Abnormal uterine bleeding in the wake of disaster: a 5-year analysis of clinical trends and the FIGO 2023 paradigm at the earthquake epicenter

Erkan Mavigök; Abdulkadir Yasir Bahar; Murat Bakacak; Alev Özer; Abdullah Tok; Selim Karaküçük; Kemal Hansu; Bülent Köstü

Abnormal uterine bleeding in the wake of disaster: a 5-year analysis of clinical trends and the FIGO 2023 paradigm at the earthquake epicenter

Abstract

Aims: Abnormal uterine bleeding (AUB) is a complex condition accounting for one-third of gynecological visits. This study aims to determine AUB etiologies using the FIGO PALM-COEIN system and investigate the clinical association between the 2023 Kahramanmaraş earthquake and the incidence of suspected ovulatory dysfunction (AUB-O), discussing potential stress induced mechanisms based on the existing literature. Methods: A retrospective cohort study (following STROBE guidelines) was conducted on 5.174 patients (ICD-10: N92, N93) at the earthquake's epicenter between January 2020 and December 2025. Patients were categorized by age and presentation periods (pre-and post-earthquake). Histopathological data from 3.120 procedures were analyzed in light of the FIGO 2023 classification. Results: The mean age was 39.7±11.4 years. The proportion of presentations for unspecified irregular menstruation (used as a clinical proxy for AUB-O) increased from 18% in the pre-earthquake period to 31% in the post-earthquake period (p<0.001). In women aged 18-35 years, the risk of suspected AUB-O increased 1.82-fold (95% CI: 1.45-2.29, p<0.001). Premalignant/malignant lesions were detected in 2.3% of cases. Notably, 15% of carcinomas occurred in premenopausal patients, including a FIGO grade 1 adenocarcinoma in a 29-year-old. Conclusion: Catastrophic environmental stressors are significantly associated with an increased incidence of AUB-O presentations, a trend that existing literature suggests may be linked to stress-induced HPO axis disruption. The findings emphasize integrating psychosocial support into disaster response and maintaining high clinical suspicion for malignancy in all age groups presenting with treatment-resistant AUB.

Keywords

Supporting Institution

Kurum Adı: Kahramanmaraş Sütçü İmam University Faculty of Medicine, Department of Obstetrics and Gynecology Kahramanmaraş /Türkiye

Ethical Statement

"This retrospective study was conducted in accordance with the Declaration of Helsinki. Ethical approval for the study was obtained from the Clinical Research Ethics Committee of Kahramanmaraş Sütçü İmam University (Approval Number: 2025/38-02, Date: December 29, 2025). As this research involved a retrospective analysis of clinical records, informed consent was waived by the institutional ethics committee, ensuring all patient data remained anonymous and strictly confidential throughout the data processing and analysis phases."

References

Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. 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. 2018;143(3):393-408. doi:10.1002/ijgo.12666
Sun Y, Wang Y, Mao L, Wen J, Bai W. Prevalence of abnormal uterine bleeding according to new International Federation of Gynecology and Obstetrics classification in Chinese women of reproductive age. Medicine (Baltimore). 2018;97(31):e11457. doi:10.1097/MD.0000000000011457
Düzgüner S, Ilgın H, Taşçı T, et al. Analysis of mixed type endometrial carcinoma. Turk J Obstet Gynecol. 2014;11(2):119-125. doi:10.4274/tjod.94759
Kiyak S, Batı S. The relationship between menstrual cycle pattern and post-traumatic stress in women following the 2023 earthquake in Turkey. Brain Behav. 2024;14(9):e70034. doi:10.1002/brb3.70034
Ağralı C, Keskin Töre F, Nacar G, Öztürk S. Effects of perceived trauma levels of women at reproductive age after earthquakes on their menstruation cycle. Disaster Med Public Health Prep. 2025;19:e237. doi:10.1017/dmp.2025.10159
Patel B, Koysombat K, Mills EG, et al. The emerging therapeutic potential of kisspeptin and neurokinin B. Endocr Rev. 2024;45(1):30-68. doi:10.1210/endrev/bnad023
Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women's health. J Endocrinol Invest. 2014;37(11):1049-1056. doi:10.1007/s40618-014-0169-3
Alp Dal N, Kurt N, Derya Beydağ K, Gunduz U, Nagórska A, Nagórska M. Period poverty among women after the 2023 Kahramanmaraş Earthquake in Turkey-a cross-sectional study. Ann Agric Environ Med. 2025;32(3):383-390. doi:10.26444/aaem/208382

