Thyroid hormones and menstrual cycle function in a longitudinal cohort of premenopausal women

In the study group, we found proliferative endometrium in most of the patients on endometrial sampling followed by secretory endometrium in hypothyroid patients. In the study by Kaur 12, 9 (64.3%) hypothyroid patients had proliferative endometrium, 3 (21.4 %) had endometrial hyperplasia, and the rest 2 (14.3 %) had secretory endometrium. Sharma 7 found 36.36 % proliferative, 36.36 % secretory and 27.27 % atrophic endometrium in hypothyroid patients. In hyperthyroid patients, they found 42.84 % proliferative, 28.56 % secretory, and 14.28 % hyperplastic endometrium on histopathology examination. In the study by Padmaleela 14, the most common finding in endometrial biopsy was proliferative endometrium (59.1 %) both in hypothyroid (60 %) and hyperthyroid cases (57.1 %). Cystic Glandular Hyperplasia was found only in 13.3 % and secretory endometrium in 26.7 % of the hypothyroid patients.

Female patients with Addison’s disease may experience menstrual irregularity, but there is no sufficient data regarding the type of menstrual disturbance that is mostly observed in this rare disorder (99). Further, a manual search in the references list of the included studies and other relevant reviews were used to maximize the identification of eligible studies. Different types of studies (review, observational, experimental) relevant to the subjects were reviewed. To do this, most will need prescription thyroid hormone replacement medication. These medications mimic the structure and function of your natural thyroid hormone.

Those taking blood thinners such as warfarin may also be at a higher risk for AUB. We underline the importance of a regular follow up of the pubertal development, including height measurements, thyroid palpation, general examination and menstrual anamnesis to intercept red flags findings for thyroid disturbances. Cerebral magnetic resonance (MR) was performed to evaluate the possible pituitary functional hypertrophy, with the finding of an enlarged adenohypophysis (16 mm in height) in contact with optic chiasm. Left hand X-Ray showed a bone age of 9.6 years according to TW2 RUS method 10.

Study population

The release of TRH stimulates your pituitary gland to release thyroid-stimulating hormone (TSH) and prolactin. Among the patients with low TSH level, 20 % had proliferative and secretory endometrium each, and 60 % had atrophic endometrium. Among the patients with high TSH level, 42.85 % had proliferative endometrium, 28.57 % had secretory endometrium, 21.42 % had hyperplastic endometrium, and 7.14 % had atrophic endometrium. Other alterations seem to be involved in this condition of hypocoagulability, like a significant reduction in coagulation factor VIII (FVIII), factor IX (FIX), and factor XI (FXI) levels 18 and qualitative platelet abnormalities 19. Autoimmune hypothyroidism (Hashimoto thyroiditis) is the most common cause of acquired hypothyroidism in children, adolescents and adults 1, with an estimated prevalence of 1–2% in pediatric age 2.

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

  • The average dose of radioiodine (I-131), R-I131, which is used for treating hyperthyroidism therapy is lower than cancer treatment, indicating that its gonadal side effects are not significant (84).
  • Daily predicted log-transformed creatinine-adjusted Pd3G (panels A and B) and E13G (panels C and D) levels across the menstrual cycle by total T4 concentrations.
  • The latter is most likely brought on by anovulation-related estrogen breakthrough hemorrhage.
  • In the study carried out by Kattel et al.23 thyroid dysfunction was present in 20% of abnormal uterine bleeding cases out of which 19% had hypothyroidism and 1% had hyperthyroidism.

A Salvadoran thirteen years old girl presented to our Emergency Department complaining of menorrhagia for the last fifteen days. She had menarche one year and seven months before, followed by absence of menstruation until the previous month, when she had a menstruation normal in duration and flow. Family history was negative for coagulopathy, the mother had hypothyroidism in pregnancy and the father had hyperthyroidism.

