Нерегулярный менструальный цикл у женщин репродуктивного возраста как часть синдрома мегаполиса

Андреева Е.Н., Шереметьева Е.В. Нерегулярный менструальный цикл у женщин репродуктивного возраста как часть синдрома мегаполиса. Гинекология. 2020; 22 (6): 6–10. DOI: 10.26442/20795696.2020.6.200487

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Andreeva E.N., Sheremetyeva E.V. Irregular menstrual cycle in women of reproductive age as part of metropolitan syndrome. Gynecology. 2020; 22 (6): 6–10. DOI: 10.26442/20795696.2020.6.200487

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Аннотация

Жизнь в современном мегаполисе – это не только интересная и насыщенная жизнь, но и источник многочисленных негативных последствий для жизни людей: неидеальная экологическая обстановка, особенности питания, нарушение сна и циркадных ритмов, изменение психологического статуса (стресс, депрессия, агрессия, апатия) и нарушения репродуктивного здоровья, особенно у женщин. По определению Всемирной организации здравоохранения, репродуктивное здоровье – это состояние полного физического, умственного и социального благополучия, а не просто отсутствие болезней во всех сферах, касающихся репродуктивной системы, ее функций и процессов. Жизнь в большом городе для женщины репродуктивного периода нередко сопровождается нарушением менструальной и овуляторной функции, что можно отнести к симптомам синдрома мегаполиса. С 1980-х годов частота нарушений менструального цикла выросла более чем в 7 раз. Врач-клиницист, к которому первично обращается женщина репродуктивного периода с нерегулярным менструальным циклом, должен не только составить план обследования женщины и исключить наличие эндокринно-гинекологических нарушений, но и подробно собрать анамнез, включая физикальный статус (например, расчет индекса массы тела, анализ колебания массы тела), пищевые привычки, спортивный анамнез, прием лекарственных препаратов, первично оценить роль психосоматического фактора. Верный патогенетический подход в данной ситуации определит корректную терапевтическую тактику ведения женщины.

Ключевые слова: синдром мегаполиса, нарушения менструального цикла, стресс, циркадные ритмы, мелатонин, метафолин.

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Life in a modern metropolis is not only an interesting and eventful life, but also a source of numerous features for human life: imperfect environmental conditions, dietary habits, sleep disturbances and circadian rhythms, changes in psychological status (stress, depression, aggression, apathy) and reproductive health problems, especially in women. As defined by the World Health Organization, reproductive health is a state of complete physical, mental and social well-being, and not simply the absence of disease in all areas related to the reproductive system, its functions and processes. Life in a big city for a woman of the reproductive period is often accompanied by a violation of the menstrual and ovulatory function, which can be attributed to the symptoms of the megalopolis syndrome. Since the 1980s, the frequency of menstrual irregularities has increased by more than 7 times. The doctor – clinician, to whom a woman of the reproductive period with an irregular menstrual cycle first turns, should not only draw up a plan for examining a woman and exclude the presence of endocrine-gynecological disorders, but also collect a detailed history, including physical status (for example, calculating body mass index, analyzing fluctuations weight), dietary habits, sports history, medication intake, first assess the role of the psychosomatic factor. The correct pathogenetic approach in this situation will determine the correct therapeutic tactics for managing a woman.

Key words: metropolis syndrome, menstrual irregularities, stress, circadian rhythms, melatonin, metapholin.

