NEUROENDOCRINE AND AUTONOMIC MECHANISMS OF MENSTRUAL CYCLE DISORDERS IN ADOLESCENT GIRLS: PROGNOSTIC ASSESSMENT USING ROC ANALYSIS

Menstrual cycle disorders (MCD) in adolescent girls frequently co-occur with autonomic dysfunction (AD), forming a persistent clinico-functional complex that compromises quality of life and increases the risk of chronic reproductive and psychosomatic disorders. Objective. To investigate the clinical and diagnostic interdependence of autonomic dysfunction and menstrual cycle disorders in adolescent girls, identifying clinical and functional markers of autonomic regulation associated with the pattern and severity of menstrual irregularities. Materials and methods. The study cohort comprised 79 adolescent girls aged 13–18 years presenting with MCD and signs of AD (study group), alongside 29 apparently healthy adolescents serving as controls. Autonomic status was evaluated using the Wayne scale and the Kerdo index. All patients underwent pelvic ultrasonography; brain magnetic resonance imaging was performed when clinically indicated Hormonal evaluation included thyroid-stimulating hormone, prolactin, luteinizing hormone, follicle-stimulating hormone, and testosterone levels. Receiver operating characteristic (ROC) analysis was employed. The study was conducted following the ethical principles for biomedical research, and the protocol was approved by the Local Ethics Committee of Samarkand State Medical University. All procedures were performed in accordance with the 2013 revision of the Declaration of Helsinki of the World Medical Association. Written informed consent was obtained from all participants or their legal representatives prior to enrollment. Patient data confidentiality was strictly maintained throughout the study. Statistical analyses were performed using the Statistica and SPSS software packages, with statistical significance set at p < 0.05. This work was conducted as part of the research program of Samarkand State Medical University, titled "Optimization of early diagnostic, therapeutic, and preventive strategies for pathological conditions affecting public health in the Samarkand Region" (2022–2026). Results. Asthenic complaints were reported by 63.3% of patients in the study group compared with 13.8% in the control group (p < 0,001). Ovarian abnormalities were detected by ultrasonography in 57.0% of patients. Elevated prolactin levels were recorded in 32.9%, thyroid-stimulating hormone abnormalities in 29.1%, and increased testosterone concentrations in 24.1% of cases. Receiver operating characteristic analysis indicated that the Wayne scale (area under the curve [AUC] = 0.82; 95% confidence interval [CI]: 0.73–0.91) and the Kerdo index (AUC = 0.79; 95% CI: 0.69–0.88) exhibited the highest prognostic value. These findings corroborate the predominant role of the autonomic nervous system and neuroendocrine mechanisms in the pathogenesis of menstrual cycle disorders in adolescent girls. The severity of clinical and autonomic manifestations was significantly greater in the study group than in the control group, underscoring the significance of autonomic dysfunction as a primary pathogenetic factor of reproductive disorders during adolescence. Instrumental and laboratory data demonstrated a close association between functional alterations in autonomic regulation and hormonal disturbances of the hypothalamic-pituitary-ovarian and thyroid axes. The absence of structural alterations in the hypothalamic-pituitary region on magnetic resonance imaging among the examined patients emphasizes the predominantly functional nature of the identified disorders. The substantial prognostic value of hormonal and ultrasonographic parameters justifies their inclusion in a comprehensive diagnostic algorithm for adolescents presenting with this condition. Conclusions. Autonomic dysfunction and neuroendocrine dysregulation play a pivotal role in the development and progression of menstrual cycle disorders in adolescent girls. The Wayne scale and the Kerdo index serve as informative prognostic tools with high sensitivity and specificity. An integrative diagnostic approach incorporating clinical, autonomic, hormonal, and instrumental data is justified for this patient population.

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