Thyroid Dysfunction in Patients with Abnormal Uterine Bleeding in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Abstract

Introduction: Abnormal uterine bleeding is a common gynecological presentation, accounting forat least 20% of all new outpatient visits. It has been recognized that thyroid dysfunction may haveprofound effects on the female reproductive system. Both hypothyroidism and hyperthyroidism areassociated with a variety of changes, including delayed onset of puberty, anovulatory cycles, andabnormally high fetal wastage. Hence, this study was conducted to know the thyroid status of thepatient with abnormal uterine bleeding.
 Methods: A descriptive cross-sectional study was conducted in all the patients with abnormaluterine bleeding in a tertiary care hospital from 2 August 2019 to 2 February 2020. Ethical clearancewas received from the institutional review committee of KIST Medical College. Convenient samplingwas done. Data was collected using a questionnaire which includes patients profile, the pattern ofabnormal uterine bleeding, and thyroid profile. Statistical analysis was done using Statistical Packagefor the Social Sciences version 23.
 Results: Out of 79 patients, it was found that 67 (84.8%) were euthyroid, 11 (13.9%) were hypothyroid,and 1 (1.2%) was hyperthyroidism. The most common type of abnormal uterine bleeding wasmenorrhagia 34 (43%), followed by polymenorrhoea 23 (29%), oligomenorrhoea 13 (16.5%),menometrorrhagia 6 (7.6%), metrorrhagia 2 (2.5%), and hypomenorrhea 1 (1.3%). The maximumnumber of patients was between 20-25 years with the mean age of 31 years. Among hypothyroid, 7(8.8%) had subclinical hypothyroidism and 4 (5%) had frank hypothyroidism.
 Conclusions: Most females with abnormal uterine bleeding were euthyroid. Menorrhagia was themost common pattern of abnormal uterine bleeding.

Thyroid Dysfunction in Patient with Abnormal Uterine Bleeding in a Tertiary Hospital of Eastern Nepal: A Descriptive Cross-sectional Study

“…Hypothyroidism is generally known to cause heavy and irregular menstrual bleeding and hyperthyroidism is generally associated with hypo, oligo and amenorrhoea. 1 Our finding is similar to studies done in Nepal and India where researchers also found majority of AUB cases associated with euthyroidism followed by hypothyroidism, Subedi, et al 10 found 89.3% cases were euthyroid and 9.3% hypothyroid; Thakur, et al 11 found 84.9% as euthyroid and 13.9% hypothyroid; Kattel, et al 4 found 80% cases euthyroid and 11.1% as subclinical hypothyroid; Bhavani, et al 12 found 81% cases as euthyroid and 10% as subclinical hypothyroid; Gowri M, et al 13 found 77.6% cases as euthyroid and 17.6% cases as hypothyroid. In contrast according to Ajmani, et al 14 44% of the patients with menstrual disorder had thyroid disorders.…”

Abnormal uterine bleeding in women of reproductive age

“…A disturbance of the hypothalamic-pituitary function is a less common cause. Additionally, other hormonal disbalances may be accompanied by anovulatory bleeding, such as diseases of the thyroid gland (hypothyroidism, hyperthyroidism), diseases of the adrenal glands, and diabetes mellitus [27,28]. Hyperprolactinemia and elevated levels of cortisol (Cushing's syndrome) can also lead to anovulation.…”

“…Hyperprolactinemia and elevated levels of cortisol (Cushing's syndrome) can also lead to anovulation. Less frequently, the causes can be eating disorders (anorexia, bulimia), chronic disease, alcoholism, drug abuse, and stress [4,27,28].…”

“…Ređi uzrok je poremećaj hipotalamo-hipofizne funkcije. Uz to, i drugi hormonski poremećaji mogu biti praćeni anovulatornim krvarenjem, kao što su oboljenja tiroidne žlezde (hipotireoidizam, hipertireoidizam), nadbubrežne žlezde i diabetes mellitus [27,28]. Hiperprolaktinemija i povišene vrednosti kortizola (Kušingov sindrom) takođe mogu dovesti do anovulacije.…”

“…Hiperprolaktinemija i povišene vrednosti kortizola (Kušingov sindrom) takođe mogu dovesti do anovulacije. Ređe, uzroci su poremećaji ishrane (anoreksija, bulimija), hronične bolesti, alkoholizam, zloupotreba droga, kao i stres [4,27,28].…”