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1. Baisova B.I. et al. Gynecology. Textbook. Ed. G.M. Savelieva, V.G. Breusenko. 4th ed., rev. and add. 2011 (in Russian).
2. Kuksina E.A. Analysis of the incidence of women in Russia based on statistical data. 2016 (in Russian).
3. Olcese JM. Melatonin and Female Reproduction: An Expanding Universe. Front Endocrinol (Lausanne) 2020; 11: 85. DOI: 10.3389/fendo.2020.00085
4. Lania A, Gianotti L, Gagliardi I et al. Functional hypothalamic and drug-induced amenorrhea: an overview. J Endocrinol Invest 2019; 42: 1001–10. DOI: 10.1007/s40618-019-01013-w
5. Available from: https://www.who.int/topics/reproductive_health/ru/ (in Russian).
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7. Available from: https://iz.ru/879607/2019-05-19/ekspert-nazval-chislo-stradaiushchikh-ot-bessonnitcy-rossiian (in Russian).
8. Xing X, Xue P, Li SX et al. Sleep disturbance is associated with an increased risk of menstrual problems in female Chinese university students. Sleep Breath 2020. DOI: 10.1007/s11325-020-02105-1
9. Kim T, Nam GE, Han B et al. Associations of mental health and sleep duration with menstrual cycle irregularity: a population-based study. Arch Womens Ment Health 2018; 21 (6): 619–26. DOI: 10.1007/s00737-018-0872-8
10. Datieva V.K., Liashenko E.A., Levin O.S. Primenenie melatonina pri narushenii sna. Sovremennaia terapiia v psikhiatrii i nevrologii. 2015; 1.
https://cyberleninka.ru/article/n/primenenie-melatonina-pri-narushenii-sna (in Russian).
11. Rapoport S.I. Melatonin: clinical perspectives. 2014 (in Russian).
12. Diaz Lopez B, Diaz Rodriguez E, Urquijio C et al. Melatonin influences on the neuroendocrinereproductive axis. Ann NY Acad Sci 2005; 1057: 337–64.
13. Roy D, Belsham DD. Melatonin receptor activation regulates GnRH gene expression and secretion in GT1-7 GnRH neurons: signal transduction mechanisms. J Biol Chem 2002; 277: 251–8.
14. Baker FC, Driver HS. Circadian rhythms, sleep, and the menstrual cycle. Sleep Medicine 2007; 8 (6): 613–22. DOI: 10.1016/j.sleep.2006.09.011
15. Baumgartner A, Dietzel M, Saletu B et al. Influence of partial sleep deprivation on the secretion of thyrotropin, thyroid hormones, growth hormone, prolactin, luteinizing hormone, follicle stimulating hormone, and estradiol in healthy young women. Psychiatry Res 1993; 48: 153–78.
16. Axelsson G, Rylander R, Molin I. Outcome of pregnancy in relation to irregular and inconvenient work schedules. Br J Ind Med 1989; 46: 393–8.
17. Available from: https://fancy-journal.com/fancy-body/health/2098-sindrom-megapolisa-metody-lecheniya (in Russian).
18. Andreeva E.N., Sheremetyeva E.V., Grigoryan O.R., Absatarova Yu.S. Acne is a disease of civilization. Reproduction problems. 2020; 26 (1): 6–12. DOI: 10.17116 / repro2020260116 (in Russian).
19. Caffrey A, McNulty H, Irwin RE et al. Maternal folate nutrition and offspring health: evidence and current controversies. Proceed Nutr Soc 2018; 2018: 1–13. DOI: 10.1017/S0029665118002689
20. Pfeiffer CM, Rogers LM, Bailey LB, Gregory JF 3rd. Absorption of folate from fortified cereal-grain products and of supplemental folate consumed with or without food determined by using a duallabel stable-isotope protocol. Am J Clin Nutr 1997; 66: 1388–97.
21. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline. Folate. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington (DC): National Academy Press (US), 1998; p. 196–305.
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(in Russian).
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24. Rance NE, Dacks AP, Mittelman-Smith MA et al. Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: A novel hypothesis on the mechanism of hot flushes. Front Neuroendocrinol 2013; 34 (3):
211–27.
25. Jukic AMZ, Wilcox AJ, McConnaughey DR et al. 25-Hydroxyvitamin D and Long Menstrual Cycles in a Prospective Cohort Study. Epidemiology 2018; 29 (3): 388–96.
26. Bae J, Park S, Kwon JW. Factors associated with menstrual cycle irregularity and menopause. BMC Womens Health 2018; 18 (1): 36. DOI: 10.1186/s12905-018-0528-x
27. Bondareva E.Yu., Shapkina L.A., Mukhotina A.G., Morozova A.M. Menstrual irregularities in combination with insulin resistance in adolescent girls. Endocrinology problems. 2008; 54 (5): 7–11. DOI: 10.14341 / probl20085457-12 (in Russian).
28. Johnson J, Whitaker AH. Adolescent smoking, weight changes, and binge-purge beh * avior: associations with secondary amenorrhea. Am J Public Health 1992; 82 (1): 47–54. DOI: 10.2105/ajph.82.1.47
29. Marquez S, Molinero O. Energy availability, menstrual dys-function and bone health in sports; an overwiew of the female athletetriad. Nutr Hosp 2013; 28 (4): 1010–7. DOI: 10.3305/nh.2013.28.4.6542
30. Loucks AB, Verdun M, Heath EM. Low energy availability, not stress of exercise, alters LH pulsatility in exercising women. J Appl Physiol 1998; 84 (1): 37–46. DOI: 10.1152/jappl.1998.84.1.37
31. Bril' Iu. Klinicheskie aspekty narushenii energeticheskogo balansa pri fizicheskikh nagruzkakh. Problemy zdorov'ia i ekologii. 2019; 59 (1): 4–9 (in Russian).

Авторы

Е.Н. Андреева1,2, Е.В. Шереметьева*1

1 ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*s1981k@yandex.ru

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Elena N. Andreeva1,2, Ekaterina V. Sheremetyeva*1

1 Endocrinology Research Centre, Moscow, Russia;
2 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*s1981k@yandex.ru

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