New Onset Oligomenorrhea as a Consequence of Trauma among Syrian Women Refugees in Turkey

Öz

Introduction: Depression is a common psychological response to trauma and stress, and research suggests that depression may play a role in the development of menstrual irregularities in women, including oligomenorrhea. Aim: The aim of this study was to investigate the gynecological symptom of oligomenorrhea as a consequence of traumatic events and its relation with depression and sexual dysfunction in Syrian refugee women in Turkey. Materials and Methods: The study was held in one of the refugee camps in Turkey (Cevdetiye, Osmaniye) in April 2013. A total of 404 Syrian refugee women were interviewed during their medical visits at the gynecology and obstetrics outpatient clinic located in the refugee camp for menstrual cycle irregularities, depression and sexual dysfunction in regard to the parameters such as the level of linguistic communication skills, ethnic origin, marital status, active involvement of husband or loss of any first degree relative in civil war. Results: A total of 404 refugee women of different ethnicities (Turkish n=310 and Arabic n=94) were interviewed. Out of 404 participants, 200 (49.5%) had secondary oligomenorrhea (study group) and 204 (50.5%) had normal menstrual cycles (control group). Oligomenorrhea was found to be significantly associated with decreased sexual function, active involvement of husband in civil war and higher depression scores. Conclusion and suggestion: Depression is one of the major component of post-traumatic events and one of the known reasons of menstrual irregularities in women. Menstrual irregularities, particularly oligomenorrhea, may be an objective and initial gynecological sign in refugee women alerting the clinicians to refer the women for further psychiatric evaluation

Anahtar Kelimeler

• Beck Depression Inventory II
• Depression
• Oligomenorrhea
• Posttraumatic stress
• Syrian refugee women

Türkiye'deki Suriyeli Kadın Mülteciler Arasında Travmanın Bir Sonucu Olarak Yeni Başlayan Oligomenore

Öz

Giriş: Depresyon, travma ve stresin yaygın psikolojik bir tepkisi olup, araştırmalar depresyonun oligomenore dahil olmak üzere kadınlarda adet düzensizliklerinin gelişiminde bir rol oynayabileceğini göstermektedir. Amaç: Bu çalışmanın amacı, Suriyeli mülteci kadınlarda ortaya çıkan oligomenore ve bunun depresyon ve cinsel işlev bozukluğu ile ilişkisini araştırmaktı. Gereç ve Yöntemler: Çalışma, Nisan 2013'te Türkiye'deki bir mülteci kampında (Osmaniye, Cevdetiye) gerçekleştirildi. Menstrüel döngü düzensizlikleri, depresyon ve cinsel işlev bozukluğu nedeniyle jinekoloji ve obstetrik polikliniğine başvuran 404 Suriyeli mülteci kadın çalışmaya dahil edildi. Etnik köken, medeni hal, eşin savaşta aktif rol alıp almaması veya birinci derece yakınının kaybı gibi parametreler değerlendirildi. Bulgular: Çalışmaya Türk (n=310) ve Arap (n=94) olmak üzere toplam 404 kadın dahil edildi. Katılımcıların %49.5’inde (n=200) sekonder oligomenore (çalışma grubu) saptanırken, %50.5’inin (n=204) normal menstrüel döngüleri (kontrol grubu) olduğu belirlendi. Oligomenore; cinsel işlev bozukluğu, eşin savaşta aktif rol alması ve daha yüksek depresyon skorları ile ilişkili bulundu. Sonuç ve Öneriler: Depresyon, travmatik olayların önemli bir bileşenidir ve kadınlarda menstrüel düzensizliklerin bilinen nedenlerinden biridir. Özellikle oligomenore, mülteci kadınlarda jinekolojik bir belirti olarak görülebilir ve klinisyenlerin kadınları daha ileri psikiyatrik değerlendirmeye yönlendirmeleri için bir uyarı işareti olabilir.

Anahtar Kelimeler

• Beck Depresyon Envanteri II
• Depresyon
• Oligomenore
• Travma sonrası stres
• Suriyeli mülteci kadınlar

Kaynakça

1. Al-Musawi, N.M. (2001), Psychometric properties of the Beck Depression Inventory-II with university students in Bahrain. Journal of Personality Assessment, 77, 568–579.
2. Berga, S.L. (1989), Neuroendocrine aberrations in women with functional hypothalamic amenorrhea. J Clin Endocrinol Metab, 68, 301–308.
3. Berga, S.L. (1989), The psychoneuroendocrinology of functional hypothalamic amenorrhea. Psychiatr Clin North Am, 12(1), 105-116.
4. Brewin, C.R. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol, 68(5),748-766.
5. Bomba, M. (2007). Endocrine profiles and neuropsychologic correlates of functional hypothalamic amenorrhea in adolescents. Fertil Steril, 87, 876–885.
6. Cohen, D.P. (2008). Amenorrhea. In: Gibbs, Ronald S, Karlan Beth Y, Haney Arthur F, Nygaard Ingrid E, editors. Danforth's Obstetrics and Gynecology, 10th Edition. Lippincott Williams & Wilkins. p.649-663.
7. Dundon, C.M. (2010). Mood disorders and sexual functioning in women with functional hypothalamic amenorrhea. Fertil Steril, 94, 2239–2243.
8. Giles, D.E. (1993). Cognitive and psychiatric correlates of functional hypothalamic amenorrhea: a controlled comparison. Fertil Steril, 60, 486–492.

9. Gordon, M.C. (2010). Functional hypothalamic Amenorrhea. N Engl J Med, 363, 365–371.
10. Gorst-Unsworth, C. (1998). Psychological sequelae of torture and organised violence suffered by refugees from Iraq. Trauma-related factors compared with social factors in exile. Br J Psychiatry, 172, 90–94.
11. Hampton, T. (2013). Health Care Under Attack in Syrian Conflict. JAMA, 310(5), 465-466.
12. Hennegan, J.(2020). Measurement in the study of menstrual health and hygiene: A systematic review and audit. PLoS One, 4, 15(6), e0232935.
13. Kapci, E.G. (2008). Beck Depression Inventory II: Evaluation of the psychometric properties and cut-off points in a Turkish adult population. Depression and Anxiety, 25, E104-E110.
14. Kastrup, M.C. (2006). Mental health consequences of war: Gender specific issues. World Psychiatry, 5, 33–34.
15. Lawson, E.A. (2009). Hypercortisolemia is associated with severity of bone loss and depression in hypothalamic amenorrhea and anorexia nervosa. J Clin Endo- crinol Metab, 94, 4710–4716.
16. Lindsey, C. (2001). Women facing war. International Committee of the Red Cross.
17. Meczekalski, B. (2008). Functional hypothalamic amenorrhea: current view on neuroendocrine aberrations. Gynecol Endocrinol, 24, 4–11.
18. Murthy, R.S. (2006). Mental health consequences of war: a brief review of research findings. World Psychiatry, 5(1), 25–30.
19. Schoevers, M.A. (2010). Illegal female immigrants in The Netherlands have unmet needs in sexual and reproductive health. Journal of Psychosomatic Obstetrics and Gynecol, 31(4), 256-64.
20. UNHCR Refugee Population Analysis (2013). Monthly Summary on Syrian Refugees in Turkey.
21. UNICEF (2013). Syria Crisis Bi-weekly Humanitarian Situation Report.