In the conditions of war, even in relatively peaceful regions, we are getting used to living under chronic stress. But this does not mean that the body does not feel the consequences of the surge of stress hormones. UNN spoke about this, as well as about some myths regarding women's health and the development of modern approaches in obstetrics and gynecology, with Vasyl Beniuk, an obstetrician-gynecologist, Doctor of Medical Sciences, professor, and head of the Department of Faculty Obstetrics and Gynecology at the Bogomolets National Medical University.
- Nowadays, there is a lot of talk about the effect of estrogens on the female body. Social media is full of information that this affects the development of tumors, fibroids, weight, and even hair quality. What of this is true, and do diets help—for example, increasing the proportion of cruciferous vegetables in the diet?
Yes, today the topic of estrogens is extremely popularized—social networks actively discuss their impact on weight, skin and hair condition, the development of fibroids, endometriosis, and even oncological processes. However, it is important to understand: estrogens are not "bad" hormones. They are fundamental regulators of the functions of the female body, ensuring the normal operation of the reproductive system, bone tissue, cardiovascular system, brain, and skin.
The problem arises not so much from the fact of the presence of estrogens themselves, but from the disruption of their metabolism and excretion. That is why modern medicine increasingly speaks not of an "excess of estrogens," but of an imbalance in estrogen metabolism.
It is important to remember that a hormone in the blood is not always a hormone in the cell. A significant portion of estrogens is in a bound state with sex hormone-binding globulin and is biologically inactive. Free estrogens have the greatest impact. In cases of insulin resistance, obesity, liver pathology, or chronic inflammation, the level of sex hormone-binding globulin may decrease, causing the proportion of active estrogens to rise even with normal laboratory indicators.
The metabolism of estrogens in the liver deserves special attention. Under the influence of the cytochrome P450 enzyme system, various estrogen metabolites are formed—some have a relatively safe profile, while others are capable of stimulating cell proliferation, oxidative stress, and DNA damage. It is the disruption of the balance between these pathways that is considered one of the mechanisms for the development of endometrial hyperplastic processes, uterine fibroids, and estrogen-dependent neoplasias.
Therefore, today we evaluate not only hormone levels but also the patient's metabolic state as a whole: liver function, body weight, the presence of insulin resistance, the state of the gut microbiota, and chronic inflammation.
Regarding nutrition—it does indeed have a certain impact. The most evidence-based data has been accumulated regarding cruciferous vegetables—broccoli, Brussels sprouts, cauliflower. They contain the compounds indole-3-carbinol and diindolylmethane (DIM), which can affect estrogen metabolism enzymes and promote a shift in their metabolism toward less proliferative metabolites. Today, Indole-3-carbinol and diindolylmethane are available in the form of medical drugs used as part of complex therapy, which requires consultation with a doctor.
A rational diet, sufficient fiber, maintaining a healthy body weight, physical activity, and normal liver and bowel function are indeed important components of preventing metabolic and gynecological disorders. At the same time, it is important to avoid extremes. No single product or "detox diet" is capable of independently "cleansing" the body of "excess" estrogens or curing hormone-dependent diseases. Also, advice on social media does not constitute qualified medical prescriptions, so if there are health problems, one should consult a doctor.
Thus, the modern view of estrogens is much deeper than the concepts popular on social media. What matters is not only the level of hormones but also how the body is able to metabolize, neutralize, and excrete them. It is the balance between hormonal stimulation and detoxification systems that determines the line between physiology and pathology.
- Another noticeable factor in our lives is stress, which has intensified with the full-scale war. In your opinion, how does severe stress affect the female body? Is there an increase in the number of certain pathologies?
Undoubtedly, chronic stress has become one of the most powerful factors affecting women's health today. The full-scale war, forced displacement, prolonged uncertainty, and constant psycho-emotional tension create conditions in which a woman's body actually operates in a mode of constant adaptation.
We already see that stress has ceased to be just a psychological problem—it has clear neuroendocrine and somatic consequences. This is especially noticeable in women of reproductive age who have been in a state of chronic psycho-emotional stress for a long time. The main mechanism lies in the constant activation of the hypothalamic-pituitary-adrenal axis. In response to stress, the secretion of cortisol increases—a hormone that helps the body adapt in the short term but begins to suppress reproductive function with prolonged exposure.
