Endocrine Abstracts

Menstrual disorders pose a huge burden on gynecology OPD, accounting for approximately 20% of attendance Thyroid hormones play an important role in reproductive function by direct effects on ovaries and indirectly influencing on sex hormone-binding globulin. Thyroid impairment can cause menstrual irregularities and infertility. In India, thyroid disorders are most common endocrine diseases. Thyroid disorders manifestation increases with age, and approximately 26% of premenopausal and menopausal women have thyroid pathology. Thyroid disorders are more common in women than in men and older people suffer more often than younger age groups. Hypothyroidism is linked to a large range of reproductive disorders: abnormal sexual development, menstrual irregularities, and infertility. The impact of hypothyroidism on the menstrual cycle has been identified since the 1950s and it leads to changes in cycle length and blood flow. Subclinical hypothyroidism has been associated with occult menorrhagia (mild disturbances in menstrual volume and duration) before becoming symptomatic. Subclinical hypothyroidism occurs in 9.5% of women. Hyperthyroidism manifesting before puberty delays the menarche. In women of fertile age, oligomenorrhea and amenorrhea are the commonest abnormalities associated with hyperthyroidism. These irregularities sometimes precede thyroid dysfunction. Nowadays subclinical hyper- and hypothyroidism can be diagnosed very early, while a few decades ago they would have passed undiagnosed. Timely detection of thyroid pathology in patients with menstrual disorders and management can prevent surgeries like curettage and hysterectomy. Thyroid autoimmunity is reported to be associated with various kinds of thyroid dysfunction. Number of foreign studies show association of thyroid dysfunction and menstrual disorders, but there are not many Indian studies in this regard.

Conclusions: There is a strong correlation between thyroid dysfunction and menstrual disorders. Timely diagnosis and treatment of thyroid pathology in patients with menstrual dysfunction leads to settlement of the menstrual irregularities, and avoidance of unnecessary interventions such as hormonal therapy and surgery. Menorrhagia followed by hypo/oligomenorrhea and polymenorrhea are the most commonly observed menstrual abnormalities. Since thyroid dysfunction is an important treatable cause of menstrual disorder, thyroid status examination should be done in patients with menstrual disorders. Prevalence of subclinical hypothyroidism in patients with menstrual dysfunctions emphasizes the need to detecting the hypothyroidism at this stage, so that treatment can be initiated on time. Anti-TPO antibody test is an expensive routine test recommended to patients with menstrual disorders. However, prospective studies are required to analyze the cost effectiveness of anti-TPO antibody testing and its possible benefits to treatment.