Hypothyroidism among menorrhagic women attending Munshaat Sultan Family Health Center, Menoufia University, Egypt

Taghreed M Farahat; Hala M Shaheen; Fatma A El Esrigy; Marwa M Mohasseb; Mohammed A Emara

doi:10.4103/mmj.mmj_654_17

ORIGINAL ARTICLE

Year : 2020 | Volume : 33 | Issue : 4 | Page : 1293-1297

Hypothyroidism among menorrhagic women attending Munshaat Sultan Family Health Center, Menoufia University, Egypt

Taghreed M Farahat¹, Hala M Shaheen¹, Fatma A El Esrigy¹, Marwa M Mohasseb¹, Mohammed A Emara²
¹ Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
² Department of Gynecology and Obstetrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission	21-Sep-2017
Date of Decision	05-Nov-2017
Date of Acceptance	12-Nov-2017
Date of Web Publication	24-Dec-2020

Correspondence Address:
Marwa M Mohasseb
3 Mahmoud Eid Street, Al-Bajur, Menoufia 32511
Egypt

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/mmj.mmj_654_17

Abstract

Objective
The aim of this study was to assess the frequency of hypothyroidism among menorrhagic women attending Munshaat Sultan Family Health Center.
Background
Menorrhagia is a very common complaint among women. The prevalence of menorrhagia is estimated at 11–13% in women in the childbearing period and increases with age. Hypothyroidism is considered a correctable cause of menorrhagia. All women with unexplained menorrhagia should be tested for thyrotrophin-releasing hormone.
Patients and methods
A cross-sectional study was conducted on 250 menorrhagic women, who were recruited from Munshaat Sultan Family Health Center, Menoufia District, Menoufia Governorate, Egypt, during the period from the first of January to the end of December 2016. The studied participants were evaluated through comprehensive medical history, clinical examination, laboratory investigation (serum free thyroxine and thyroid-stimulating hormone), and radiological (local vaginal and thyroid ultrasound) investigations.
Results
The study revealed that the frequency of hypothyroidism among the studied menorrhagic women was ~17%, subclinical hypothyroidism represented ~83%, and overt hypothyroidism represented ~17%. There was statistically significant difference between menorrhagic women experiencing hypothyroidism and those who did not regarding duration of menorrhagia in days, number of sanitary pads used daily, gush of blood during menses, staining of clothes, need for double protection, impairment of daily activities, presence of blood clots, and the amount of blood loss during menses (P < 0.001).
Conclusion
Hypothyroidism is a frequent abnormality in menorrhagic women that needs to be highlighted as a correctable cause of menorrhagia.

Keywords: female, hypothyroidism, menorrhagia, prevalence, referral

How to cite this article:
Farahat TM, Shaheen HM, El Esrigy FA, Mohasseb MM, Emara MA. Hypothyroidism among menorrhagic women attending Munshaat Sultan Family Health Center, Menoufia University, Egypt. Menoufia Med J 2020;33:1293-7

How to cite this URL:
Farahat TM, Shaheen HM, El Esrigy FA, Mohasseb MM, Emara MA. Hypothyroidism among menorrhagic women attending Munshaat Sultan Family Health Center, Menoufia University, Egypt. Menoufia Med J [serial online] 2020 [cited 2023 Oct 3];33:1293-7. Available from: http://www.mmj.eg.net/text.asp?2020/33/4/1293/304513

Introduction

Many women visit their family physicians complaining of heavy blood loss during menses. It is the fourth common complaint that requires referral to a gynecologist for investigation and treatment^[1].

Menorrhagia is defined as menstrual blood loss of more than 80 ml per month. Moreover, it is defined as excessive vaginal bleeding lasting for 7 days or more^[2].

Menorrhagia affects 11–13% of women during their productive life and increases with age, reaching 24% at the age of 36–40 years^[3].

Menorrhagia can cause psychological, emotional, and physical strain from excess unpredictable painful bleeding, with the limitation of daily activities^[4],[5]. Moreover, it increases the healthcare costs involving expensive hormonal drugs and laboratory tests^[6].

