scholarly journals Study of thyroid dysfunction in perimenopausal women with abnormal uterine bleeding

Author(s):  
Velicheti Satya Sree ◽  
Gomathy E.

Background: AUB is a common but complicated clinical presentation and occurs in 15-20% of women between menarche to menopause and significantly affects the women’s health. Women with thyroid dysfunction often have menstrual irregularities, infertility and increased morbidity during pregnancy. The objective of present study is to find the correlation between thyroid disorders and AUB in perimenopausal women attending gynecology OPD.Methods: In the present study, Ninety patients with AUB were included and were evaluated for the cause including thyroid abnormality. Thyroid function tests were done in all patients.Results: Among 90 patients, 22 patients were diagnosed as hypothyroidism and 9 as hyperthyroidism, women with AUB 59 (65.4%) were euthyroid. Among 31 women with thyroid abnormality, heavy menstrual bleeding was seen in 14 (45.1%) women, 11 (35.4%) had Polymenorrhagia, 6 (19.3%) had oligomenorrhea. The frequent menstrual abnormality in women with hypothyroidism (22 women) was heavy menstrual bleeding in 9 (40.9%) women, 5 (22.7%) had oligomenorrhea, 8 (36.3%) had Polymenorrhagia. Out of 9 women with hyperthyroidism, 3 (33.3%) had oligomenorrhoea, 4 (44.4%) had heavy menstrual bleeding, 2 (22.2%) had Polymenorrhagia.Conclusions: AUB might be because of structural or non-structural causes. Thyroid abnormalities may present in perimenopausal women with abnormal uterine bleeding, therefore proper identification of the cause of AUB is needed to give appropriate treatment to the patient. And to avoid unnecessary surgical intervention.

Author(s):  
Sreelakshmi U. ◽  
Tushara Bindu V. ◽  
Subhashini T.

Background: Abnormal uterine bleeding is the most common and frequent presenting complaint in Gynaecology Outpatient Department in all age groups, especially in perimenopausal women. Objective of present study was clinicopathological evaluation and management of abnormal uterine bleeding in perimenopausal age group women.Methods: The present study was prospective analytical study conducted at Mallareddy Narayana Multi-speciality Hospital, reputed teaching hospital, in Obstetrics and gynaecology department in association with department of pathology from January 2015 to December 2016. Perimenopausal women in age group 45-55 years included in this study. Other age groups with abnormal uterine bleeding, isolated cervical or vaginal pathology, bleeding diathesis, and pregnancy related causes of bleeding excluded from this study. Endometrial tissue collected by sampling procedure such as dilatation and curettage. Proper counselling about management was given to all women related to medical and surgical interventional approaches.Results: A total of 135 women with abnormal uterine bleeding in perimenopausal age were examined after fulfilling criteria during study period of 2 years. The age of participants in mean±SD was 46.68±2.03 years (min 45 years and max 55 years). Maximum number of patients with abnormal uterine bleeding presented in age group of 45-50 years. The most common symptoms were heavy menstrual bleeding (83.7%), followed by frequent menstrual bleeding (26.6%). Proliferative endometrium was the most common histopathological (30.3%) study followed by secretory endometrium (27.4%). Surgical management was given to 94 patients.Conclusions: Heavy menstrual bleeding and frequent menstrual bleeding were mostly correlated with abnormal endometrial histopathological findings in this study. Gynaecologists should pay attention towards these abnormal bleeding patterns along with the evaluation of endometrial tissue for histopathological findings, which will help us to plan for successful management. 


Author(s):  
Sweety Rani ◽  
Abha Rani Sinha

Aim: To evaluate the relationship between of thyroid dysfunction and abnormal Uterine bleeding. Materials and Methods: The present retrospective hospital based study was conducted in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar from September 2016 to July 2017.110 patients with abnormal uterine bleeding of were found to be eligible for inclusion in the study. Results: Mean age of the study subjects was 32.71 years. Majority of patients was multiparous (58.2%). 40.0% of women presented with complaint of heavy menstrual bleeding. 42.7% of the study subjects were having thyroid dysfunction Conclusion: Abnormal uterine bleeding found strongly associated with thyroid related disorders. Hence the evaluation of thyroid function forms an essential component among abnormal uterine bleeding patients Keywords: Abnormal Uterine Bleeding, Thyroid Dysfunction


