Role of Thyroid Dysfunction in Patients with Menstrual Disorders in Tertiary Care Center of Walled City of Delhi

The most common type of abnormal uterine bleeding in our study was also menorrhagia. In 2014, among patients with thyrotoxicosis examined by Krassas et al., 11% had hypomenorrhea, 2% had oligomenorrhea, and 7% had polymenorrhea, and the prevalence of any menstrual abnormality was not significantly different from that in controls 14. Kakuno et al. also found no differences in the prevalence of menstrual abnormalities between the control and patient groups in their study involving 586 women with hyperthyroidism due to Graves’ disease. Our results showed a high prevalence of oligomenorrhea in women with hyperthyroidism. Consistent with the literature, the prevalence of these disorders was not significantly different from that observed in our control population. Hyperprolactinemia may occur due to physiological adaptation, or it may be pathological or induced by pharmacological medication (63).

• It is caused by high thyrotropin-releasing hormone (TRH) levels, that stimulate pituitary thyrotrope cells, leading to the enlargement of the pituitary gland 24.
• Databases used for searching articles included Google Scholar, Scopus, PubMed, and Web of science for observational, experimental, and review studies.
• To do this, most will need prescription thyroid hormone replacement medication.
• Thyroid hormone levels were measured in serum of study participants without a history of thyroid disease and who were not currently taking thyroid-disrupting medication.
• Ethical clearance was received from the institutional review committee of KIST Medical College.

Among the patients with metrorrhagia, one case (16.67%) had subclinical hypothyroidism. Timely detection of Thyroid disorder in patients presenting with menstrual disorders and their management can prevent surgical intervention like curettage and hysterectomy. To study the prevalence of thyroid disorders and its correlation with menstrual disorders. While a thyroid condition can lead to an irregular menstrual cycle, medication can help restore a cycle and balance hormones. When taken responsibly and at the correct dosage, thyroid medications will rarely, if ever, negatively impact your menstrual cycle. But, both feedback loops begin in your brain, specifically the hypothalamus, with the release of thyrotropin-releasing hormone (TRH).

Among five hyperthyroid patients, the commonest complaint was hypo/oligomenorrhea followed by amenorrhea. In the study by Kaur 12, the patient with hyperthyroidism was found to have hypomenorrhea. In the study by Padmaleela 14, among the hyperthyroid patients, 42.8 % had menorrhagia, 28.6 % had polymenorrhea, and 14.3 % had hypo/oligomenorrhea. Endocrine glands (pituitary, thyroid, pancreas, adrenal, and ovaries) play a functional role in the endocrine regulation of a women’s menstrual cycle. As a result, endocrine disorders are the triggers of onset of menstrual disturbance across the reproductive lifespan of women. Oligomenorrhea is the most common menstrual disturbance in endocrine disorders.

• All patients of abnormal uterine bleeding attending the gynecology department during this period from puberty to those who have not attended menopause were included.
• Autoimmune conditions potentially related to Hashimoto thyroiditis (such as type I diabetes, coeliac disease, autoimmune gastritis, hypoparathyroidism and Addison disease) were excluded.
• Hypothyroidism usually presents with unspecific symptoms, as fatigue, weight gain, growth retardation, cold intolerance, constipation 2.
• It is recognized universally that menstrual disturbances may accompany and even may precede thyroid dysfunction.
• Non-classical congenital adrenal hyperplasia (NCCAH) is another disorder that may influence the menstrual cycle; the most common manifestations of menstrual disorder in these patients are primary or secondary amenorrhea and oligomenorrhea (94).

Understanding the Impact of Thyroid Medication

• Accurate diagnosis is the first step in how to balance thyroid hormones and treat thyroid dysfunction.
• Accordingly, they can help reregulate the menstrual cycle to stimulate normal blood flow and regular ovulation.
• The prevalence rates of secondary amenorrhea, hypomenorrhea, hypermenorrhea, oligomenorrhea, polymenorrhea, menorrhagia, metrorrhagia, and menometrorrhagia in the patients and controls are shown in Table 2.
• Further studies are needed to identify the unknowns about the association between endocrine disorders and the menstrual cycle.

