EARLY DETECTION AND MANAGEMENT OF MENSTRUAL AND OVARIAN DYSFUNCTION ASSOCIATED WITH THYROID DISORDERS IN REPRODUCTIVE-AGED WOMEN
DOI:
https://doi.org/10.37547/Keywords:
thyroid dysfunction, menstrual disorders, abnormal uterine bleeding, ovarian dysfunction, ovulatory disorders, female infertility, polycystic ovary syndrome, thyroid autoimmunity.Abstract
Thyroid disorders are among the most prevalent endocrine conditions affecting women of reproductive age and are increasingly recognized as significant contributors to menstrual and ovarian dysfunction. Despite this, thyroid-related reproductive abnormalities remain underdiagnosed in gynecologic practice. Objective: This narrative review aims to synthesize current evidence on the pathophysiological mechanisms, clinical manifestations, early detection strategies, and management of menstrual and ovarian dysfunction associated with thyroid disorders in reproductive-aged women. Methods: A comprehensive narrative review was conducted using Scopus-indexed literature, including observational studies, clinical reviews, and international guidelines. Relevant studies examining the association between thyroid dysfunction and menstrual abnormalities, ovulatory disorders, ovarian reserve, and fertility outcomes were critically analyzed. Results: Thyroid dysfunction, particularly subclinical hypothyroidism, is highly prevalent among women presenting with abnormal uterine bleeding, with reported rates ranging from 20% to 44%. Menstrual irregularities may precede overt thyroid disease, highlighting their role as early clinical indicators. Thyroid dysfunction disrupts the hypothalamic–pituitary–ovarian axis, contributing to anovulation, altered ovarian reserve, and infertility.
Downloads
References
1.Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31(5):702-55. doi:10.1210/er.2009-0041
2.Redmond GP. Thyroid dysfunction and women’s reproductive health. Thyroid. 2004;14 Suppl 1:S5-15. doi:10.1089/105072504323024543
3.Sharma J, Mahat B, Tiwari S, Singh NK, Yadav R, Thapa D. Thyroid disorders in patients with polycystic ovarian syndrome in a tertiary care center: an observational study. J Nepal Med Assoc. 2024;62(280):819-22. doi:10.31729/jnma.8833
4.Kirkegaard S, Torp NMU, Andersen S, Andersen SL. Endometriosis, polycystic ovary syndrome, and the thyroid: a review. Endocr Connect. 2024;13(2). doi:10.1530/EC-23-0431
5.Brown EDL, Obeng-Gyasi B, Hall JE, Shekhar S. The thyroid hormone axis and female reproduction. Int J Mol Sci. 2023;24(12):9815. doi:10.3390/ijms24129815
6.Lazarus JH. Thyroid dysfunction: reproduction and postpartum thyroiditis. Semin Reprod Med. 2002;20(4):381-8. doi:10.1055/s-2002-36711
7.Poppe K, Velkeniers B, Glinoer D. Thyroid disease and female reproduction. Clin Endocrinol (Oxf). 2007;66(3):309-21. doi:10.1111/j.1365-2265.2007.02752.x
8.Joshi JV, Bhandarkar SD, Chadha M, Balaiah D, Shah R. Menstrual irregularities and lactation failure may precede thyroid dysfunction or goitre. J Postgrad Med. 1993;39(3):137-41.
9.Verma K, Verma S, Rajoria L. A cross sectional study to evaluate the relation between thyroid disorders and abnormal uterine bleeding in reproductive age group. Ind J Obstet Gynecol Res. 2019;6(2):177-80. doi:10.18231/j.ijogr.2019.041
10.Mahale NA, Prathima KN, Mahale A, Prabhu S, Ullal S, Fernandes M. A study of thyroid function in patients with abnormal uterine bleeding. Gazz Med Ital Arch Sci Med. 2022;181(1-2):15-8. doi:10.23736/S0393-3660.19.04204-9
11.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 Gynecol India. 2016;66(2):115-9. doi:10.1007/s13224-014-0650-0
12.Sridevi AS, Kollur AM, Kanthi AG, Sunil Kumar KS. Prevalence of thyroid disorders and pattern of bleeding among women with abnormal uterine bleeding, a cross-sectional study. Ind J Obstet Gynecol Res. 2025;12(3):529-33. doi:10.18231/j.ijogr.v.12.i.3.27
13.Sahu R, Rath SK. Thyroid disorders in reproductive age presenting with abnormal uterine bleeding. Ind J Obstet Gynecol Res. 2021;8(2):259-63. doi:10.18231/j.ijogr.2021.053
14.Altuntaş SÇ, Güneş M. Investigation of the relationship between autoimmune and nodular goiter in patients with euthyroid polycystic ovary syndrome and their phenotypes. Horm Metab Res. 2022;54(6):396-406. doi:10.1055/a-1825-0316
15.Kabodmehri R, Sharami SH, Sorouri ZZ, Gashti NG, Milani F, Chaypaz Z, et al. The relationship between thyroid function and ovarian reserve: a prospective cross-sectional study. Thyroid Res. 2021;14(1). doi:10.1186/s13044-021-00112-2
16.Weghofer A, Barad DH, Darmon S, Kushnir VA, Gleicher N. What affects functional ovarian reserve, thyroid function or thyroid autoimmunity? Reprod Biol Endocrinol. 2016;14(1). doi:10.1186/s12958-016-0162-0
17.Ashrafi M, Fallahian M, Eshrati B, Yazdi RS. The presence of anti thyroid and anti ovarian auto-antibodies in familial premature ovarian failure. Int J Fertil Steril. 2008;1(4):171-4.
