2 years ago, K was getting upset as she was gaining weight even though she worked out regularly and was meticulous about her eating habits. Her menstrual cycle which was regular also became erratic occurring once in 2 to 3 months. The menstrual flow varied from heavy to scanty. Often, she would have post menstrual staining for up to 10 days. She was married a year ago at the age of thirty. She was keen to get pregnant and had missed her period for the past 4 months. But the urine pregnancy test was negative repeatedly. Her husband encouraged her to seek medical advice.
K walked into my consultation room. She appeared sluggish and was obese with a BMI of 32. She looked anxious with a slightly puffy face and dry skin. There was no palpable lump in her thyroid gland and her uterus and ovaries were normal on pelvic examination and ultrasound scan. Blood tests reveal that her thyroid hormones were low. K was suffering from hypothyroidism, a condition in which the thyroid gland is under active in producing the hormones.
Thyroid gland and metabolism Thyroid is a small, butterfly-shaped gland situated on the front of the neck, just below the Adam's apple. Thyroid hormones— triiodothyronine (T3) and thyroxine (T4) — play an important role in regulating many of the body’s functions, including metabolism, growth, heart rate, and body temperature. If they are deficient, the bodily functions slow down, and one may experience constipation, fatigue, depression, dry skin, thinning hair, intolerance to cold, muscle cramps, joint pain and weight gain.
Hypothyroidism and menstruation When thyroid hormone levels decrease, the pituitary gland in the brain starts producing extra hormones to stimulate the thyroid gland to increase its hormone production. This also causes the milk hormone, prolactin from the brain to become excessive. Prolactin suppresses growth of the egg and ovulation.
Left untreated, disruption of ovulation may lead to disordered growth and shedding of the uterine lining, causing unpredictable bouts of heavy bleeding from the uterus. Over time, menses can stop completely due to thinning of the uterine lining.
Hypothyroidism may not cause noticeable menstrual symptoms in the early stages. Problems tend to develop slowly, often over a number of years. Hypothyroidism and Infertility Hypothyroidism could cause infertility in the following ways. · Disruption of ovulation: To conceive, one needs to ovulate regularly · Disturbance in the lining of the uterus: a good endometrial lining is a prerequisite for an embryo to implant. · Increase the risk of miscarriage in untreated hypothyroidism
Diagnosis of Hypothyroidism Hypothyroidism is diagnosed by measuring the blood levels of various thyroid hormones.
K was referred to the endocrinologist. Her hypothyroidism was due to an autoimmune disease called Hashimoto's disease. This disease causes a person’s immune system to attack their thyroid gland, preventing it from working properly.
She was treated with thyroxine. Her body weight and menstruation gradually returned to normal. She was overjoyed when she conceived naturally 3 months after her menses returned to normal.