinical course of uterine leiomyoma and adenomyosis in the context of psycho-emotional changes in women of reproductive age affected by military intervention.Materials and methods. The clinical course of diseases and the psycho-emotional state of 110 women of reproductive age with adenomyosis and uterine leiomyoma were evaluated.Depending on the severity of the influence of the factors of military aggression, the patients were divided into three groups: the 1st group – 37 women who were in the occupied territories (the examination of this group of patients was carried out after the deoccupation of the territories), the 2nd group – 35 patients who were under the influence factors of the armed conflict, but were not directly invaded by the occupiers, the 3d group – 38 female patients who were internally displaced during the armed conflict.The Spielberger–Khanin questionnaire and the Beck Depression Scale-2 were used to determine the psycho-emotional state.Results. Disorders of the menstrual cycle (75.5%) and pain syndrome (40.0%) prevailed among the complaints. Heavy menstrual bleeding (54.1%, 65.7%, and 65.8%, respectively, by group), perimenstrual bleeding (13.5%, 22.9%, and 26.3% of cases, respectively) were most often diagnosed in all groups. Abnormal uterine bleeding was detected significantly more often in women who were in the occupied territories (10.8% in the 1st group versus 2.9% in the 2nd and 2.6% in the 3d groups; p<0.05).The average score of situational anxiety, which is directly related to dangerous conditions, indicates a high anxiety level in women of the 1st (45.9±1.0 points) and 3d (45.2±1.2 points) groups. The average score of patients in the 2nd group corresponded to a moderate anxiety level (44.1±0.8 points).The level of personal anxiety was the highest in the 3d group (45.3±1.3 points), in the 2nd group women had moderate personal anxiety (43.7±1.0 points), and in the 1st group – low one (29.6±0.9 points).The lowest level of depression was found in women of the 3d group (8.9±0.8 points). In the 2nd group, the average score of depressive manifestations was 10.9±0.6 points, which corresponded to a normal emotional state. In the 1st group, the average depression score was 12.1±0.5 points.Conclusions. Negative outcomes of military aggression were found in patients with adenomyosis and uterine leiomyoma. In the first place in the frequency of reproductive health disorders was ranked by menstrual disorders (from 78.9% to 85.7%) without differences by group. Most often, heavy menstrual bleeding was detected (from 54.1% to 65.8%).Women who were in places of direct war invasion had a much harder time enduring stressful events, as evidenced by high levels of situational anxiety. Women who were under the influence of the factors of the armed conflict, but were not directly invaded by the occupiers, are more prone to experiences of a social nature. Temporarily displaced persons showed certain tendencies towards adaptation, they were more concerned about the existing illness and had the highest level of personal anxiety.