Effect of War on the Menstrual Cycle Antoine B. Hannoun, MD, Anwar H. Nassar, MD, Ihab M. Usta, MD, Tony G. Zreik, MD, and Antoine A. Abu Musa, MD OBJECTIVE: To study the effect of a short period of war on the menstrual cycles of exposed women. METHODS: Six months after a 16-day war, women in exposed villages aged 15– 45 years were asked to com- plete a questionnaire relating to their menstrual history at the beginning, 3 months after, and 6 months after the war. A control group, not exposed to war, was also interviewed. The data collected were analyzed to esti- mate the effect of war on three groups of women: those who stayed in the war zone for 3–16 days (Group A), those who were displaced within 2 days to safer areas (Group B), and women not exposed to war or displace- ment (Group C-control). RESULTS: More than 35% of women in Group A and 10.5% in Group B had menstrual aberrations 3 months after the cessation of the war. These percentages were significantly different from each other and from that in Group C (2.6%). Six months after the war most women regained their regular menstrual cycles with the excep- tion of 18.6% in Group A. CONCLUSION: We found a short period of war, acting like an acute stressful condition, resulted in menstrual abnormalities in 10 –35% of women and is probably related to the duration of exposure to war. This might last beyond the war time and for more than one or two cycles. In most women the irregular cycles reversed without any medical intervention. (Obstet Gynecol 2007;109:929–32) LEVEL OF EVIDENCE: II R egular menstrual cycles result from the delicate interaction between different organ systems and hormonal response in the female body. The proper functioning of the hypothalamic–pituitary– ovarian axis plays the major role in achieving normal regular menses. 1 Menstrual irregularities can result from or- ganic diseases, but more so from endocrinologic as well as psychologic causes. 1 Stress, whether physical, emotional or psychologic has been shown to cause menstrual perturbations. 2–4 Many epidemiologic studies tackled the associa- tion between chronic stressful conditions and men- strual aberrations. Environmental stresses can vary from mild changes in life conditions to severe, drastic ones like periods of war. Difficult life conditions, 5 changes in occupation, 6 stressful jobs, 4 school exami- nations, 7 and midlife changes, 3 were all associated with menstrual irregularities. War times are among the most stressful condi- tions that people face. Very old reports showed the association between long periods of war and men- strual dysfunction. Before the time of execution, 8 and during World War II, many imprisoned women suffered from amenorrhea. 9,10 The more recent liter- ature dealing with the effect of war times on the menstrual cycle is scarce. During the Desert Storm war in 1996 in Iraq, many women soldiers experi- enced menstrual irregularities. 11,12 Although long periods of war might affect men- strual cycles, the effect of a short period of war on these cycles has not been evaluated. In this study, the menstrual aberrations in women subjected to a short period of war are reported. MATERIALS AND METHODS The study was approved by the Institutional Review Board at the American University of Beirut, and it targeted civilian women living in small towns and villages in southern Lebanon that were subjected to 16 days of shelling and bombardment from April 11–27, 1996. Those women either stayed in their villages or were displaced into safer areas. The reason for the displacement was fear of death and the availability of dwellings in safer places. Six months after cessation of the war, social workers went to those villages and interviewed non- pregnant and nonlactating women, aged 15– 45 years, and completed a questionnaire related to their men- From the American University of Beirut Medical Center, Beirut, Lebanon. Corresponding author: Antoine Hannoun, MD, American University of Beirut, Medical Center, Beirut, Lebanon; e-mail: ahannoun@aub.edu.lb. © 2007 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/07 VOL. 109, NO. 4, APRIL 2007 OBSTETRICS & GYNECOLOGY 929