Menorrhagia and hypothyroidism: Evidence supports association between hypothyroidism and menorrhagia

This case report describes the case of a thirteen years old girl who presented to our Emergency Department complaining of menorrhagia for the last fifteen days, leading to severe anemia. The objective examination revealed clinical signs of hypothyroidism and a severe short stature, lower than mid-parental height, with stunting of growth and a significant bone age delay. Blood exams and thyroid ultrasound were consistent with the diagnosis of severe hypothyroidism in autoimmune thyroiditis with acquired von Willebrand syndrome, growth hormone deficiency.

Thyroid hormone levels were measured in serum of study participants without a history of thyroid disease and who were not currently taking thyroid-disrupting medication. Daily quality control samples were run before and after all study samples, and blinded controls were run throughout. If QC samples were more than two standard deviations from the expected values, the assay was repeated. The levothyroxine (LT4) therapy is the standard treatment option for hypothyroidism (81). Jamilian et al. (82) reported that in euthyroid women, menstrual irregularity is improved by taking levothyroxine.

6. Other Endocrine Causes of Menstrual Disturbances

• Prentice asserts that routine thyroid function tests are of no value in the investigation of women with menorrhagia.
• Among the patients with metrorrhagia, one case (16.67 %) had subclinical hypothyroidism.
• Kaur 12 observed that among 14 hypothyroid patients, 9 (64.3 %) had menorrhagia, 3 (21.4 %) had oligomenorrhea, and 2 (14.28 %) had metrorrhagia.
• In this study (which reported the women’s perceived loss) and more recent studies in which the menstrual loss was measured3 treatment of hypothyroidism with thyroxine decreased menstrual blood loss.
• With the exception of certain diagnostic test panels, list available here, the tests we offer access to are not intended to diagnose or treat disease.
• She was 133.8 cm tall (-3.53 standard deviation scores, SDS 9), her mid-parental height was 155 cm (- 1.25 SDS 9), weight was 44 kg (-0.32 SDS 9) and Body Mass Index, BMI 24.6 (1.37 SDS 9).

After obtaining informed consent, the patients were asked about the amount, frequency, and duration of menstrual bleeding. Information was sought to characterize menstrual irregularities, such as secondary amenorrhea, hypomenorrhea, hypermenorrhea, oligomenorrhea, polymenorrhea, menorrhagia, metrorrhagia, and menometrorrhagia (Table 1) 4,6,7. In our study, the prevalence of anti-thyroid peroxidase antibodies in patients with menstrual disorders is almost four times higher than in the control population.

Table3.

In Kakuno’s study, 558 patients with euthyroid chronic thyroiditis (antithyroid antibody-positive) were compared with controls in terms of the prevalence of menstrual disorders. Oligomenorrhea was found in 6.1%, polymenorrhea in 2.5%, and secondary amenorrhea in 1.4%; these percentages were not significantly different from those observed in their control group 9. 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 2016, Ajmani et al. reported on the role of thyroid dysfunction in people with menstrual disorders 12. While 44% of those with menstrual disorders had thyroid dysfunction, only 20% of the controls had thyroid dysfunction. In a more recent study, thyroid dysfunction was found in 48% of women presenting with abnormal uterine bleeding, and hypothyroidism was found in most of them 13.

Among hypothyroid cases 7 (8.8%) had subclinical and 4 (5.06%) had overt hypothyroidism. This study is similar to study carried otc synthroid out by Kumar AHS et al.22 in which out of 200 cases 162 (81 %) cases were euthyroid, 38 (19%) cases had thyroid dysfunction out of which 33 (16.5%) were hypothyroid and 5 (2.5%) were hyperthyroid. Among hypothyroid 21 cases (10.5%) were subclinical and 12 (6%) has overt hypothyroidism. The most common type of abnormal uterine bleeding in this study was also menorrhagia. In another study done by Gowri M et al.21 out of 170 cases, 132 (77.6%) cases were euthyroid, 30 (17.6%) of cases had hypothyroidism and 8 (4.7%) had hyperthyroidism. The most common bleeding disorder in this study was oligomenorrhoea followed by menorrhagia and hypomenorrhea.

