War leaves deep traces not only on the battlefield, but also in the souls and bodies of those who are forced to experience its horrors. Especially vulnerable are women who, facing the unique challenges of war, experience psychological and physical stress. This is exacerbated by stress, which is a trigger for many diseases, from early menopause to cervical cancer.
The journalist of IA “FACT” spoke with Serhiy Formalyuk, the head of the women’s consultation department at the Central City Hospital No. 2 named after V.P. Pavlusenko” and learned how the war affected women’s health, what problems became more frequent, and how doctors help them cope with stress and maintain health
How did the war affect the condition of female patients in the gynecological department?
The war became a difficult test for all Ukrainians, causing great stress and forced migration, especially among women and children. Unfortunately, this has led to a decrease in the number of pregnancies and the reduction of our department. We are seeing a significant decline in the birth rate, which is a nationwide trend.
Although the Zhytomyr region was not directly bombarded, constant air raids and war-related stress have a negative impact on women’s health. The most frequent health complication for pregnant Ukrainian women as a result of the war, with which they turn to doctors, has become premature birth or its threat, and for children – a delay in physical development.
Stress affects a woman’s hormonal background, which can lead to ovarian dysfunction, changes in her cycle, and complications during pregnancy. We prescribe magnesium supplements, vitamins and provide psychological support to help women cope with stress and maintain health. It is especially difficult for those women whose husbands are on the front lines, because constant concern for loved ones increases the psychological burden.
We also observe an increase in cases of early onset of menopause, uterine bleeding, and exacerbation of chronic diseases in women in general. Many older women who have moved abroad face difficulties in accessing medical care. After all, you have to wait for a gynecologist’s consultation abroad for several months, or even more. This is much easier for us, because we strive to ensure the availability of medical care for all patients.
How does stress affect reproductive health and to what extent is a healthy pregnancy possible during wartime?
Stress has very negative consequences on women’s reproductive health, their ability to conceive and then carry a pregnancy to term. The level of stress hormones increases, which suppresses the level of female hormones. It is worth noting that nature has endowed the female body with an amazing ability to adapt and protect the future baby. Usually, most pregnancies proceed physiologically without complications, and women give birth to healthy children on their own. However, each pregnant woman has individual health characteristics, and some women may have co-morbidities such as cardiovascular problems, thyroid disease, etc. In such cases, war-related stress can exacerbate these diseases and lead to complications during pregnancy. Therefore, it is important that pregnant women receive timely and qualified medical care, especially in wartime.
Did the incidence of cancer increase during the war?
We actively screen for cervical cancer and other gynecological cancers. Unfortunately, some patients neglect regular examinations, which leads to the detection of diseases in the late stages. During the war, many Ukrainian women did not have the opportunity to undergo regular examinations and consult oncologists due to active hostilities, forced migration and limited access to medical services.
Only cervical pathology can be predicted. In the future, as the risk of developing cervical cancer. This is a Pap test, which is performed preventively once a year. Or, if the patient has a complicated medical history, she knows that someone had cancer of the organs of the reproductive system, or she has papillomas. Then the collection of material for the Pap test is done twice a year. And ultrasound of the mammary glands and pelvic organs will help detect any malignant cell, tumor, and life will go on in the early stages.
According to statistics, in 2022 almost every fourth case of cancer in Ukraine was detected at late stages (22.4%), which is 1.4% more than in 2021. The most critical situation occurred in the Kherson and Kharkiv regions, where the level of neglect reached 32.4–34.8%. Fortunately, there are far fewer such cases in Zhytomyr, but we still urge women not to neglect preventive examinations and to consult a doctor at the slightest suspicion.
How did the war affect the number of patients and cooperation with other organizations?
The number of patients who come to our department has significantly decreased due to migration. However, we continue to provide assistance to all who need it, including internally displaced persons. We understand that the war has created additional difficulties for many women, so we try to provide them with the necessary support and treatment. We also actively cooperate with volunteer organizations and international missions to provide patients with access to medicines, equipment and psychological assistance. Together, we work to ensure that every woman receives the necessary medical care, despite difficult circumstances.
How did the war affect the availability of medicines and family planning services?
Of course, the war created certain difficulties with logistics and the supply of medicines, so some drugs may be temporarily unavailable in pharmacies. However, we are always ready to offer alternative options that are no less effective and safe. Our doctors constantly monitor the situation on the pharmaceutical market and inform patients about available alternatives.
In addition, we actively cooperate with volunteer organizations and international partners who help us provide women with the necessary contraceptives and other medical supplies. Thanks to this cooperation, we can provide assistance even in the most remote corners of the region.
We understand that in wartime the issues of family planning and contraception become especially relevant. Therefore, we urge women not to postpone a visit to the doctor and get all the necessary information and help. Our department is always ready to support you in this difficult period.
Is there an increase in the number of cases of depression, anxiety, post-traumatic stress disorder (PTSD) in female patients? And has the number of abortions increased?
Yes, we are seeing a significant increase in the number of cases of depression, anxiety and PTSD in our patients. War, with its constant stress, loss and uncertainty, leaves deep psychological scars. Especially women who survived shelling, lost loved ones, were forced to leave their homes, often face these disorders. We try to provide them with the necessary psychological support, cooperating with psychologists and psychotherapists. As for abortions, we do not observe a significant increase in their number. On the contrary, fewer and fewer women want to have abortions.
Of course, each situation is individual, and the decision to have an abortion is always difficult and painful. War, of course, creates additional difficulties for women who become pregnant during this difficult time. We provide them with full information about all available options, including being able to keep the pregnancy and getting the support they need. Our goal is to empower women to make an informed and informed decision that is best for them in this situation. We understand that war creates additional challenges for women’s health, so we try to provide them with all the necessary help and support, both medical and psychological.
If we take general statistics for Ukraine, the number of abortions decreases by an average of 7% every year. Over the past 13 years, abortions in Ukraine have decreased 3.6 times — from 163,000 to 45,000 per year. From 2020 to 2022, there was a decrease in their number by 15% every year. Most likely, it is related to the pandemic and the war. According to the results of 2023, the number of abortions per year decreased by only 4% – to 45 thousand per year.
Now there are 250 abortions for every thousand newborns, while in 2011 there were 330 such operations per one thousand. At the same time, 2/3 of all abortions last year were performed by women aged 20 to 34. 1% of the total number of abortions in girls under 17 years of age – last year, underage girls had 464 abortions, of which 29 abortions were for children under 14 years of age.