Hypothyroidism is one of the systemic diseases that has a causal relationship with menorrhagia^[7],[8]. Thyroid dysfunction can cause infertility, abortion, and menstrual abnormalities^[9]. Menorrhagia is reported to occur in 32–56% of cases experiencing hypothyroidism^[10].

Menorrhagia in patients with hypothyroidism can be explained by the following mechanisms: owing to impairment of hemostasis as hypothyroidism causes platelet dysfunction leading to excessive bleeding^[11],[12]; owing to neuroendocrine dysfunction because of alteration of thyroid-releasing hormone and luteinizing hormone response, peripheral conversion of androgens to estrogens, change in androstenedione metabolism, catechol-estrogens, and altered sex hormone-binding globulin levels^[13]; or owing to disturbance of hypothalamic–pituitary–ovarian axis and hypothalamic–pituitary–thyroid axis^[14].

One being a family physician allows seeing many patients having menorrhagia, so the first step is complete evaluation through detailed documented history, complete clinical examination, and investigations taking in consideration the importance of thyroid function tests in assessing a case of menorrhagia^[15].

The aim of the study was to assess the frequency of hypothyroidism in menorrhagic women attending Munshaat Sultan Family Health Center in Menoufia District, Menoufia Governorate, Egypt.

Patients and methods

This study was a descriptive cross-sectional study performed among 250 menorrhagic women attending Munshaat Sultan Family Health Center, Menoufia District, Menoufia Governorate, Egypt. Data were collected through simple random sampling technique calculated based on the prevalence of menorrhagia among women using EPI Info program, version 7 (Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology and Laboratory Services, and U.S. Department of Health and Human Services, USA). The total number of women in the childbearing period in the catchment area was 4331, Sample size was calculated considering the power of the study 80%, the childbearing females number and prevalence of menorrhagia according to literature review 13%^[3].

The study sample was collected from women aged 18–45 years old complaining of menorrhagia for 3 successive months during working days in family medicine clinic during the period from the first of January to the end of December 2016.

The participants were subjected to the following:

The predesigned questionnaire which included items related to sociodemographic characteristics through assessing the socioeconomic score, criteria of menorrhagia, and medical history related to menorrhagia
Complete physical examination included measurement of vital signs, colors, weight, height, BMI, and skin, eye, face, local vaginal, and thyroid examination
Laboratory investigations: free thyroxine (T4) and thyroid-stimulating hormone (TSH) were estimated by enzyme-linked immunosorbent essay. Free T4 estimation was based on the principle of competitive enzyme immunoassay (AccuDiag, Diagnostic Automation Inc., Los Angeles, California, USA). TSH estimation was based on the principle of sandwich enzyme-linked immunosorbent essay (Abcam Company, Cambridge, UK) to confirm hypothyroidism diagnosis
Radiological investigations included vaginal and thyroid ultrasonography using the Mindray portable ultrasound machine (Mindray DC-8 Expert; MedCorp Company, Moraine, Ohio, USA) to confirm hypothyroidism.

This study excluded women having chronic illness (hypertension, diabetes mellitus, cardiac, renal, and liver diseases), bleeding disorders, use of contraceptive pills or intrauterine contraceptive device, local uterine, or vaginal pathology (polyp, endometrial hyperplasia, fibroid, cancer), antepartum hemorrhage, abortion, puerperium, pelvic inflammatory disease, women on anticoagulant drugs, and uncooperative women. These exclusion criteria were confirmed through detailed medical history, clinical examination, relevant laboratory and radiological investigations through reviewing their family health records.

The menorrhagic women included in the study were divided into two groups: with hypothyroidism (43 patients) and without hypothyroidism (207 patients). Women having hypothyroidism were subdivided into subclinical (TSH was elevated, whereas free T4 was normal) hypothyroid women, comprising 34 patients, and overt hypothyroid (TSH was elevated and serum free T4 was reduced), comprising nine patients.

A written consent was taken from each participant, and the study was approved by the ethical committee of the Faculty of Medicine, Menoufia University.

