Dysfunctional Uterine Bleeding and the Stress Axis
| dc.contributor.author | Dogan, Umran Karabulut | |
| dc.contributor.author | Karaer, Abdullah | |
| dc.contributor.author | Yildiz, Sedat | |
| dc.date.accessioned | 2026-04-04T13:31:22Z | |
| dc.date.available | 2026-04-04T13:31:22Z | |
| dc.date.issued | 2025 | |
| dc.department | İnönü Üniversitesi | |
| dc.description.abstract | Background: Dysfunctional uterine bleeding (DUB) affects up to 30% of women of reproductive age and may result in anemia, diminished quality of life, and increased healthcare utilization. While stress-axis dysregulation has been implicated in various menstrual disorders, the role of autonomic and hypothalamic-pituitary-adrenal (HPA) axis dysfunction in DUB remains insufficiently understood. This study aims to investigate whether women with the International Federation of Gynecology and Obstetrics (FIGO)-classified DUB exhibit alterations in autonomic nervous system (ANS) function and endocrine profiles compared to healthy controls during the early follicular phase. By assessing heart rate variability (HRV) indices and circulating reproductive and metabolic hormones, the study seeks to clarify the potential role of autonomic imbalance and the HPA axis-related hormonal markers in the pathophysiology of DUB. Methods: In this prospective case-control study, 34 women with FIGO-classified DUB and 36 age- and body mass index-matched healthy controls underwent biochemical and hormonal assays and five-minute HRV recordings during the early follicular phase (days 3-7 of menses). Serum cortisol was not measured. Time-domain (standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), percentage of successive NN intervals differing by more than 50 ms (pNN50)) and frequency-domain (very-low-frequency power (VLF), low-frequency (LF), high-frequency (HF), LF/HF) HRV metrics were analyzed alongside follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, thyroid-stimulating hormone (TSH), dehydroepiandrosterone sulfate (DHEA-SO4), glucose, and hemoglobin. Statistical comparisons employed Student's t-tests or Mann-Whitney U tests, with Pearson/Spearman correlations exploring interrelationships among variables. Results: Anthropometric, biochemical, hormonal, and HRV parameters did not differ significantly between DUB and control groups (all p > 0.05). Correlation analyses across the combined cohort revealed expected age-related declines in vagal indices (e.g., RMSSD) and hormone levels (testosterone, DHEA-SO4), inverse associations between body mass index (BMI) and SDNN/total power, and robust intercorrelations among HRV measures. Notably, FSH positively correlated with VLF power (r = 0.243, p < 0.05), while heart rate inversely tracked RMSSD (r = -0.567, p < 0.01). Conclusions: In a rigorously controlled, follicular-phase cohort, women with DUB exhibit preserved cardiac autonomic regulation and comparable endocrine profiles to healthy peers. These negative findings suggest that, under resting conditions, ANS imbalance may not drive DUB pathophysiology. Future research should integrate direct HPA-axis biomarkers (e.g., cortisol), longitudinal HRV across the menstrual cycle, and stratification by DUB subtype to uncover subtler stress-reproductive interactions. | |
| dc.identifier.doi | 10.24976/Discov.Med.202537199.141 | |
| dc.identifier.endpage | 1629 | |
| dc.identifier.issn | 1539-6509 | |
| dc.identifier.issn | 1944-7930 | |
| dc.identifier.issue | 199 | |
| dc.identifier.startpage | 1622 | |
| dc.identifier.uri | https://doi.org/10.24976/Discov.Med.202537199.141 | |
| dc.identifier.uri | https://hdl.handle.net/11616/108769 | |
| dc.identifier.volume | 37 | |
| dc.identifier.wos | WOS:001561962000013 | |
| dc.identifier.wosquality | Q3 | |
| dc.indekslendigikaynak | Web of Science | |
| dc.language.iso | en | |
| dc.publisher | Discovery Medicine | |
| dc.relation.ispartof | Discovery Medicine | |
| dc.relation.publicationcategory | Makale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı | |
| dc.rights | info:eu-repo/semantics/openAccess | |
| dc.snmz | KA_WOS_20250329 | |
| dc.subject | dysfunctional uterine bleeding | |
| dc.subject | electrocardiogram | |
| dc.subject | heart rate | |
| dc.subject | menstruation | |
| dc.subject | autonomic nervous system | |
| dc.subject | parasympathetic nervous system | |
| dc.subject | sympathetic nervous system | |
| dc.title | Dysfunctional Uterine Bleeding and the Stress Axis | |
| dc.type | Article |