• Among the patients with menorrhagia, six cases (24 %) had subclinical hypothyroidism and four cases (16 %) had overt hypothyroidism.
• Her background includes caring for critical care, internal medicine, and surgical patients.
• Between 2004–2014, 86 euthyroid premenopausal women not lactating or taking hormonal medications participated in a study measuring menstrual function.
• The objective examination revealed clinical signs of hypothyroidism and a severe short stature, lower than mid-parental height, with stunting of growth and a significant bone age delay.

Associated Data

Start your journey toward improved thyroid and menstrual health with Everlywell. Through this telehealth program, we’ll connect you with a licensed provider who can meet with you virtually to discuss your concerns and recommend treatment. This section collects any data citations, data availability statements, or supplementary materials included in this article. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Dr. Sakar Raj Pandey (6th batch Bachelor of Medicine, Bachelor of Surgery) for their support without which this study could not have been possible.

By increasing your thyroid hormone, your hypothalamus will decrease TRH release, thus decreasing TSH and prolactin release. Your menstrual cycle requires a delicate balance of your hormones, including estrogen and progesterone. But, an imbalance in other hormones not directly related to your menstrual cycle can influence reproductive hormone levels and cause AUB. The hypothalamic-pituitary-thyroid axis and the hypothalamic-pituitary-gonadal axis are physiologically intertwined. The function of the thyroid is under the control of the hypothalamic-pituitary-thyroid axis.

Failure to conceive in a menstrual cycle is followed by the shedding of the endometrium (5). In different stages of life, women sometimes experience various changes in their menstrual cycle (7). Databases used for searching articles included Google Scholar, Scopus, PubMed, and Web of science for observational, experimental, and review studies. The above 2018 study found that polymenorrhea and menorrhagia were the most common types of AUB seen in those with subclinical or overt hypothyroidism.

Understanding the Impact of Thyroid Medication

• From our study, it may be concluded that there is a strong correlation of thyroid dysfunction with menstrual disorders.
• In another study done by Singh Pet al.18out of 400 cases, 65% were euthyroid, 26% had hypothyroid, and 9% had hyperthyroidism.
• After obtaining informed consent, the patients were asked about the amount, frequency, and duration of menstrual bleeding.
• The levothyroxine (LT4) therapy is the standard treatment option for hypothyroidism (81).

Out of all the types of menstrual irregularities, patients with menorrhagia 34 (43%), polymenorrhoea 23 (29.1%), oligomenorrhoea 13 (16.5%), menometrorrhagia 6 (7.6%), metrorrhagia 2 (2.5%), hypomenorrhea 1 (1.3%) (Figure 1). 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. Additionally, regular check-ups, discussions about medication adjustments, and follow-up appointments will all contribute to effective thyroid dysfunction management and improved menstrual health.

Out of 79 patients in the study, twelve (15.1%) had thyroid disorders, 67 (84.8%) were euthyroid. Out of 12 patients, eleven (13.9%) had hypothyroidism and 1 (1.2%) had hyperthyroidism. Out of 11 patients, seven (8.8%) had subclinical hypothyroidism and 4 (5%) had frank hypothyroidism (Table 1). Patients were evaluated as euthyroid if the TSH, fT3, and fT4 were within the normal ranges; when TSH was high with fT3 and fT4 within the normal ranges, they were labeled as subclinical hypothyroidism. Overt hypothyroidism was diagnosed when TSH was high; fT3 and fT4 levels were below normal. Subclinical hyperthyroidism was diagnosed if TSH was low and fT3 and fT4 levels were within the normal ranges, and overt hyperthyroidism was diagnosed when TSH level was low and fT3 and fT4 levels were high.