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DOI: 10.18203/2320-1770.ijrcog20150077
Research Article
*Correspondence:
Dr. Prasad Yeshwant Deshmukh,
E-mail: drpydeshmukh@gmail.com
Copyright: the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Dysfunctional uterine bleeding is an abnormal bleeding from the uterus in absence of organic disease
of genital tract and demonstrable extragenital cause. Thyroid dysfunction is marked by large number of menstrual
aberrations. This study is aimed at detecting thyroid dysfunction in patients with provisional diagnosis of AUB and
refers positive cases to physician for further evaluation.
Methods: 100 cases of clinically diagnosed AUB were taken from Gynaecology OPD and inpatients of MGM
hospital, Kalamboli. All patients from 19 to 45 age groups presenting as menorrhagia, acyclical metropathia,
polymenorrhagia, metrorhhagia, oligomenorrhoea, polymenorrhoea and hypomenorrhoea were tested for their thyroid
function by T3, T4, TSH estimations in their serum. Patients who had clinical signs and symptoms of thyroid disease,
were on hormonal treatment, IUCD users, or had bleeding disorders were excluded from the study.
Results: 30% of patients who were studied had thyroid dysfunction, of which 18% of patients had subclinical
hypothyroidism, 9% of patients had hypothyroidism and only 3% of patients had hyperthyroidism. The commonest
bleeding abnormalities in subclinical hypothyroid patients were polymenorrhaggia and menorrhaggia. Most of the
hyperthyroid cases were oligomenorrhoeic.
Conclusions: Both subclinical hypothyroid and profoundly hypothyroid cases together were the commonest thyroid
dysfunction and menorrhagia was their commonest menstrual abnormality. So this study concludes that, biochemical
evaluation of thyroid functioning should be made mandatory in all provisionally diagnosed cases of DUB to detect
thyroid dysfunction.
Keywords: Dysfunctional uterine bleeding, Abnormal uterine bleeding, Thyroid dysfunction, Hypothyroidism,
Subclinical hypothyroidism, Hyperthyroidism, Menstrual disorders
Women who experience abnormal uterine bleeding will It has been stated that menorrhagia is more common in
often present to a physician because of a subsequent hypothyroidism or myxoedema, whilst anovulation or
negative impact on their daily lives and activities.2,3 oligomenorrhoea is common in hyperthyroidism. The
Abnormal uterine bleeding has been shown to adversely relative frequency and type of menstrual disorders and
affect mood, energy/vitality, work productivity, social the chronology of the onset of reproductive dysfunction
interactions, family life and sexual functioning.4,5 The with respect to the onset and type of thyroid disorder
effect abnormal uterine bleeding has on a womens have not been well defined. It is common practice to
Health Related Quality of Life (HRQL) derives from both investigate for thyroid functions when goiter or clinical
the efforts associated with managing menstrual bleeding symptoms and signs are present.
and the consequences of excessive blood loss, such as
fatigue and iron deficiency anaemia.6 METHODS
Abnormality of menstruation is primarily a disorder of The present study has been carried out at Obstetrics and
hypothalamico-pituitary-ovarian axis either through Gynaecology outpatient department of MGM Medical
direct effect or indirectly by their effect on target organ. College and Hospital; Kalamboli. The study consists of
Endocrinological disturbances other than the reproductive 100 patients coming to OPD with complaints of abnormal
hormones form a small but significant sub-group in the uterine bleeding from May 2011 to November 2013.
aetiopathogenesis of abnormal uterine bleeding. Amongst
the endocrinological causes, after the pituitary, thyroid is Sample size
probably the most important endocrine organ which
exerts a broad range of effects on the development, 100 patients
growth, metabolism and function of virtually every organ
system in the human body.7 Ethical committee approval
Alterations in production and activity of the thyroid Permission from ethical committee of MGM Hospital had
hormones thyroxine (T 4) and tri-iodothyronine (T3) may been taken before starting the proposed study and
result in menstrual abnormality. Both hyperthyroidism informed consent from all the subjects recruited in the
and hypothyroidism may result in menstrual disturbances. present study was obtained beforehand.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 4 Issue 3 Page 702
Deshmukh PY et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):701-708
with respect to onset, duration, amount of bleeding and Total number of patients studied was 100.
any other associated menstrual complaints. Any
complaint regarding thyroid dysfunction was recorded. Table 1: Distribution of patients according to age.
1. Serum T3
2. Serum T4 Figure 1: Distribution of patients according to age.
3. Serum TSH
Table 2: Distribution of patients according to parity.
Considering their normal values; patients were
categorized into four groups as follows: No. of
Percentage
patients
1. Euthyroid Unmarried 19 19%
2. Subclinical hypothyroid 0 09 09%
3. Hypothyroid 1 10 10%
4. Hyperthyroid 2 24 24%
3 18 18%
RESULTS
4 11 11%
5 09 09%
Dysfunctional uterine bleeding is one of the most
frequently encountered condition in gynaecological 100 100%
practice.