Chronic hypercortisolemia disrupts the secretion of gonadotropin-releasing hormone in the hypothalamus, which, in turn, affects the levels of follicle-stimulating and luteinizing hormones. The consequences are ovulation disorders, shortening of the luteal phase, and oligo-ovulatory or anovulatory cycles. Clinically, this manifests as irregular menstruation, worsening of premenstrual syndrome, dysmenorrhea, cycle disruptions, and even a temporary decrease in fertility.
In addition to the hormonal component, stress directly affects the central nervous system. A prolonged increase in cortisol levels is associated with increased anxiety, emotional lability, sleep disturbances, and exhaustion of adaptive mechanisms. A vicious circle is formed: stress worsens hormonal balance, and hormonal disorders, in turn, intensify psycho-emotional symptoms.
We also observe an increase in functional gynecological disorders specifically related to the stress factor. Among them: menstrual cycle disorders; severe PMS; dysmenorrhea; chronic pelvic pain syndrome; complaints of mucosal dryness and sexual discomfort; and exacerbation of existing gynecological diseases.
It is important to understand that chronic stress affects not only through the nervous system. It is also accompanied by oxidative stress, changes in the immune response, microcirculation disorders, and metabolic changes. This creates conditions for systemic imbalance in the body.
Today, we increasingly talk about the need for a comprehensive approach to such patients. Hormonal therapy should not always be the first solution. In many cases, correcting deficiency states, normalizing sleep, maintaining magnesium balance, working with anxiety, nutraceutical support, psycho-emotional stabilization, and restoring the body's adaptive resources are effective.
Our clinical observations also demonstrate that with a comprehensive approach, it is possible to significantly reduce the manifestations of PMS and dysmenorrhea, normalize the menstrual cycle, and improve the psycho-emotional state of patients.
Therefore, today stress is not an abstract concept but a powerful pathophysiological factor that directly affects a woman's reproductive health. And in the conditions of war, the issue of preserving women's health cannot be considered separately from the patient's psycho-emotional state.
- In the world and in Ukraine, the number of births by cesarean section is growing—what is your opinion on this? What risks does this pose for the health of the mother and the newborn?
Yes, such a trend is observed. During the time I have been working, the rate of births by cesarean section has increased from 8% to almost 30%.
Cesarean section is one of the most important operations in the history of medicine. It saves the lives of mother and child in cases of placenta previa, fetal distress, severe preeclampsia, and many other conditions. And that is exactly how it should be treated: as a medical procedure performed according to indications, not as a "convenient" birth option.
The problem is not the operation itself, but that in many countries its frequency already exceeds the level explained only by medical indications. Globally, the frequency of cesarean sections is steadily growing. The WHO does not set an "ideal percentage" but emphasizes: a cesarean section should be performed when it is medically necessary.
Global trend in cesarean sections: indications, risks, and the situation in Ukraine30.04.26, 09:20
For the mother, a cesarean section increases the risk of bleeding, infectious complications, thrombosis, and most importantly—a scar on the uterus, which complicates all subsequent pregnancies and increases the risks of placenta previa and placenta accreta.
In most cases, children after a cesarean are born perfectly healthy. But there are certain peculiarities—the absence of passage through the birth canal matters for the formation of the microbiome and the immune system. Children born by cesarean section statistically more often have certain allergic and autoimmune conditions—although it is important not to overgeneralize: for many of them, a cesarean section was the only safe birth option.
In my opinion, it is important to avoid two extremes: the romanticization of "only natural birth" and the perception of cesarean as a "default easier" or "safer" way of giving birth.
Cesarean section saves lives, has sharply reduced maternal and perinatal mortality, and in many situations is the only safe option.
The problem is not the method itself, but the balance. It is necessary to avoid unjustified operations, but also not to delay a necessary cesarean due to excessive "commitment to naturalness."
- Is cesarean section associated with such a pathology as placenta accreta? What risks does it carry? Does it necessarily threaten uterine resection?
Yes, as I already said, cesarean section is indeed associated with an increased risk of placenta accreta—it is one of the main risk factors. The pathology is called placenta accreta spectrum (PAS): the placenta attaches too deeply or grows into the uterine wall.
After a cesarean, a scar remains on the uterus. In a subsequent pregnancy, the placenta may implant exactly in the scar area, where the normal layer between the placenta and the uterine muscle is disrupted.
