Menstrual Cycle Characteristics in Women With and Without Thyroid Disease

Conversely, thyroid function should be evaluated in women presenting with abnormal uterine bleeding. Menstrual disorders pose a huge burden on gynecology OPD, accounting for approximately 20% of attendance 1. Thyroid hormones play an important role in normal reproductive physiology through direct effects on the ovaries and indirectly by interacting with sex hormone-binding globulin. 100 women aged between 15 and 45 years who attended gyne OPD in Kasturba Hospital, Delhi, were included for this cross-sectional study.

4. Menstrual Cycle Disturbances in Women with Thyroid Disease

Among the patients with hypo/oligomenorrhea, one case (10 %) had subclinical hypothyroidism, one case (10 %) had overt hypothyroidism, one case (10 %) had subclinical hyperthyroidism, and three cases (30 %) had overt hyperthyroidism. Thyroid dysfunction is an important causative etiology of menstrual abnormalities. Assessment of thyroid function should be done in all patients with menstrual disorders to avoid unnecessary interventions like curettage and hysterectomy. Healthcare providers typically perform blood tests to measure thyroid hormone levels, including thyroid-stimulating hormone (TSH), T3, and T4.

Table 3. Type and frequency of menstrual disorders in patients with mild, moderate, and severe hypothyroidism.

In a normal menstrual cycle, prolactin level decreases in the follicular phase and rises in luteal phases (64). Prolactin also stimulates progesterone synthesis in follicles granulosa cells (64). Prolactin-releasing factors include thyrotropin-releasing hormone (TRH), serotonin, opioids, and other neuropeptides and neurotransmitters (64). The mean prevalence of prolactinemia in women is 30 per 100,000, the peak prevalence of which is seen between 25 to 34 years of life (65). The link between hyperprolactinemia and menstrual irregularity is well established (24).

We underline the importance of a regular follow up of the pubertal development, including height measurements, thyroid palpation and menstrual anamnesis to intercept red flags findings for hypothyroidism. It can take up to 8 weeks for thyroid hormone replacement medications to become fully effective. Hypothyroidism can also interfere with your blood clotting factors, and your blood can take longer to clot.

On the other hand, Kakuno et al. reported that the incidence of menstrual disturbances was similar among 586 women with hyperthyroidism (18.3%), 111 women with hypothyroidism (15.3%) and 105 healthy controls (23.8%) 15. Endocrine disorders trigger the onset of menstrual disturbance across the reproductive lifespan of women. Endocrine glands (pituitary, thyroid, pancreas, adrenal, and ovaries) have a functional role in endocrine regulation of the menstrual cycle. According to available evidence, oligomenorrhea (cycles longer than 35 days) is the most common menstrual disturbance among endocrine disorders (thyrotoxicosis, hypothyroidism, polycystic ovary syndrome, Cushing’s syndrome, and diabetes). Complex endocrine pathways play an essential role in a women’s menstrual calendar.

• Among the patients with polymenorrhea, two cases (25 %) had subclinical hypothyroidism and 2 (25 %) had overt hypothyroidism.
• This study is similar to study carried out by Kumar AHS et al.22 in which out of 200 cases 162 (81 %) cases were euthyroid, 38 (19%) cases had thyroid dysfunction out of which 33 (16.5%) were hypothyroid and 5 (2.5%) were hyperthyroid.
• A 2018 study screened 100 perimenopausal women with a provisional diagnosis of AUB for thyroid dysfunction.

Primarily, it controls metabolism and energy use, but it serves additional purposes, too. For data analysis, patients without any pathology on physical and laboratory examinations were classified as controls. In the second day of hospitalization, she required a red blood cells transfusion for worsening of anemia (hemoglobin 6,3 g/dl).

• The first line of treatment for hyperprolactinemia is the use of dopamine antagonist (DA) medications, and it has been shown that Cabergoline has been more efficacious than bromocriptine (70, 71).
• Currently, although the same studies focus on a menstrual abnormality in different endocrine disorders, there is no comprehensive study that has searched and summarized these studies.
• Since thyroid dysfunction is an important treatable cause of menstrual disorder, estimation of thyroid status should be a part of the battery of investigations being done in the patients of menstrual disorders.
• Pahwa 13 found a total of 22 hypothyroid patients, in which 16 (78.94 %) had menorrhagia and 4 (10.5 %) had polymenorrhea.

The prevalence rates of secondary amenorrhea, hypomenorrhea, hypermenorrhea, oligomenorrhea, polymenorrhea, menorrhagia, metrorrhagia, and menometrorrhagia in the patients and controls are shown in Table 2. Blood levels of free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were measured, and thyroid Doppler ultrasonography was performed on all patients. So, we can see that atrophic endometrium (60 %) is the commonest histopathological finding in women with hyperthyroidism and proliferative endometrium (42.85 %) with hypothyroidism.

The control group consisted of 50 women of same age group with complaints other than menstrual disorders. Thyroid function tests, anti-TPO antibody estimation, and endometrial sampling were done in all patients. Data available on the subject of women’s reproductive health show menstrual disorders to be a fundamental problem (8, 9). The prevalence of irregular menstrual cycles in women varies from 14.2% to 27% in different regions of the world (10, 11).

Every month, a woman’s body goes through hormonal changes to prepare the body for a possible pregnancy. A total of 79 patients were included in our study after satisfying all inclusion and exclusion criteria. The data were collected and entered in MS-Excel 2007 and analyzed using the Statistical Package for Social Sciences (SPSS) version 20 software. Out of all the types of menstrual synthroid ppi irregularities, 25 (50 %) presented with menorrhagia, 10 (20 %) had hypo/oligomenorrhea, 8 (16 %) had polymenorrhea, 6 (12 %) had metrorrhagia, and 1 (2 %) had amenorrhea (Table 1). Thyroid dysfunction, whether overactive or underactive, can impact the menstrual cycle.

Data was collected using a questionnaire which includes patients profile, the pattern of abnormal uterine bleeding, and thyroid profile. Statistical analysis was done using Statistical Package for the Social Sciences version 23. Treating thyroid dysfunction and its subsequent impact on the menstrual cycle is best achieved through a collaborative approach between an individual and healthcare provider. Individuals should communicate openly with their healthcare providers, share their symptoms and concerns, and adhere to their treatment plans for optimal results.