The above column shows relationship of DUB with
The following tables will analyse: parity. Among 100 cases of DUB, 19 patients were
unmarried and nulliparas were 9. 10 patients were para 1.
1. Age 11 patients were para 4. 9 patients were para 5. In this
2. Parity study maximum number of patients were para 2 (24%)
3. Symptomatology of DUB and minimum number of patients presenting as clinical
4. Association with thyroid dysfunction DUB were of para 5 and nulliparas.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 4 Issue 3 Page 703
Deshmukh PY et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):701-708
The above column shows 100 patients who came with the
complaint of different bleeding pattern. Commonest was
UNMARRIED
menorrhagia 40%. Among others 18% presented with
9 0 acyclical, 15% with oligomenorrhoea, 18% had
19
11 1 polymenorrhagia, 4% had polymenorrhoea, 2% had
9 hypomenorrhoea, 3% had metrorrhagia. Maximum
2 patients were seen with complaint of menorhhagia,
18
10 3 following which polymenorrhagia and acyclical bleeding
24 4 was seen (18% each).
5 NO OF CASES
45
40
35
Figure 2: Distribution of patients according to parity.
30
No. of patients
Table 3: Distribution of patients according to bleeding 25
pattern. 20
15
No. of 10
Type of bleeding Percentage
cases
5
Acyclical 18 18%
0
Hypomenorrhoea 2 2%
Menorrhagia 40 40%
Metrorhhagia 3 3%
Oligomenorrhoea 15 15%
Polymenorrhagia 18 18% Pattern of bleeding
Polymenorrhoea 4 4%
Total 100 100% Figure 3: Distribution of patients according to
bleeding pattern.
14
12 0
10
Followed by acyclical bleeding (36.3%). 8 21-30
6
Oligomenorhoea was present in 4.5% of the cases. 4 31-40
2
0 41-50
Similarly in age group 21-30 years and 31-40 years,
the commonest bleeding pattern was menorrhagia.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 4 Issue 3 Page 704
Deshmukh PY et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):701-708
No. of Euthyroid
Thyroid function Percentage
cases 3
Euthyroid 70 70%
18
Hypothyroid 9 9% Hypothyroid
Subclinical hypothyroid 18 18%
9
Hyperthyroid 3 3%
Total 100 100% 70 Subclinical
Hypothyroid
According to this Table 5, maximum number of
apparently normal patients with DUB belonged to the Hyperthyroid
category of subclinical hypothyroidism (18%). Hormonal
levels revealing profound hypothyroidism in patients
without any symptoms was present in only 9% of cases.
3% of cases had hyperthyroidism though they were
clinically normal. Figure 5: Distribution of patients as per thyroid
function.
Total thyroid
No. of Hypo Sub Hyper
Age Euthyroid dysfunction
cases thyroid hypothyroid thyroid
%
20 22 15 4 3 0 7 31.8%
21-30 27 21 2 2 2 6 22.2%
31-40 44 30 1 12 1 14 31.8%
41-45 7 4 2 1 0 3 42.8%
Total 100 70 9 18 3 30
This Table 6 shows the relationship between thyroid Table 7 shows the relationship of hypothyroidism,
dysfunction to different age groups. Thyroid dysfunction subclinical hypothyroidism and hyperthyroidism to the
was commonest in the age group of 41-45 years (42.8%). different types of clinically diagnosed cases of DUB.
Followed with 31.8% in 31-40 and 20 years. Thyroid
dysfunction was least common in the age group of 21-30 In acyclical metropathia, patients were hypothyroid in
years (22.2%). This shows that thyroid dysfunction 11.1% of cases and 11.1% of patients had subclinical
becomes more common as age advances and in this study hypothyroidism. Whereas in patients with menorrhagia
it is commonly seen in age group of more than 41-45 20% of patients had hypothyroidism and 12.5% of
years. patients had subclinical hypothyroidism. Patients with
oligomenorrhoea had hyperthyroidism in 13.33% of
40
patients, hypothyroidism in 60% of patients and
35 20 subclinical hypothyroidism in 6.66%. In polymenorrhoea
30
patients 83.3% of cases had profound hypothyroidism.
No. of patients
25 21 - 30
20
15 31 -40
10 So patients who were subclinically hypothyroid were
5 41 - 50 maximally presenting as polymenorrhoea (50%) and
0
menorrhagia (12.5%) and only 6.66% of patients had
oligomenorrhoea. Patients who were profound
hypothyroid were predominantly having polymenorrhagia
(83.33%) and (60%) of patients had oligomenorrhoea.
Age groups On the other hand patients who were hypothyroid also
presented as oligomenorrhoea.
Figure 6: Thyroid dysfunction in different age Subclinical hypothyroid patients have polymenorrhoea
groups. and menorrhagia as their commonest bleeding pattern.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 4 Issue 3 Page 705
Deshmukh PY et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):701-708
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 4 Issue 3 Page 706
Deshmukh PY et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):701-708
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 4 Issue 3 Page 707
Deshmukh PY et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):701-708
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 4 Issue 3 Page 708