Because the pituitary gland also governs reproductive functioning, the thyroid and menstrual cycle are believed to be connected. 3 Due to the function of the pituitary gland and increased hormonal imbalance, there could also be a link between thyroid and fertility health. They can order a blood test to measure your thyroid hormone levels and can help you to take the appropriate actions in terms of treatment and medication. Addison’s disease is a rare adrenal disorder characterized by low secretion of adrenocortical hormones (98).

For example, during pregnancy, elevated estrogen levels lead to increased total T4 due to thyroxine-binding globulin (TBG).22 In this study, total T4 was positively correlated with E13G and Pd3G throughout the cycle. Therefore, even given this longitudinal study design, it is difficult to parse out the directionality of these relationships. The aim of this study was to evaluate the frequency and type of menstrual disorders in women with hypothyroidism, hyperthyroidism, and normal thyroid function. Patients without any pathology on physical and laboratory examinations were classified as controls. Furthermore, unlike prior studies, we included patients with subclinical hypothyroidism and hyperthyroidism.

off your first Thyroid Test

According to their results, 32% of the women had a form of thyroid dysfunction, with the majority having either subclinical (mild form) or overt hypothyroidism. Joshi et al. found that 68% of hypothyroid women had menstrual irregularities, compared with only 12% in controls 12. Krassas et al. reported that among 171 hypothyroid women, 23% presented irregular cycles (compared with only synthroid endocrinologist 8% in controls); of those, 17 had oligomenorrhea, 6 hypomenorrhea, 6 amenorrhea, and 12 hypermenorrhea/menorrhagia 13. Among the menstrual irregularities described in literature the most common form is oligomenorrhea 6 and there is an increase in the occurrence of menstrual irregularities with increase in severity of hypothyroidism 14.

The mother referred stunting of growth in the last two years but no previous height measurements were available. The objective examination revealed xerotic and desquamating skin, thinning hair and acanthosis nigricans on neck, armpits and ankles. She presented a mildly enlarged thyroid gland at palpation, also visible at extended head, heart rate was 54 beats per minute, nothing relevant was noted at abdominal and pulmonary examination.

Prolactin hormones are produced by pituitary lactotrophs and play a role in neuroendocrine regulation. Hyperprolactinemia is one of the causes of amenorrhea (absence of menstrual bleeding for three consecutive cycles) (67), and the mechanism suggested for amenorrhea is the suppression of the pulsatile GnRH (68). Also, increasing the level of prolactin can suppress the secretion of luteinizing hormone (LH) and inhibit ovulation in the menstrual cycle (69). Thyroid disorders in general and hypothyroidism in particular are the common causes of menstrual disorders in women. Menarche, pubertal growth and development, menstrual cycles, fertility and fetal development, postpartum period, reproductive years, and postmenopausal years are profoundly influenced by the thyroid status of women. It is recognized universally that menstrual disturbances may accompany and even may precede thyroid dysfunction.

Based on the results, they can determine the type and severity of thyroid dysfunction. It is caused by high thyrotropin-releasing hormone (TRH) levels, that stimulate pituitary thyrotrope cells, leading to the enlargement of the pituitary gland 24. According to this mechanism, with the normalization of the thyroid function we also saw the complete regression of the pituitary hyperplasia after three months. As regards the other findings in our case, the short stature with stunting of growth should have been investigated before with exams including thyroid function. Growth retardation is a common sign in hypothyroidism, due to the great importance of thyroid hormones in growth process. Acromegaly is a rare disease with possible manifestation on menstrual cycle due to the higher levels of prolactin and estrogen deficiency.

This result is quite similar to that of Moghal et al.16 which was about 41 % and quite near to that of the studies of Pilli et al.11 about 34% and Sangeeta Pahwaet al.13 about 50% and Javed Ali et al. about 42%. The second most complaint was polymenorrhoea in 23 (29.11%) patients which are followed by oligomenorrhoea in 12 (15.1%) patients. This study is similar to a study carried out by Kaur et al.17 and Singh P et al.18 in which polymenorrhoea was second most complain accounting for 37.5% cases. Fakhar et al.19 observed menorrhagia in 45% followed by polymenorrhagia in 30% cases.