Modern Pediatrics. Ukraine. (2026).3(155): 87-95. doi: 10.15574/SP.2026.3(155).8795
Dynnik V. O.¹, Dynnik O. O.², Belyaeva O. E.¹, Verhoshanova O. G.¹, Novokhatska S. V.^1
1SI «Institute for Children and Adolescents Health Care of the NAMS of Ukraine», Kharkiv
²National Technical University "Kharkiv Polytechnic Institute", Ukraine

For citation: Dynnik VO, Dynnik OO, Belyaeva OE, Verhoshanova OG, Novokhatska SV. (2026). The relationship between the level of psychological stress and hormone markers of stress in the case of menstrual cycle disorders in adolescent girls against the Russian-Ukrainian war. Modern Pediatrics. Ukraine. 3(155): 87–95. doi: 10.15574/SP.2026.3(155).8795.
Article received: Dec 02, 2025. Accepted for publication: Apr 13, 2026.

Prolonged residence in a war zone may adversely affect menstrual function in adolescent girls.
Aim – to determine the relationship between psychological stress and adrenal stress hormones in adolescent girls with menstrual disorders living in a frontline city.
Materials and methods. Between 2022 and 2024, 142 girls aged 11-17 years with menstrual disorders were examined, including 69 with abnormal uterine bleeding (AUB) and 73 with oligomenorrhea (OM). Psychological stress was assessed in all participants. Serum cortisol and dehydroepiandrosterone sulfate (DHEA-S) levels were measured, and the cortisol/DHEA-S ratio was calculated as an indicator of hypothalamic-pituitary-adrenal (HPA) axis activity.
Results. Hormonal stress markers were associated with psychological stress severity. Elevated cortisol levels were observed only in girls with moderate stress in both groups. Increased DHEA-S was uncommon in AUB but occurred in nearly half of the girls with OM, particularly those with moderate stress. In the AUB group, low stress was mainly associated with a normal cortisol/DHEA-S ratio, indicating balanced HPA axis function, whereas high stress was more often accompanied by an elevated ratio, suggesting impaired adaptive capacity. In contrast, girls with OM predominantly exhibited normal or reduced cortisol/DHEA-S ratios across all stress levels, reflecting a more adaptive hormonal response. Hormonal responses also varied according to physical and sexual development.
Conclusions. Psychological stress is associated with alterations in adrenal stress hormones in adolescent girls with menstrual disorders. Understanding these relationships may facilitate the development of strategies to prevent and mitigate the effects of chronic war-related stress.
The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants and their parents or legal guardians.
The authors declare no conflict of interest.
Keywords: psychological stress, abnormal uterine bleeding, oligomenorrhea, adolescent girls, cortisol, dehydroepiandrosterone sulfate, war.

REFERENCES

1. ACOG. (2015). Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. ACOG Committee Opinion No. 651. Obstetrics and gynecology. 126(6): e143-e146. https://doi.org/10.1097/AOG.0000000000001215; PMid:26595586

2. Ahmed T, Qassem M, Kyriacou PA. (2023). Measuring stress: a review of the current cortisol and dehydroepiandrosterone (DHEA) measurement techniques and considerations for the future of mental health monitoring. Stress. 26(1):29-42. https://doi.org/10.1080/10253890.2022.2164187; PMid:36625303

3. Benjamin JJ, K M, Koshy T, K N M, R P. (2021). DHEA and polycystic ovarian syndrome: Meta-analysis of case-control studies. PLoS One. 16(12): e0261552. https://doi.org/10.1371/journal.pone.0261552; PMid:34932604 PMCid:PMC8691613

4. Cumberland AL, Hirst JJ, Badoer E, Wudy SA, Greaves RF, Zacharin M et al. (2021). The Enigma of the Adrenarche: Identifying the Early Life Mechanisms and Possible Role in Postnatal Brain Development. Int J Mol Sci. 22(9): 4296. https://doi.org/10.3390/ijms22094296; PMid:33919014 PMCid:PMC8122518