Author(s):  
Lakshmi Manjeera M. ◽  
Prabhneet Kaur

Background: Abnormal uterine bleeding is a common complaint for women being referred to the gynaecologist and is associated with an array of symptoms. The objective of this study was to detect association of thyroid dysfunction in patients with menstrual irregularitiesMethods: This non-interventional prospective study was done over a period of one and half years in a private medical college in Mangalore. All patients in age group of 15-55 years who presented with history of menstrual disturbances were enrolled and evaluated in the study. Patients with structural causes of AUB or using IUCDs or hormonal steroids were excluded. Total of 85 patients were hence evaluated. These 85 patients were subjected to routine investigations like Hb, BT, CT and platelets (to rule out coagulation defects) along with TSH, T3, T4 estimation. Ultrasound abdomen and pelvis with endometrial thickness was done to rule out structural causes.Results: The most common menstrual disturbance was menorrhagia (47 patients: 55.3%). Thyroid abnormalities were found in 29 of the 85 patients with AUB (34.11%). Of the 29 patients with thyroid dysfunction, 24 were hypothyroid and 5 patients were found to be hyperthyroid.Conclusions: Thyroid abnormalities are frequently associated with menstrual irregularities. Hence Thyroid Function Tests are extremely valuable in patients with provisional diagnosis of AUB and should be made mandatory to avoid unnecessary hormonal or surgical treatment in such patients.


Author(s):  
Bhavani L. Nair ◽  
Lency S. Kuriakose

Background: Abnormal uterine bleeding (AUB) is one of the common symptoms in the gynaecology outpatient department. About one third of women are affected at some time in their lives. The perimenopausal women show significant number of underlying organic pathology. The evaluation of endometrium and/or organ histopathology has the dual advantage of finding the cause of AUB and to rule out endometrial cancer or the potential for cancer in future like endometrial hyperplasia with atypia. The aim of the study was to determine the histopathological pattern of endometrial sampling in perimenopausal women with AUB and to follow them up for a period of six months after the procedure.Methods: The prospective observational study was conducted at the department of obstetrics and gynaecology at Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, Kerala, for a period of one year from December 2019 to December 2020. The study was conducted on 116 perimenopausal women 41-52 years who presented with AUB and had undergone endometrial sampling. These ladies were subsequently followed up for six months post procedure to assess the response to medical treatment or the need for any surgical intervention like hysterectomy.Results: A total 39.65% patients had heavy and prolonged menstrual bleeding and 18.16% patients had irregular bleeding. 14.65% patients had prolonged flow, 8.6% had heavy flow, 6.8% had infrequent with prolonged flow, 6% had prolonged, infrequent with heavy bleeding. Non-structural (COEIN) causes contributed to about 60.4% of AUB in perimenopausal women and 39.6% had structural (PALM) causes. 49% cases were secretory endometrium. 29.3% had disordered proliferative endometrium, 4.3% had proliferative endometrium, 5.2% each had polyp or hyperplasia without atypia. 18 (15.5%) cases underwent hysterectomy, 3 patients who had adenocarcinoma underwent staging laparotomy, 2 patients had LNG IUS insertion and 40 patients were on follow up requiring either no treatment and 53 (45.68%) patients were given antifibrinolytics or hormonal therapy.Conclusions: Heavy and prolonged menstrual bleeding was the most common presenting symptom. COEIN contributed to about 60.4% of cases. Evaluation of the endometrium showed that, secretory endometrium was commonest (49%) followed by disordered proliferative endometrium (29.3%). On follow up for six months, 15.5% patients underwent hysterectomy, 2 patients had insertion of levonorgestrel IUD, 45.68% patients had medical management with antifibrinolytics or hormones and were on follow up. The responsibility of gynaecologist in the management of AUB in perimenopausal women is to exclude hyperplasia of endometrium and endometrial cancer.


