Original Articles
 

By Dr. Tajinder Kaur , Dr. Veena Aseeja , Dr. Sujata Sharma
Corresponding Author Dr. Veena Aseeja
Obs and Gynae MMIMSR Mullana Ambala, - India 160104
Submitting Author Dr. Veena Aseeja
Other Authors Dr. Tajinder Kaur
MMIMSR, Mullana, Ambala, - India

Dr. Sujata Sharma
GMCH, Amritsar, - India

OBSTETRICS AND GYNAECOLOGY

Thyroid dysfunction, Dysfunctional uterine bleeding

Kaur T, Aseeja V, Sharma S. Thyroid Dysfunction in Dysfunctional Uterine Bleeding. WebmedCentral OBSTETRICS AND GYNAECOLOGY 2011;2(9):WMC002221
doi: 10.9754/journal.wmc.2011.002221
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Submitted on: 20 Sep 2011 12:42:11 PM GMT
Published on: 20 Sep 2011 02:13:52 PM GMT

Abstract


Dysfunctional uterine bleeding is one of the most frequently encountered conditions in gynecology being principal diagnosis in at least 10% of all new outpatients both in hospital and private practice. The diagnosis depends upon exclusion of general and local disease. It is recognized universally that menstrual disturbances may accompany and even may precede thyroid dysfunction .In the present study thyroid status of patients presenting with dysfunctional uterine bleeding was assessed by TSH assay.

Introduction


Dysfunctional uterine bleeding is one of the most frequently encountered conditions in gynecology and is defined as abnormal bleeding from uterus in absence of organic disease of the genital tract.
It is recognized universally that menstrual disturbances may accompany clinical alterations in thyroid function, and every clinician has encountered altered menstrual patterns among women suffering from hypothyroidism and hyperthyroidism.
Both hypothyroidism and hyperthyroidism may result in menstrual disturbances. Hyperthyroidism reduces menstruation and hypothyroidism causes menorrhagia.
Hyperthyroidism in contrast is associated with amenorrhoea and oligomenorrhoea and the decrease in flow is proportional to the severity of the thyrotoxicosis.

Materials and Methods


For the purpose of study 100 premenopausal women with dysfunctional uterine bleeding were evaluated for their thyroid status by determining their serum. Thyroid stimulating hormone (TSH) levels with the help of panthozyme TSH assay .Patients with TSH level >7IU/ml were considered to have hypothyroidism and those with <0.4IU/ml were considered to have hyperthyroidism.

Observations


Out of total 100 patients studied 14 were found to have hypothyroidism and one was found to have hyperthyroidism, the rest 85% were euthyroid.(Table1)
Of the 14 hypothyroid women 9 (64.3%) had menorrhagia, 2 (14.3%) had metrorrhagia and 3 (21.4%) had oligomenorrhoea, patient with hyperthyroidism was found to have hypomenorrhoea.(Table2)
Of the total of 14 patients with hypothyroidism those with levels below 13.5 had either menorrhagia or metrorrhagia but as TSH levels rises upto 20.0 Oligomenorrhoea was the chief complaint. (Table3)
9(64.3%) hypothyroid patients had proliferative endometrium and 3 (21.4%) had endometrial hyperplasia, both being anovulatory.Two (14.3%) had secretory cycles.

Discussion


Thyroid disorders are more common in women with menstrual irregularities as compared to general population. Both hypothyroidism and hyperthyroidism may result in menstrual disturbances.
Scot and Mussey observed abnormal menstrual pattern in 56% of myxedematous patients. Menorrhagia and metrorrhagia alone or combined constituted abnormal pattern in 75% of patients(4).
Wilansky et al showed a prevalence of 22% of early hypothyroidism by thyrotropin releasing hormone test in menorrhagic women, that is much higher than that found in general female population .(5)
Joschi et al showed 44% of the women with menstrual abnormality were apparently euthyroid. Menstrual irregularity was significantly more frequent in hypo or hyperthyroidism as compared to control cases and in more than 45% of cases this preceded the appearance of goiter or clinical sign and symptoms.(6)
Our study too had apparently euthyroid patients none showing signs and symptoms of thyroid disease but with TSH assay 15 patients were found to have subclinical disease.
Menstrual disturbance in thyrotoxicosis is two and half times more frequent than in normal general population. (7)
Our study showed menstrual irregularities to be significantly more frequent in patient with thyroid dysfunction concluding that systematic study of thyroid function in dysfunctional uterine bleeding is warranted.
Goldsmith demonstrated a 70% occurrence of ovulatory failure in patients with hypothyroidism while 20% had normal ovulation. 72.2% of patients with thyrotoxicosis had ovulatory cycles.(8)
Our study showed 85.7% of hypothyroid patients had anovulatory cycles 14.3% had ovulatory cycles.
These studies shows that thyroid disorder are more common in patients with dysfunctional uterine bleeding. Both hypothyroidism and hyperthyroidism may result in abnormal uterine bleeding.Thyroid function test should be done in patients presenting with dysfunctional uterine bleeding.

Conclusion


The menstrual irregularities are significantly more frequent in patients with thyroid dysfunction and may precede thyroid dysfunction. Further systematic study of thyroid dysfunction in dysfunctional uterine bleeding is warranted.

References


1. Isadore N. Rosenberg. Menstrual instability in thyroid disease. Clin Obstet Gynecol 1969; 12(3): 755-70.
2. Cope E. Dysfunctional uterine bleeding. Br Med J 1971; 2(762): 631-2.
3. Ralph CB and Morris ED. The menstrual pattern in hyperthyroidism and subsequent post therapy hypothyroidism. Surg Gynec Obstet 1955; 100: 19-26.
4. Scot JC and Mussey E. Menstrual patterns in myxedema. Am J Obstet Gynaecol 1964; 90: 161-65.
5. Wilansky DL, Griesman B. Early hypothyroidism in patients with menorrhagia. Am J Obstet Gynaecol 1989; 160:673-7
6. Joschi JV, Bhandarkar SD, Chadha M, Balaiah D, Shah R. Menstrual irregularities and lactation failure may precede thyroid dysfunction on goiter. J Postgrad Med 1993; 39(3): 137-41.
7. Krassas GE, Pontirides N, Kaltsas J, Papadopoulou P, Batrinos M. Menstrual disorders in thyrotoxicosis. Clin Endocrinol 1994; 40 (5): 641-44.
8. Goldsmith RE, Sturgis SH, Leiman J and Standbury JB. J clin Endocrinology 1952; 12: 846-55.

Source(s) of Funding


Nil

Competing Interests


None

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