5. Dutheil F, de Saint Vincent S, Pereira B, Schmidt J, Moustafa F, Charkhabi M et al. (2021). DHEA as a Biomarker of Stress: A Systematic Review and Meta-Analysis. Front Psychiatry. 12: 688367. https://doi.org/10.3389/fpsyt.2021.688367; PMid:34295276 PMCid:PMC8290065

6. Gingold JA, Jain M, Jalai C. (2022). Hypothalamic-Pituitary-Ovarian Axis and Control of the Menstrual Cycle. In: Falcone T, Hurd WW. (eds) Clinical Reproductive Medicine and Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-99596-6_1; PMid:36640693

7. Gonçalves Júnior J, de Amorim LM, Neto MLR, Uchida RR et al. (2022). The impact of "the war that drags on" in Ukraine for the health of children and adolescents: Old problems in a new conflict? Child Abuse Negl. 128: 105602. Epub 2022 Mar 29. https://doi.org/10.1016/j.chiabu.2022.105602; PMid:35364467 PMCid:PMC8963741

8. Guyon AJAA, Studer RK, Hildebrandt H, Horsch A, Nater UM, Gomez P. (2020). Music performance anxiety from the challenge and threat perspective: psychophysiological and performance outcomes. BMC Psychol. 8(1): 87. https://doi.org/10.1186/s40359-020-00448-8; PMid:32843074 PMCid:PMC7448432

9. Hamidovic A, Soumare F, Naveed A, Davis J, Sun J, Dang N. (2022). Reduced Dehydroepiandrosterone-Sulfate Levels in the Mid-Luteal Subphase of the Menstrual Cycle: Implications to Women's Health Research. Metabolites. 12(10): 941. https://doi.org/10.3390/metabo12100941; PMid:36295844 PMCid:PMC9611561

10. Hennegan J, Winkler IT, Bobel C, Keiser D, Hampton J, Larsson G et al. (2021). Menstrual health: a definition for policy, practice, and research. Sex Reprod Health Matters. 29(1): 1911618. https://doi.org/10.1080/26410397.2021.1911618; PMid:33910492 PMCid:PMC8098749

11. Hillard PJA. (2022, Aug). Using the Menstrual Cycle as a Vital Sign: What We Still Want to Know about Adolescent Menstrual Cycles. J Pediatr Adolesc Gynecol. 35(4): 413-414. https://doi.org/10.1016/j.jpag.2022.06.004; PMid:35842236

12. Ibragimov S, Rayimjanova K, Kobilova Z, Rustamova D, Ibraheem S. (2023). Hormonal imbalance in females under chronic psychological stress: a multidimensional exploration. Collection of scientific papers SCIENTIA: 217-219. URL: https://previous.scientia.report/index.php/archive/article/view/1359.

13. Irshad S, Aijaz A, Husain A. (2022). A study of menstruation and stress: the biological and psychological overview on menarche and menstrual disorders. EPRA IJMR. 8(3): 85-90. https://doi.org/10.36713/epra9706

14. Koskinen MK, Aatsinki A, Kortesluoma S, Mustonen P, Munukka E, Lukkarinen M et al. (2023). Hair cortisol, cortisone and DHEA concentrations and the composition of microbiota in toddlers. Psychoneuroendocrinology. 154: 106309. https://doi.org/10.1016/j.psyneuen.2023.106309; PMid:37257330

15. Leff-Gelman P, Flores-Ramos M, Carrasco AEÁ, Martínez ML, Takashima MFS, Coronel FMC et al. (2020). Cortisol and DHEA-S levels in pregnant women with severe anxiety. BMC Psychiatry. 20(1): 393. https://doi.org/10.1186/s12888-020-02788-6; PMid:32758184 PMCid:PMC7409431

16. Leistner C, Menke A. (2020). Hypothalamic-pituitary-adrenal axis and stress. Handb Clin Neurol. 175: 55-64. https://doi.org/10.1016/B978-0-444-64123-6.00004-7; PMid:33008543

17. Lennartsson AK, Arvidson E, Börjesson M, Jonsdottir IH. (2022). DHEA-S production capacity in relation to perceived prolonged stress. Stress. 25(1): 105-112. https://doi.org/10.1080/10253890.2021.2024803; PMid:35037820

18. Lewiński A, Brzozowska M. (2022). Female infertility as a result of stress-related hormonal changes. Gynecological and Reproductive Endocrinology and Metabolism. 3(2-3): 94-98. doi: 10.53260/grem.22302035.

