ABSTRACT

Corresponding Author:
Dr. Shiva Kumar H. C,
Plot No. 48, Ward No. 31,
West 2nd Cross, Soudaghar Colony,
Bellary-583104.
E-mail: dr.hcshivkumar@gmail.com

ABSTRACT

BACKGROUND AND OBJECTIVES

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 aimed at detecting thyroid dysfunction and further evaluating in patients with a provisional diagnosis of DUB.

METHODS

One hundred cases of clinically diagnosed DUB were taken from Gynaecology OPD and in patients of OBG Department VIMS, Bellary. All patients from puberty to premenopausal age groups presenting as menorrhagia, acyclical metropathia, polymenorrhagia, metrorrhagia, oligomenorrhoea, polymenorrhoea and hypomenorrhoea were tested for their thyroid function by T3, T4, TSH estimations in their serum. Patients who had clinical symptoms and signs of thyroid disease, was on hormonal treatment, IUCD users, or had bleeding disorders were excluded from the study.

RESULTS

A 23% of patients who were studied had thyroid dysfunction of which 13% of patients had subclinical hypothyroidism, 7% of patients had hypothyroidism and only 3% of patients had hyperthyroidism. The commonest bleeding abnormality in subclinical hypothyroid patients were polymenorrhoea and menorrhagia. All hyperthyroid cases were oligomenorrhoeic.

CONCLUSION

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

Dysfunction Uterine Bleeding (DUB), Thyroid Dysfunction, Hypothyroidism, Subclinical Hypothyroidism,

INTRODUCTION

Dysfunctional uterine bleeding is one of the most frequently encountered conditions in gynaecology and is defined as abnormal bleeding from uterus in absence of organic disease of the genital tract. It is recognized universally that menstrual disturbances may accompany clinical alterations in thyroid function, and every clinician has encountered altered menstrual patterns among women suffering from hypothyroidism and hyperthyroidism.

Both hypothyroidism and hyperthyroidism may result in menstrual disturbances. Hyperthyroidism reduces menstruation and hypothyroidism causes menorrhagia. Hyperthyroidism in contrast is associated with a menorrhagia and oligomenorrhoea and the decrease in flow is proportional to the severity of the thyrotoxicosis.¹

DISCUSSION

Thyroid dysfunction is marked by large number of menstrual abnormalities. Our study includes <20 to >45 years and majority 31-40 years similar to Charusheela et al.² Maximum number of patients with thyroid dysfunction in our study were unmarried (Adolescent) 25% and multiparous 43.4%, whereas in Doifode et al., primi para 33.33% were maximum. Thyroid dysfunction was commonest in the age group (31-40 years), both in the present study (43.4%) and also in the Doifode et al. (48.33%). In less than 20 years, 26% had thyroid dysfunction, whereas it was 11.67% in Doifode et al. 23.33% of patients with thyroid dysfunction belonged to age group above 40 years in Doifode et al. compared to 13.04% in our study.

In our study and Doifode et al., the commonest complaint was menorrhagia. In our study hypothyroidism was the commonest 20% and also in Doifode et al. 28.16% and by Kaur et al. 14%.^2,3 Menorrhagia was the commonest menstrual abnormality in our hypothyroid patients 40% similar to C.D. Doi Fode et al. (63.3%), Singh et al. (44.4%), Willansky and Bernard et al. (100%).^4,5 In our study polymenorrhoea and polymenorrhagia, both together was the menstrual abnormality in 20% of hypothyroid cases. Oligomenorrhoea was the menstrual pattern in 15% of hypothyroid patient. In C.D. Doi Fode et al. Polymenorrhagia was present in 23.33% of hypothyroid patients.

Subclinical hypothyroidism is diagnosed in cases with normal levels of T3 and T4 [Low normal levels] and raised TSH levels, i.e. (Slightly raised). In our study, 13% had subclinical hypothyroidism almost similar to Douglas L et al. 18.75%.²

In our study less than 20 age group menorrhagic patients, 22.22% had hypothyroidism and in Jayadev Mukherji et al. 7% were hypothyroid.⁶

Among our oligomenorrhoea cases, age group ranged from <20 to >40 years, Kalyani Mukherjee et al. age ranged 25-39 years. Thyroid dysfunction in oligomenorrhoea patients in our study is 31.6% and in Kalyani Mukherjee et al. is 80%. In our study 15.3% were hyperthyroid, 15.3% were having hypothyroidism, but no cases of hyperthyroid in Kalyani Mukherjee et al.^7,8 Among cases of oligomenorrhoea Lakshmi Singh et al. conducted on infertile patients with menstrual aberrations, cases of oligomenorrhoea showed 64% of hyperthyroidism and 36% of hypothyroidism.

In our study patients with oligomenorrhoea and thyroid dysfunction showed 50% of hyperthyroid and 50% of hypothyroid cases. In our study hyperthyroidism was seen only in cases of oligomenorrhoea. In Lakshmi Singh et al. hyperthyroidism was seen in 64% of cases with oligomenorrhoea. So in both studies oligomenorrhoea was the commonest menstrual aberration among hyperthyroid patient.^4,9

CONCLUSION

Thyroid dysfunction should be considered as an important etiological factor for menstrual abnormality. Thus biochemical evaluation of T3, T4 and TSH estimations should be made mandatory in DUB cases to detect apparent and occult thyroid dysfunction. These patients with thyroid dysfunction if given medical treatment avoids necessity of hormonal treatment or surgical intervention.

BIBLIOGRAPHY

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