Functional and stress-related menstrual cycle disorders in gynecological practice (literature review)

Functional menstrual disorders encompass a broad spectrum of abnormalities in the regularity, duration, and volume of menstrual bleeding in the absence of organic pathology. Over the past decades, substantial progress has been made in understanding the etiological factors, diagnostic criteria, and therapeutic strategies associated with these conditions. The pathogenesis is primarily linked to dysfunction of the hypothalamic–pituitary–ovarian (HPO) axis, in which key regulatory roles are played by kisspeptin, gonadotropin-releasing hormone (GnRH), gonadotropins, and sex steroids. Contemporary literature places particular emphasis on the neuropeptidergic regulation of GnRH secretion, notably the roles of kisspeptin and neurokinin B, whose impaired expression is implicated in the development of hypothalamic amenorrhea. Lifestyle-related factors exert a significant influence on menstrual function — energy deficiency resulting from intensive physical activity, common among athletes, may lead to secondary amenorrhea. Chronic psychological stress, associated with elevated cortisol levels, can indirectly disrupt neuroendocrine regulatory mechanisms at multiple levels. The COVID-19 pandemic is considered an additional factor associated with menstrual disturbances, attributed to both the presumed direct damage to reproductive tissues and indirect effects mediated by stress-related and immune-driven pathophysiological mechanisms. Environmental exposures, including air pollution and endocrine-disrupting chemicals, are also gaining attention as relevant contributors to menstrual rhythm disturbances. This review summarizes current knowledge on hormonal dysregulation mechanisms, the influence of internal and external triggers, viral agents, and emerging diagnostic and therapeutic approaches for managing patients with functional menstrual disorders, including the use of a complex of plant components and microelements Time Factor, the composition of which is aimed at correcting the functioning of the hypothalamic-pituitary axis in case of non-organic disorders of the menstrual cycle.