CORRECTION OF HORMONAL DISORDERS IN WOMEN WITH ABNOMAL UTERINE BLEEDING AND CHRONIC PSYCHO-EMOTIONAL STRESS

Abstract

The aim of the research was to evaluate the effectiveness of the optimized treatment in the correction of hormonal disorders in women with abnormal uterine bleeding (AUB) and chronic psycho-emotional stress.
 Materials and methods. 100 women of reproductive age with AUB and chronic psycho-emotional stress were examined. I group included 50 patients who received complex optimized treatment, II group included 50 persons who received standard treatment. The control group included 30 healthy women without AUB and chronic psycho-emotional stress. The standard approach provided for diagnostic and therapeutic measures in accordance with the recommendations of the order of the Ministry of Health of Ukraine N 353 dated 13.04.2016. Inclusion criteria: AUB, age 18-45 years, satisfactory condition of the sample of the material from the uterine cavity for histological examination, chronic psychogenic stress, patient consent. Exclusion criteria: pregnancy, premenstrual dysphoric disorder, acute pelvic inflammatory disease, mental disorders, blood diseases associated with coagulation disorders, hypothyroidism, hyperthyroidism, hormonal adrenal tumors, chronic intestinal diseases, severe somatic pathology. Optimized treatment additionally included recommendations for lifestyle changes, melatonin, vitamin D, medicament’ correction of iron deficiency without anemia. Estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, progesterone, prolactin, and cortisol levels were determined in all subjects.
 Results of the research. In the follicular phase of menstrual cycle after the standard treatment there is a positive dynamics of progesterone and FSH levels in the patients in the I and II groups whose concentrations reached the control group. However, LH level in patients in both groups and estradiol amount in the II group differed significantly from those in healthy women. After optimized treatment, the levels of prolactin and cortisol reached the amount of healthy women, while after the standard treatment the prolactin concentration was increased by 17.22 % (p=0.049), cortisol – by 43.84 % (p<0.001) compared with controls. In the luteal phase, the greatest correction of estradiol and progesterone concentrations in the I and II groups and prolactin level in women in the I group were determined. However, the amount of prolactin in patients of the II group remained high, exceeding the rate of healthy women by 33.64 % (p=0.007), while in the I group it corresponded to the control value. No significant changes in the concentration of FSH, LH and testosterone on the background of treatment in women of the two groups were observed, as their levels corresponded to the control group. FSH and LH levels in patients before and after the standard and optimized treatment were at the lower limit of healthy persons.
 Conclusions. The use of standard and optimized approaches in the management of patients with abnormal uterine bleeding and chronic psycho-emotional stress has been successful in normalizing in female sex hormones, but the standard approach has demonstrated an insufficient correction of stress-induced hormone levels, in contrast, the optimized treatment led to a more effective correction of all hormonal disorders.