Camur D, Vaizoglu SA, Guler C. Evaluating post-earthquake sexual and reproductive health services in Turkiye: a qualitative study. Eur J Public Health. 2025;35(1):ckae210. doi:10.1093/eurpub/ckaf161.575
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573-577. doi:10.7326/0003-4819-147-8-200710160-00010
Ghaferi AA, Schwartz TA, Pawlik TM. STROBE reporting guidelines for observational studies. JAMA Surg. 2021;156(6):577–578. doi:10.1001/jamasurg.2021.0528
Tintaş, Pelin, Birsen Karaca Saydam, Aysun Ekşioğlu, and Esın Turfan. Assessment of reproductive health problems and health service needs of women living in disaster areas in Hatay Province following the earthquake. J Midwifery Health Sci. 2025;8(4):326-334. doi:10.62425/esbder.1675017
Uenoyama Y, Inoue N, Pheng V, et al. The roles of kisspeptin and GnIH/RFRP-3 in stress-induced reproductive disorders. Endocr J. 2018;65(2):119-125. doi: 0.1507/endocrj.EJ18-0026
Skorupskaite K, George JT, Anderson RA. The kisspeptin-GnRH pathway in human reproductive health and disease. Hum Reprod Update. 2014;20(4):485-500. doi:10.1093/humupd/dmu009
Direct Relief. After Turkey’s cataclysmic earthquake, women’s health programs offer a model for long-term disaster response. ReliefWeb. Published September 18, 2025. Accessed July 2, 2026. https://reliefweb.int/report/turkiye/after-turkeys-cataclysmic-earthquake-womens-health-programs-offer-model-long-term-disaster-response
Berek JS, Matias-Guiu X, Creutzberg C, et al. FIGO staging of endometrial cancer: 2023. Int J Gynaecol Obstet. 2023;162(2):383-394. doi:10.1002/ijgo.14923
Zheng W. Molecular classification of endometrial cancer and the 2023 FIGO staging: exploring the challenges and opportunities for pathologists. Cancers (Basel). 2023;15(16):4101. doi:10.3390/cancers15164101
Sehnal B, Driák D, Haltufová M, et al. New FIGO 2023 staging of endometrial cancer. Geburtshilfe Frauenheilkd. 2025;85(4):405-416. doi:10.1055/a-2494-8395
Menendez-Santos M, Gonzalez-Baerga C, Taher D, Waters R, Virarkar M, Bhosale P. Endometrial cancer: 2023 revised FIGO staging system and the role of imaging. Cancers (Basel). 2024;16(10):1869. doi:10.3390/cancers16101869
Al-Asadi FAHS, Jasim SK. Accuracy of office hysteroscopy in diagnosis of endometrial pathologies compared to ultrasound and histopathology in Baghdad Teaching Hospital. J Popul Ther Clin Pharmacol. 2022;29(3): e104-e108. doi:10.47750/jptcp.2022.954

