Nature of the relationship between adrenal and sex hormones in case of menstrual disorders in girls from a frontline city depending on psychopathology

Background. Given the increasing prevalence of mental health problems in the Ukrainian population of girls affected by war, there is significant interest in understanding potential biological mechanisms, including the contribution of sex hormones. The purpose was to clarify the patterns of relationships of adrenal and sex hormones in adolescent girls with menstrual disorders in a front-line city, taking into account mental status. Materials and methods. In 2022–2024, 179 adolescent girls aged 11–17 years with menstrual disorders were examined: 85 with abnormal uterine bleeding (AUB) and 94 with oligomenorrhea (OM). The examination algorithm included determination of blood levels of testosterone (T), estradiol (E2), cortisol (C), dehydroepiandrosterone sulfate (DHEA-S). The coefficients T/E2, T/C, C/DHEA-S were calculated using untransformed, raw values of basal hormone levels. The diagnosis of psychopathology was made based on the clinical picture at the time of examination meeting the ICD-10 criteria. Results. When comparing the average levels of steroid hormones between patients with AUB and OM, it was found that the content of sex hormones (testosterone, E2, T/E2) in girls with OM without manifestations of psychopathology was significantly higher than in AUB (P < 0.04–0.002). In the presence of psychopathology, the reliability was maintained only in relation to E2 (P < 0.04). Adrenal hormones (cortisol, DHEA-S, C/DHEA-S) did not have a significant difference between patients with AUB and OM without manifestations of psychopathology. In mental disorders, the level of DHEA-S was significantly higher in adolescents with OM (P < 0.02), and the ratio of C/DHEA-S was lower (P < 0.03) than in girls with AUB. The formation of psychopathology against the background of war in adolescent girls with different types of menstrual disorders occurs under the influence of specific changes in steroid hormones. AUB is characterized by an increase in sex hormones (testosterone, E2), a decrease in cortisol and an increase in the ratio of C/DHEA-S. Psychopathology in OM, on the contrary, is formed against the background of reduced levels of sex hormones, an increase in the protective adrenal hormone DHEA-S and a decrease in the ratio of C/DHEA-S. All this may indicate that in girls with OM and psychopathology, the adrenal system parameters demonstrate a more adequate response of the body to stress. Adolescents with AUB are more maladapted, which may contribute to the transition of AUB to a recurrent form. Conclusions. The implementation of the steroid hormone response to war stress in girls with opposite conditions (AUB and OM) occurs differently depending on the type of disorder. In AUB and OM, opposite changes in sex hormones are noted, especially against the background of psychopathological states. The concentration of adrenal hormones also differs significantly in adolescents with AUB and OM. The general pattern of steroid hormones indicates a more adequate response to stress in girls with OM.