The risk increases especially if there have been several cesarean sections (with the first scar it is about 0.3%, with the third—already over 6%), if there is placenta previa, or if there were other operations on the uterus (myomectomy, curettage, etc.).
The main danger is massive bleeding during childbirth or when attempting to detach the placenta. Does it necessarily end in the removal of the uterus? No, not necessarily.
In severe forms of PAS, removal of the uterus is often the standard of treatment because it is the safest way to stop bleeding. At the same time, in milder or local forms, it is possible to save the uterus. This depends on the depth of penetration, the location of the placenta, the volume of bleeding, the experience of the center, and the woman's reproductive plans.
- Are organ-preserving operations performed in Ukraine for women with this pathology?
Yes, such operations are performed in Ukraine—and in recent years, this is a direction that has been actively developing. One of the leading centers in Kyiv performing complex organ-preserving operations is the Kyiv Perinatal Center under the leadership of Professor Dmytro Govseiev. Every year, the perinatal center performs more than 20 organ-preserving operations in patients with placenta accreta. In particular, in 2024, doctors at the Kyiv Perinatal Center managed to save the uterus even for a patient after several cesarean sections with placenta previa and accreta.
In general, pregnant women from the city of Kyiv with complicated pregnancies and premature births before the 34th week of gestation are referred to the Kyiv Perinatal Center, and our colleagues demonstrate good obstetric and perinatal results.
The staff of the Department of Faculty Obstetrics and Gynecology at the O.O. Bogomolets National Medical University, which I head, also provide assistance for complications related to placenta accreta. We have two bases for providing assistance to pregnant women and new mothers—the Mother and Child Center of the KNP "Kyiv City Hospital No. 5" and the KNP "Kyiv City Hospital No. 3."
In particular, I must say that in 2024, together with Professor Dmytro Govseiev, we published the monograph "Obstetric Hemorrhages," which, among other things, discusses organ-preserving operations for placenta accreta spectrum complications.
The experience of organ-preserving treatment for placenta accreta is a combination of thorough preoperative preparation, a multidisciplinary team (obstetricians, vascular surgeons, anesthesiologists, transfusiologists), and a clear protocol of action.
Techniques such as balloon vascular occlusion, vascular embolization, local resection, leaving part of the placenta under control, staged uterine devascularization, and multidisciplinary interventions involving vascular surgeons and urologists are used.
For a woman with suspected placenta accreta, the choice of the place of birth is a critical decision. But it is important to understand several things: an organ-preserving operation is not possible in all cases, the decision is often made during the operation itself, the main priority is the safety of the woman's life and bleeding control, and in cases of placenta percreta (especially with penetration into the bladder), hysterectomy is still often the safest option.
The best results usually occur when the diagnosis is established during pregnancy—ultrasound and MRI provide us with this opportunity, the birth is planned in advance, and the operation is performed in a center that has experience with placenta accreta operations, a blood bank, intensive care, and a multidisciplinary team.
- What in the current Ukrainian protocol for pregnancy management, in your opinion, needs changes?
Speaking professionally and from the standpoint of evidence-based medicine, Ukrainian standards for pregnancy management have become significantly more modern in recent years—especially after the implementation of the Ministry of Health's 2022 "Normal Pregnancy" standard, which is based on WHO and NICE recommendations.
But there are points that, in my opinion, require attention.
First, a more systematic approach to psychological screening—especially now, in the conditions of war. Depression and anxiety during pregnancy are risk factors for the health of the mother and child.
Second, the unification of access to quality care—the difference between pregnancy management in a large city and in a regional center is still very noticeable. Fewer "unnecessary" prescriptions and treatment "just in case." Currently, there is a trend toward prescribing excessive tests and "treating test results" rather than the patient.
Third, better routing of high-risk pregnancies. For example, the issue of prevention and early detection of pathological placental attachment in women with uterine scars, and the problems of monochorionic twins, should be given more attention at the level of women's consultations, and pregnant women should be timely referred to specialized centers. This can literally save lives.
At the same time, I want to say that Ukrainian obstetrics is actively developing, meets world standards, and finds psychological, physical, and financial resources to provide high-quality care to pregnant women and new mothers. And for this, I have immense respect and gratitude for my colleagues.