2021 ◽  
pp. 15-16
Author(s):  
Kumari Ragini ◽  
Kumar Sourav ◽  
Lata Shukla Diwedi ◽  
Debarshi Jana

Introduction: Abnormal uterine bleeding (AUB) is a common disorder occurring in reproductive age group females. It can be understood as bleeding that occurs from the uterus outside the normal parameters and there is no structural defects in the genital tract. One of the most common association with AUB is thyroid dysfunctions. Hence this study aimed to see the incidence of thyroid related disorders in AUB and also to assess the menstrual pattern. Material and Methods: 100 women suffering from AUB who presented to OPD of Obstetrics and Gynecology department of Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar were recruited in the study. All females in 19 to 45 years of age group with abnormal uterine bleeding were included excluding those with previously known thyroid disorder, abortion history within 3 months etc. Thyroid function tests were done in all along with ultrasonography of pelvis region. Statistical analysis done. Results: The bleeding abnormality that was found in the most of the women was heavy menstrual bleeding. Women who presented with thyroid dysfunction were 33%. 23% had subclinical hypothyroidism, 6% had hypothyroidism and 4% had hyperthyroidism. Conclusion: Abnormal Uterine Bleeding has strong association with thyroid disorders. Most common type of disorder is subclinical hypothyroidism. Thus all patient of AUB must be evaluated for thyroid dysfunction


Author(s):  
Dinesh Gurjar ◽  
Purnima Pachori ◽  
Sandhya Chaudhary ◽  
Dharmendra Singh

Background: Hypothyroidism and Hyperthyroidism leads to menstrual irregularities. Females with thyroid gland abnormality have chances of reproductive abnormalities ranging from abnormal sexual development, menstrual irregularities, infertility and premature menopause. The objectives were to study the association between thyroid dysfunction and AUB in the reproductive age group (18-45 years), To study the thyroid abnormalities in different types of AUB in the reproductive age group, to establish if screening for thyroid abnormalities is justified using T3, T4 and TSH.Methods: This cross-sectional study conducted among 250 women with ‘abnormal uterine bleeding’ (AUB). Inclusion criteria for participants were females in the age group of 18-45 years, females presenting with abnormal uterine bleeding, with thyroid dysfunction, females who do not have signs of demonstrable pelvic pathologyincluding PID.Results: Majority of the patients belonged to the age group of 24 - 32 years i.e.56.8%, 9.2% cases were nullipara, 44.0% cases have menorrhagia, 32.2% have oliogomennorrhea, 19.6% have amenorrhea. Around 3.6% had Thyromegaly, 12.4% have weight gain in hypothyroidism, 28.4% have fatigue in hyperthyroidism, 6.8% cases have higher T4 level, 18.0% cases have higher TSH level.Conclusions: The risk of progression to overt hypothyroidism (about 5% per year) in patients with subclinical disease and the cost-benefit ratio also emphasises the need for selective screening. Early detection of subclinical disease by selective screening facilitates appropriate therapy early in the course of the disease.


2016 ◽  
Vol 8 (3) ◽  
Author(s):  
John J. E. Wantania

Abstract: WHO identifies adolescence as a period in human growth and development that occurs after childhood and before adulthood from age 10 to 19 years. Two large studies have shown that a greater increase in BMI in childhood is associated with earlier onset of puberty. In general, the age of menarche ranges relatively stable from 11 to 14 years with a median of 12.43 years. The average of menstrual cycle interval is 32.3 days in the first reproduction year. After that, the interval of menstrual cycles generally ranges from 21 to 45 days. Duration of menstruation is 7 days or less. The use of tampons or pads are generally three to six pieces per day. Abnormal uterine bleeding (AUB) is defined as a significant change in the pattern of menstruation or the volume of blood discharge, and is the most common complaint in women. In early adolescence, 75% of adolescents experience abnormal uterine bleeding. Heavy menstrual bleeding (HMB) as well as heavy and prolonged menstrual bleeding (HPMB) is the preferred term for excessive menstrual bleeding. Medical treatment is performed as the initial treatment as long as there is no contraindication. When the acute bleeding has been handled, it is recommended to arrange a transition in the long-term treatmentKeywords: menstruation, teens, abnormal uterine bleeding (AUB)Abstrak: WHO mengidentifikasi remaja sebagai periode pada pertumbuhan manusia dan perkembangan yang terjadi setelah masa kanak-kanak dan sebelum dewasa, dari umur 10 sampai 19 tahun. Dua studi besar telah membuktikan bahwa peningkatan IMT yang lebih besar pada masa kanak-kanak berhubungan dengan onset pubertas yang lebih awal. Usia menarche umumnya relatif stabil berkisar antara 11 dan 14 tahun dengan median 12,43 tahun. Interval siklus rata-rata ialah 32,3 hari pada tahun reproduksi pertama dan interval siklus mentruasi umumnya 21-45 hari. Lama menstruasi ialah 7 hari atau kurang. Penggunaan tampon atau pembalut umumnya tiga sampai enam buah per hari. Perdarahan uterus abnormal (PUA) adalah perubahan signifikan pada pola atau volume darah menstruasi dan merupakan hal yang paling banyak dikeluhkan oleh wanita. Pada awal usia remaja, 75% remaja mengalami keluhan PUA. Perdarahan haid berat (heavy menstrual bleeding) dan perdarahan haid berat dan memanjang (heavy and prolonged menstrual bleeding) ialah istilah yang lebih sering digunakan untuk perdarahan haid yang berlebihan. Penanganan medis menjadi terapi awal bila tidak ada kontrindikasi. Bila perdarahan akut sudah ditangani, direkomendasikan untuk melakukan transisi pada penanganan jangka panjang.Kata kunci: menstruasi, remaja, perdarahan uterus abnormal (PUA)