Statistical analysis

Statistical presentation and analysis of the present study were conducted by a statistical package of social science, version 20 (SPSS Inc., Chicago, Illinois, USA). Quantitative data were expressed as mean ± SD and analyzed applying Student's t-test. Qualitative data were expressed as number and percentage and analyzed applying χ² and Z-tests.

Results

The present study showed that mean age of menorrhagic women was 30.3 ± 2.5, most of them were married and of medium socioeconomic standard (71 and 80%, respectively), approximately half of them were of basic education, and 60% were housewives [Table 1]. Among 250 studied menorrhagic women, ~17% had hypothyroidism [Figure 1], with subclinical hypothyroidism represented 83% of the participants, whereas overt hypothyroidism was in 17% of the patients [Figure 2].

Figure 1: Prevalence of hypothyroidism among menorrhagic women.

Click here to view

Figure 2: Distribution of overt and subclinical hypothyroidism among menorrhagic women.

Click here to view

The current study showed that there was a high statistically significant difference in the favor of menorrhagic women who did not have hypothyroidism rather than those with hypothyroidism regarding the duration of menorrhagia in days (P < 0.001), number of daily used sanitary pads (P < 0.001), gush of blood during menses (P < 0.001), staining of clothes or seats (P < 0.001), the need for double protection (P < 0.001), impairment of daily activities (P < 0.001), and presence of blood clots and amount of blood loss in ml (P < 0.001) [Table 2].

Table 1: Sociodemographic data of the studied group

Click here to view

Table 2: Comparison between the studied groups regarding severity of menorrhagia

Click here to view

Discussion

In the current study, menorrhagia was higher (80.4%) among those in the medium socioeconomic standard. This is similar to a study conducted by Randhawa et al. ^[16] which showed that 87% of women in middle socioeconomic status had menorrhagia.

In this study, more than 50% of menorrhagic women were literate and had basic education. This is agreed with the study of Geetha et al. ^[17] that showed 43.3% of women having menorrhagia were illiterate and had primary education.

In the present study, the frequency of hypothyroidism among menorrhagic women was 17.2%. This is similar to a study conducted by Gowri et al. ^[18] who found that 17.6% of women having menorrhagia had hypothyroidism. Moreover, it is similar to a study by Kaur et al. ^[19] which stated that of 100 patients studied, 14 had hypothyroidism. A study by Sharma and Sharma^[20] and another study by Pahwa et al. ^[21] showed that the prevalence of hypothyroidism was detected in 22% patients with menorrhagia. In addition, a study conducted by Ajmani et al. ^[22] and Subedi et al. ^[23] declared that there is a strong correlation of thyroid dysfunction with menstrual disorders. This is different from a study conducted by Khatiwada et al.^[24], which showed that only 5% of menorrhagic women had hypothyroidism. This may be because the mean age of women was 20.7 ± 6.8 years which was younger than those in this study (30.2 ± 2.5 years).

The current study shows that 13.6% of menorrhagic women had subclinical hypothyroidism and 3.6% had overt hypothyroidism, which is similar to a study conducted by Gazareen et al. ^[25] that showed subclinical hypothyroidism occurred in 4–20% of women. However, this is inconsistent with the study by Moragianni et al. ^[13] which found that only 2.7% of patients had subclinical hypothyroidism; this difference may be attributed to the small sample size in our study compared with that of Moragianni et al.^[13].