18.Poppe K. Thyroid and female infertility: more questions than answers? Eur J Endocrinol. 2021;184(4):R123-35. doi:10.1530/EJE-20-1284
19.Poppe K, Bisschop P, Fugazzola L, Minziori G, Unuane D, Weghofer A. 2021 European Thyroid Association guideline on thyroid disorders prior to and during assisted reproduction. Eur Thyroid J. 2021;9(6):281-95. doi:10.1159/000512790
20.Dittrich R, Beckmann MW, Oppelt PG, Hoffmann I, Lotz L, Kuwert T, et al. Thyroid hormone receptors and reproduction. J Reprod Immunol. 2011;90(1):58-66. doi:10.1016/j.jri.2011.02.009
21.Brown EDL, Obeng-Gyasi B, Hall JE, Shekhar S. The thyroid hormone axis and female reproduction. Int J Mol Sci. 2023;24(12):9815. doi:10.3390/ijms24129815
22.Bucci I, Giuliani C, Di Dalmazi G, Formoso G, Napolitano G. Thyroid autoimmunity in female infertility and assisted reproductive technology outcome. Front Endocrinol (Lausanne). 2022;13:768363. doi:10.3389/fendo.2022.768363
23.Iqbal N, Tariq MM, Bajwa MA, Naheed R, Abbas F, Javed Y. Incidence of menstrual irregularities associated with hypothyroidism in Balochistan, Pakistan. Pak J Med Health Sci. 2011;5(4):634-8.
24.Potiris A, Machairiotis N, Christidis I, Karampitsakos T, Variawa R, Drakaki E, et al. Thyroid disorders; an insidious cause leading to female infertility. HJOG. 2024;23(1):24-31. doi:10.33574/HJoG.0547
25.Gul E, Riaz H, Altaf A, Memon S, Memon SS, Abro SA. Evaluating thyroid stimulating hormone in women with ovulatory disorders: a clinical and statistical assessment. Rawal Med J. 2025;50(3):656-8.
26.Ganvir S, Sahasrabuddhe AV, Pitale SU. Thyroid function tests in polycystic ovarian syndrome. Natl J Physiol Pharm Pharmacol. 2017;7(3):269-72. doi:10.5455/njppp.2017.7.0926503102016
27.Poppe K, Velkeniers B. Thyroid disorders in infertile women. Ann Endocrinol (Paris). 2003;64:45-50.
28.Antolič B, Geršak K, Verdenik I, Novak-Antolič Ž. Adverse effects of thyroid dysfunction on pregnancy and pregnancy outcome: epidemiologic study in Slovenia. J Matern Fetal Neonatal Med. 2006;19(10):651-4. doi:10.1080/14767050600850332
29.Mahadik K, Choudhary P, Roy PK. Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC Pregnancy Childbirth. 2020;20(1):769. doi:10.1186/s12884-020-03448-z
30.Kumar S, Kotur P. Effects of hypothyroidism in Indian women of reproductive age group - a review article. Ind J Obstet Gynecol Res. 2020;7(1):1-6. doi:10.18231/j.ijogr.2020.001
31.Hussain Z, Pathan S, Bibi F, Sultana S, Yasmeen R, Hanan S. Integrated pathology management of thyroid-linked sub-fertility: a multidisciplinary systematic approach. Rawal Med J. 2025;50(2):384-8.
32.Petruk AO, Lytvak OO, Sheptukha SA. Assessment of thyroid status in women with menstrual function disorders after COVID-19. Clin Prev Med. 2025;7:64-70. doi:10.31612/2616-4868.7.2025.09
33.Tsysar YV, Andriiets OA, Andriiets AV, Semenyak AV. The role of proinflammatory cytokines interleukin 1-β and tumor necrosis factor-α in diagnostics of pubertal menorrhages against thyroid pathology. Neonatol Surg Perinat Med. 2022;12(4):31-7. doi:10.24061/2413-4260.XII.4.46.2022.5