Author(s):  
Stergios K. Doumouchtsis ◽  
S. Arulkumaran ◽  
Tahir Mahmood

This chapter discusses abnormal menses and bleeding. It explores the physiological basis of menstrual bleeding, and the causes, investigations, and management of abnormal uterine bleeding, heavy menstrual bleeding (HMB), and dysmenorrhoea (period pains).


Author(s):  
Zahra Tavoli ◽  
Melika Agha Mohammad Ali Kermani ◽  
Somayeh Moradpanah ◽  
Ali Montazeri

Introduction: The most common causes of Abnormal Uterine Bleeding (AUB) in women of reproductive age are uterine polyps. Operative hysteroscopy is the management of choice to remove polyp. However, the certainty of the treatment remains to be examined. Aim: To investigate the outcome of hysteroscopy polypectomy in women with AUB. Materials and Methods: This was a cross-sectional study on the samples of women with AUB who underwent a hysteroscopy polypectomy. Patients were assessed pre and postoperatively and were asked to respond to a number of outcome measures including duration of monthly cycle, menstruation cycle, heavy menstrual bleeding, the number of pads used in day and night and improvement of inter-menstrual bleeding, postcoital bleeding, and limited activity. Pre-and postsurgery data were compared using Wilcoxon and McNemar tests. Results: In all, 83 patients were entered into the study. The mean age of participants was 41.8 (±8.37) years. The most common preoperative complaint was heavy menstrual bleeding (n=63, 76%) followed by intermenstrual bleeding (n=40, 48%). There were significant differences between preoperative and postoperative symptoms (p-values <0.05). Perceived complete recovery (n=54, 65%), partial recovery (n=13, 15.7%) and satisfaction (n=66, 79.5%) were high after hysteroscopy. Conclusion: AUB due to polyp might be improved with hysteroscopy. Further investigations are needed to confirm the results and to study on co-existence of other causes of AUB after hysteroscopy polypectomy.


2021 ◽  
Vol 12 (8) ◽  
pp. 88-93
Author(s):  
Subha Shrestha ◽  
Babita Thapa ◽  
Sebina Baniya ◽  
Vivek Pandey

Background: Ormeloxifene, a selective estrogen receptor modulator, is a safer, cost effective and convenient dosing medical therapy in heavy menstrual bleeding of acute abnormal uterine bleeding. Aims and Objective: The study aimed to find the effectiveness of Ormeloxifene as 1st line therapy for heavy menstrual bleeding in menopausal transition women to prevent unnecessary hysterectomies and improve quality of life. Materials and Methods: This descriptive study was conducted at Lumbini Medical College for a period of one year. Sixty-five cases of acute Abnormal Uterine Bleeding with heavy menstruation during menopausal transition period were provided with Ormeloxifene therapy of 60 milligrams dose two times per week after evaluating pre treatment hemoglobin percentage, Pictorial Blood Loss Assessment Chart (PBAC) score and endometrial thickness. The dose of the drug was reduced to 60 mg weekly after 3rd month if subjective improvement was documented and continued for further 3 months. Results: There was a statistically significant reduction in mean PBAC score, mean endometrial thickness and rise in hemoglobin level. Eighty percentages of women had marked subjective improvement of symptoms, 87.7% women had reduction of blood clots, 15. 8% women had relief from dysmenorrheal pain and 50.8% women had regularization of menstrual pattern after 6 months. Amenorrhea (25.3%) was the most common side effect reported in 6 months therapy. Conclusion: Ormeloxifene is an effective 1st line medical therapy in acute heavy menstrual bleeding in menopausal transition women.


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