  • Similarly, Bolland et al. (91) observed that 35.5% of women with CS in a New Zealand nationwide survey, presented with menstrual irregularity.
  • In our study, in line with the literature, oligomenorrhea was the most common menstrual disorder (22.3%) in the euthyroid group, and this prevalence was not significantly different from that in the control group.
  • In more recent literature, the most common bleeding patterns in women presenting with abnormal uterine bleeding were oligomenorrhea (23%) and menorrhagia (21%).
  • The detailed data on menstrual cycle function is reflected in a demanding study protocol, which was a contributing factor to the small number of women who participated in the study.

This study aimed to review and summarize the features of menstrual disturbances in some endocrine diseases. TSH is part of the hypothalamus-pituitary-thyroid feedback loop regulating thyroid hormone levels. Once there is enough thyroid hormone in your bloodstream, TSH production decreases. A “regular” menstrual cycle ranges from 21 to 35 days, with menstrual bleeding lasting 4 to 7 days. But everyone’s menstrual cycles are different; what is normal for you might not be the same for someone else.

Does Thyroid Medication Affect the Menstrual Cycle?

Prolactin’s primary role is to stimulate breast milk production after childbirth. High prolactin levels, a term called hyperprolactinemia, can cause hormonal imbalances in your reproductive hormones, such as follicle-stimulating hormone (FSH) or luteinizing hormone (LH). Because of this, hyperprolactinemia can result in AUB, with amenorrhea being the most common.

  • Even in the setting of normal thyroid function, thyroid autoimmunity may significantly affect reproductive activity and pregnancy.
  • Those taking blood thinners such as warfarin may also be at a higher risk for AUB.
  • Among the patients with high TSH level, 42.85 % had proliferative endometrium, 28.57 % had secretory endometrium, 21.42 % had hyperplastic endometrium, and 7.14 % had atrophic endometrium.
  • The most common type of abnormal uterine bleeding in this study was also menorrhagia followed by polymenorrhoea.

First, it was limited by small sample size even though there were multiple cycles per woman. The detailed data on menstrual cycle function is reflected in a demanding study protocol, which was a contributing factor to the small number of women who participated in the study. This limited sample size prevented thorough investigation of potential effect measure modification by several characteristics that are known to affect menstrual cycle function parameters, such as age. It is theoretically possible that the associations between thyroid hormones and menstrual cycle function may differ by proximity to menopause.

Management of hypothyroidism-related AUB

Among the patients with polymenorrhea, two cases (25 %) had subclinical hypothyroidism and 2 (25 %) had overt hypothyroidism. Among the patients with menorrhagia, six cases (24 %) had subclinical hypothyroidism and four cases (16 %) had overt hypothyroidism. Thyroid autoimmunity has been shown to have association with various kinds of thyroid dysfunction. Although there are foreign studies to relate the occurrence of thyroid dysfunction in women with menstrual disorders, but there are not many Indian studies in this regard 10, 11. Accurate diagnosis is the first step in how to balance thyroid hormones and treat thyroid dysfunction. As noted, symptoms such as fatigue, weight changes, hair loss, and menstrual irregularities may indicate an underlying thyroid issue.

The latter is most likely brought on by anovulation-related estrogen breakthrough hemorrhage. Polymenorrhea and menorrhagia may also be caused by hemostasis factor deficiencies. The percentage of menstruation irregularity in hypothyroidism approaches 80% in the oldest published research. In more recent literature, the most common bleeding patterns in women presenting with abnormal uterine bleeding were oligomenorrhea (23%) and menorrhagia (21%). Hypothyroidism (22%) was more common than hyperthyroidism (6%) in women with synthroid bipolar abnormal bleeding 3. In the present study out of 79 cases, only 1 2 of abnormal uterine bleeding cases had thyroid dysfunction which accounts for 15.1% cases out of which 11 (13.9%) had hypothyroidism and 1 (1.3%) had hyperthyroidism.