19. Mousikou M, Kyriakou A, Skordis N. (2023). Stress and Growth in Children and Adolescents. Horm Res Paediatr. 96(1): 25-33. https://doi.org/10.1159/000521074; PMid:34814153

20. MOZ Ukrainy. (2024). Pro zatverdzhennia kryteriiv otsiniuvannia fizychnoho rozvytku ditei vikom do 18 rokiv. Nakaz Ministerstva okhorony zdorovia Ukrainy vid 13.09.2024 No.1590. URL: https://zakon.rada.gov.ua/laws/show/z1459-24#Text.

21. Mulligan EM, Hajcak G, Crisler S, Meyer A. (2020). Increased dehydroepiandrosterone (DHEA) is associated with anxiety in adolescent girls. Psychoneuroendocrinology. 119: 104751. https://doi.org/10.1016/j.psyneuen.2020.104751; PMid:32559611 PMCid:PMC7423745

22. Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. (2018). The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 143(3): 393-408. Epub 2018 Oct 10. https://doi.org/10.1002/ijgo.12666; PMid:30198563 PMCid:PMC9580798

23. Rauch SAM, King A, Kim HM, Powell C, Rajaram N, Venners M et al. (2020). Cortisol awakening response in PTSD treatment: Predictor or mechanism of change. Psychoneuroendocrinology. 118: 104714. https://doi.org/10.1016/j.psyneuen.2020.104714; PMid:32446108 PMCid:PMC7984524

24. Riad A, Drobov A, Krobot M, Antalová N, Alkasaby MA, Peřina A et al. (2022). Mental Health Burden of the Russian-Ukrainian War 2022 (RUW-22): Anxiety and Depression Levels among Young Adults in Central Europe. Int J Environ Res Public Health. 19(14): 8418. https://doi.org/10.3390/ijerph19148418; PMid:35886269 PMCid:PMC9318466

25. Saadedine M, Berga SL, Faubion SS, Shufelt CL. (2025). The silent pandemic of stress: impact on menstrual cycle and ovulation. Stress. 28(1): 2457767. Epub 2025 Jan 25. https://doi.org/10.1080/10253890.2025.2457767; PMid:39862134 PMCid:PMC11793426

26. Stetsevych MM, Malanchuk L, Malanchuk A, Franchuk U, Malanchuk S, Martyniuk V. (2025). Evaluation of Menstrual Cycle Parameters under the Influence of Stress. Romanian Journal of Diabetes Nutrition and Metabolic Diseases. 32(1): 5-14. URL: http://www.rjdnmd.org/index.php/RJDNMD/article/view/1747.

27. Taylor-Cavelier SJ, Micol VJ, Roberts AG, Geiss EG, Lopez-Duran N. (2021). DHEA Moderates the Impact of Childhood Trauma on the HPA Axis in Adolescence. Neuropsychobiology. 80(4): 299-312. https://doi.org/10.1159/000511629; PMid:33472214

28. UNICEF. (2022). War in Ukraine: Support for children and families. URL: https://www.unicef.org/emergencies/war-ukraine-pose-immediate-threat-children.

29. Yaşa C, Güngör Uğurlucan F. (2020). Approach to Abnormal Uterine Bleeding in Adolescents. J Clin Res Pediatr Endocrinol. 12; Suppl 1: 1-6. https://doi.org/10.4274/jcrpe.galenos.2019.2019.S0200; PMid:32041387 PMCid:PMC7053441