Conclusion

Hypothyroidism especially subclinical hypothyroidism is frequent abnormality among women with menorrhagia. So, it may be beneficial to screen patients with menstrual disorder for thyroid dysfunction especially to rule out thyroid disorders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Lukes AS, Moore KA, Muse KN, Gersten JK, Hecht BR, Edlund M, et al. Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Obstet Gynecol 2010; 116:865–875.
2.	Weisberg E, McGeehan K, Fraser S. Effect of perceptions of menstrual blood loss and menstrual pain on women's quality of life. Eur J Contracept Reprod Health Care 2016; 21:431–435.
3.	Marret H, Fauconnier A, Chabbert-Buffet N, Cravello L, Golfier F, Gondry J, et al. Clinical practice guidelines on menorrhagia: management of abnormal uterine bleeding before menopause. Eur J Obstet Gynecol Reprod Biol 2010; 152:133–137.
4.	Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the Treatment of Hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid 2014; 24:1670–1751.
5.	Orkin SH, Nathan DG, Ginsburg D, Look AT, Fisher DE, Lux Se. Nathan and Oski's hematology and oncology of infancy and childhood. 8^th ed. Cambridge, MA: Elsevier Health Science; 2014. pp. 1000–1001.
6.	Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev 2014; 36:104–113.
7.	Byams VR, Anderson BL, Grant AM, Atrash H, Schulkin J. Evaluation of bleeding disorders in women with menorrhagia: a survey of obstetrician-gynecologists. BMJ 2000; 320:649.
8.	Sruthi T, Shivanna SB. Prevalence of hypothyroidism in patients with provisional diagnosis of DUB, J Evol Med Dent Sci 2014; 3:2967–2972.
9.	Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010; 31:702–755.
10.	Browne LP, Boswell HB, Crotty EJ, O'Hara SM, Birkemeier KL, Guillerman RP. Van Wyk and Grumbach syndrome revisited: imaging and clinical findings in pre- and postpubertal girls. Pediatr Radiol 2008; 38:538–542.
11.	Stuijver DJ, Piantanida E, van Zaane B, Galli L, Romualdi E, Tanda ML, et al. Acquired von Willebrand syndrome in patients with overt hypothyroidism: a prospective cohort study. Haemophilia 2014; 20:326–332.
12.	Ma BJ. Excessive uterine bleeding in a non-compliant patient with profound hypothyroidism: a case report and review of the literatures. J Med Cases 2016; 7:234–238.
13.	Moragianni VA, Somkuti SG. Profound hypothyroidism-induced acute menorrhagia resulting in life-threatening anemia. Obstet Gynecol 2007; 110:515–517.
14.	Squizzato A, Romulaldi E, Buller H, Gerdes V. Thyroid dysfunction and effectson coagulation and fibrinolysis: a systematic review. J Clin Endocrinol Metab 2007; 92:2415–2420.
15.	Telner DE, Jakubovicz D. Approach to diagnosis and management of abnormal uterine bleeding. Can Fam Physician. 2007; 53:58–64.
16.	Randhawa JK, Mahajan K, Kaur M, Gupta A. Effect of dietary habits and socio-economic status on menstrual disorders among young females. Am J Bio Sci 2016; 4:19–22.
17.	Geetha P, Chenchuprasad C, Sathyavathi RB, Bharathi T, Reddy SK, Reddy KK. Effect of socioeconomic conditions and lifestyles on menstrual characteristics among rural women. J Women Health Care 2016; 5:298.
18.	Gowri M, Radhika BH, Harshini V. Role of thyroid function tests in women with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol 2014; 3:54–57.
19.	Kaur T, Aseeja V, Sharma S. Thyroid dysfunction in dysfunctional uterine bleeding. Webmed Central Obstet Gynaecol 2011; 2:1–7.
20.	Sharma N, Sharma A. Thyroid profile in menstrual disorders. JK Sci 2012; 14:14–17.
21.	Pahwa S, Gupta S, Kaur J. Thyroid dysfunction in dysfunctional uterine bleeding. J Adv Res Med Sci 2013; 5:78–83.
22.	Ajmani NS, Sarbhai V, Yadav N, Paul M, Ahmad A, Ajmani AK. Role of thyroid dysfunction in patients with menstrual disorders in tertiary care center of Walled City of Delhi. J Obstet Gynaecol India 2016; 66:115–119.
23.	Subedi S, Banerjee B, Manisha C. Thyroid disorders in women with dysfunctional uterine bleeding. J Pathol Nepal. 2016; 6:1018-1020.
24.	Khatiwada S, Gautam S, Singh S, Shrestha S, Jha P, Baral N, et al. Pattern of thyroid dysfunction in women with menstrual disorders. Ann Clin Chem Lab Med 2016; 2:3–6.
25.	Gazareen SS, Shoeib SA, Dawoud AA, Attiyab IS. Subclinical endocrine disorders: a brief overview of risks, diagnosis, and workup of these disorders. Menoufia Med J 2015; 28:295–307.