Evaluating Patterns Of Abnormal Uterine Bleeding (AUB) In Thyroid Dysfunction At A Tertiary Care Centre In North Kerala , India

Abstract

Background: Menstrual cycle function is determined by a complex endocrine axis that controls the ovaries and endometrium and it represents the underlying hormonal milieu of the female reproductive system . It is closely related to hypothalamic-pituitary-thyroid axis which controls the thyroid function and is determined by TSH levels. Both hypothyroidism and hyperthyroidism can be associated with abnormal uterine bleeding. Hence, we evaluated the association of Abnormal uterine bleeding(AUB) and thyroid disorders in women of reproductive age group.Methods: This research conducted in a tertiary care hospital in North Kerala included 236 women of reproductive age group with abnormal uterine bleeding who attended Department of Obstetrics and Gynaecology, KMCT Medical College, Kozhikode, over a period of 10 months ( December 2018 to October 2019). Detailed clinical history with specific relevance to parity and bleeding pattern was taken and after thorough clinical examination including general, gynaecological and systemic examination , clinical diagnosis of abnormal uterine bleeding was made. FT3 FT4 TSH results were then evaluated and grouped into Euthyroid Hypothyroidism, Subclinical hypothyroidism and Hyper-thyroidism.Results: Maximum patients in AUB belonged to the age group of 31-40 years. Maximum patients in the study belonged to para 2 (38.6%).The most common bleeding patterns were HMB (69%) and least common bleeding pattern (1.3%) was amenorrhea. 89% of patients had euthyroid status.11% of patients had thyroid dysfunction out of which subclinical hypothyroidism(6.8%) was more common followed by hypo-thyroidism (2.5%).Least common was hyperthyroidism(1.7%).Subclinical hypothyroidism was the most predominant thyroid dysfunction.Conclusion: Hence TSH appears to be the most sensitive test to evaluate thyroid function and is advocated to screen for thyroid abnormality in women who present with AUB especially with non-structural causes of AUB as correction of thyroid abnormalities also relieves AUB.