Abnormal uterine bleeding in relation to thyroid dysfunction

Authors

  • H. C. Sudha Department of Obstetrics and Gynecology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
  • K. M. Sunanda Department of Obstetrics and Gynecology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
  • Anitha G. S. Department of Obstetrics and Gynecology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20184501

Keywords:

AUB, DUB, Hyperthyroid, Hypothyroid, Inter menstrual bleeding, Menorrhagia, Metrorragia, Polymenorrhoea, Thyroid, TSH

Abstract

Background: Abnormal uterine bleeding is an abnormal bleeding from the uterus in absence of any organic disease of genital tract and demonstrable extra genital causes. Thyroid dysfunction is marked by large number of menstrual abnormalities. This study is aimed at detecting thyroid dysfunction in patients with provisional diagnosis of AUB (abnormal uterine bleeding).and refer positive cases to physician for further management.

Methods: All patients from are from puberty to pre-menopausal age groups, presenting as menoraghia, metrorragia, polymenorrhoea, polymenorragia, hypomenorrhoea, and acyclical bleeding. Onset, duration, amount of bleeding, complaints related to thyroid dysfunction was noted in detail. A thorough clinical examination including general physical examination, neck examination, systemic and gynecological examination was carried out, with special reference to thyroid dysfunction. A provisional clinical diagnosis of DUB was made. Patients with clinical signs and symptoms of thyroid disease were excluded. All these patients were subjected to routine investigations like Hb%, blood counts, urine routine, and bleeding and clotting time to rule out coagulation defects. Then all were subjected for serum T3, T4, and TSH estimation. Patients were then grouped into 4 categories: euthyroid, subclinical lhypothyroid, hypothyroid, and hyperthyroid. Patients who had thyroid disease, on hormonal treatment, IUCD users, and bleeding disorders were excluded.

Results: Among 100 patients studied with abnormal uterine bleeding, patients were distributed according to age groups from puberty to perimenopause age. Majority of patients belongs to 31-40 years of age about 40% and the least age group were between 41-45 years of age.(7%).Among different parity status AUB was more common among para three patients(26%). Out of 100 patients, 32% of patients had thyroid dysfunction of which 16% of patients had subclinical hypothyroidism. 15% of patients had hypothyroidism and only 2% of patients had hyperthyroidism. The commonest bleeding abnormality in AUB were polymenorrhoea (30%) and menorrhagia (35%). All hyperthyroid cases were oligomenorrhoeic.

Conclusions: This study concludes that thyroid dysfunction should be considered as an important etiological factor for menstrual abnormality. The biochemical evaluation of T3, T4, and TSH estimations should be made mandatory in AUB cases to detect apparent and occult thyroid dysfunction.

References

Davey da, Dewhurst, text book of Obstetrics and Gynecology. chapter 40,5th ed,1990; pp 590-600.

William J Butler. Normal and abnormal uterine bleeding. In: Telendes Operative Gynecology. 8th ed; 1996: 453-473.

Nicholson WK, Ellison SA, Grason H, Powe NR. Of ambulatory care use for gynecologic conditions; A national study. Am J Obstet Gynecol. 2001;184(4):523-30.

Topper YJ. Multiple hormone interactions in the development of mammary gland in vitro. InProceedings of the 1969 Laurentian Hormone Conference 1970. pp. 287-308.

Poppe K, Glinoer D. Thyroid autoimmunity and hypothyroidism before and during pregnancy. Human Reproduct Update. 2003;9(2):149-61.

Mohanty S, Amruthlal W, Reddy GC, Kusumanjali G, Kanagasabapathy AS, Rao P. Diagnostic strategies for subclinical hypothyroidism. Indian J Clinic Biochem. 2008;23(3):279.

Singh L, Agarwai CG, Chowdhary SR, Mehra P, Khare R. Thyroid profile in infertile women. J Obstet Gynecol India. 1990;40:248.

Wilansky DL, Greisman B. Early hypothyroidism in patients with menorrhagia. Am J Obstet Gynecol. 1989;160(3):673-7.

Danese MD, Powe NR, Sawin CT, Ladenson PW. Screening for mild thyroid failure at the periodic health examination: a decision and cost-effectiveness analysis. Jama. 1996;276(4):285-92.

Ingbar SH, Wiwams RH. Text book of endocrinology. 7th ed; 1985:792.

Doifode CD, Fernades K. Study of Thyroid dysfunction in patients with DUB. J Obstet Gynecol India. 2001:51(2);93-5.

Mukherjee J, Chowdhary NR. A review of 70 cases of puberty menorrhagia. J Obst and Gynaec of India. 1986:121.

Mukherjee K, Ghosh AK. Thyroid prolactin related menstruation. J Obstet Gynecol India. 1985;35:549-2.

Downloads

Published

2018-10-25

Issue

Section

Original Research Articles