Erkan MAVİGÖK, Abdulkadir Yasir BAHAR, Süleyman Murat BAKACAK, Alev ÖZER, Abdullah TOK, Selim KARAKÜÇÜK, Kemal HANSU, Bülent KÖSTÜ
Anatolian Current Medical Journal - 2026;8(4):740-746
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.