Details

Primary Language

English

Subjects

Obstetrics and Gynaecology

Journal Section

Research Article

Authors

Erkan Mavigök ^*
0009-0000-0867-1106
Türkiye

Abdulkadir Yasir Bahar
0000-0002-6963-3389
Türkiye

Murat Bakacak
0000-0003-4398-7055
Türkiye

Alev Özer
0000-0002-0934-0226
Türkiye

Abdullah Tok
0000-0003-0998-5531
Türkiye

Selim Karaküçük
0000-0002-9317-7926
Türkiye

Kemal Hansu
0000-0002-1204-9093
Türkiye

Bülent Köstü
0000-0003-2349-7569
Türkiye

Publication Date

July 16, 2026

Submission Date

April 20, 2026

Acceptance Date

June 30, 2026

Published in Issue

Year 2026 Volume: 8 Number: 4

IZ

https://izlik.org/JA22HL94TC

Cite

RIS / Bibtex

APA

Mavigök, E., Bahar, A. Y., Bakacak, M., Özer, A., Tok, A., Karaküçük, S., Hansu, K., & Köstü, B. (2026). Abnormal uterine bleeding in the wake of disaster: a 5-year analysis of clinical trends and the FIGO 2023 paradigm at the earthquake epicenter. Anatolian Current Medical Journal, 8(4), 740-746. https://izlik.org/JA22HL94TC

AMA

1.Mavigök E, Bahar AY, Bakacak M, et al. Abnormal uterine bleeding in the wake of disaster: a 5-year analysis of clinical trends and the FIGO 2023 paradigm at the earthquake epicenter. Anatolian Curr Med J / ACMJ / acmj. 2026;8(4):740-746. https://izlik.org/JA22HL94TC

Chicago

Mavigök, Erkan, Abdulkadir Yasir Bahar, Murat Bakacak, et al. 2026. “Abnormal Uterine Bleeding in the Wake of Disaster: A 5-Year Analysis of Clinical Trends and the FIGO 2023 Paradigm at the Earthquake Epicenter”. Anatolian Current Medical Journal 8 (4): 740-46. https://izlik.org/JA22HL94TC.

EndNote

Mavigök E, Bahar AY, Bakacak M, Özer A, Tok A, Karaküçük S, Hansu K, Köstü B (July 1, 2026) Abnormal uterine bleeding in the wake of disaster: a 5-year analysis of clinical trends and the FIGO 2023 paradigm at the earthquake epicenter. Anatolian Current Medical Journal 8 4 740–746.

IEEE

[1]E. Mavigök et al., “Abnormal uterine bleeding in the wake of disaster: a 5-year analysis of clinical trends and the FIGO 2023 paradigm at the earthquake epicenter”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 4, pp. 740–746, July 2026, [Online]. Available: https://izlik.org/JA22HL94TC

ISNAD

Mavigök, Erkan - Bahar, Abdulkadir Yasir - Bakacak, Murat - Özer, Alev - Tok, Abdullah - Karaküçük, Selim - Hansu, Kemal - Köstü, Bülent. “Abnormal Uterine Bleeding in the Wake of Disaster: A 5-Year Analysis of Clinical Trends and the FIGO 2023 Paradigm at the Earthquake Epicenter”. Anatolian Current Medical Journal 8/4 (July 1, 2026): 740-746. https://izlik.org/JA22HL94TC.

JAMA

1.Mavigök E, Bahar AY, Bakacak M, Özer A, Tok A, Karaküçük S, Hansu K, Köstü B. Abnormal uterine bleeding in the wake of disaster: a 5-year analysis of clinical trends and the FIGO 2023 paradigm at the earthquake epicenter. Anatolian Curr Med J / ACMJ / acmj. 2026;8:740–746.

MLA

Mavigök, Erkan, et al. “Abnormal Uterine Bleeding in the Wake of Disaster: A 5-Year Analysis of Clinical Trends and the FIGO 2023 Paradigm at the Earthquake Epicenter”. Anatolian Current Medical Journal, vol. 8, no. 4, July 2026, pp. 740-6, https://izlik.org/JA22HL94TC.

Vancouver

1.Erkan Mavigök, Abdulkadir Yasir Bahar, Murat Bakacak, Alev Özer, Abdullah Tok, Selim Karaküçük, Kemal Hansu, Bülent Köstü. Abnormal uterine bleeding in the wake of disaster: a 5-year analysis of clinical trends and the FIGO 2023 paradigm at the earthquake epicenter. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 Jul. 1;8(4):740-6. Available from: https://izlik.org/JA22HL94TC