Ajit Kumar Nayak

Abstract

. Thyroid hormone plays an important role in the regulation of menstrual cycle in women. Thyroid dysfunctions are frequently associated with dysfunctional uterine bleeding which is a type of abnormal uterine bleeding in absence of organic disease of the genital tract. This hospital based prospective study was carried out on 150 women in different age groups who presented with dysfunctional uterine bleeding in the Department of Obstetrics & Gynecology, F.M. Medical College & Hospital, Balasore, Odisha over a period of one year. Thyroid function test was done and was correlated with abnormal bleeding patterns and endometrial histopathological study.Out of 150 patients with dysfunctional uterine bleeding, 27 (18%) had hypothyroidism, 2(1.33%) had hyperthyroidism and 121(80.67%) were euthyroid. Majority i.e. 96 (64%) were in the age group of 26-35 years, out of which 21(21.87%) had hypothyroidism and one (1.04%) was hyperthyroid. Menorrhagia and metrorrhagia were the most common pattern of menstrual irregularities noticed among the patients having hypothyroidism (81.48%) . 52.04%, 30.62% and 17.34% patients had proliferative pattern, secretory pattern and endometrial hyperplasia respectively. 21.5% of proliferative endometrium, 23.33% of secretory endometrium and 17.64% of endometrial hyperplasia were seen in histopathological study of patients having hypothyroidism. Most of the patient with hypothyroidism i.e. 70.37% had normal endometrial thickness found during pelvic ultrasonography. Prevalence of thyroid disorders particularly hypothyroidism is quite common in patients having dysfunctional uterine bleeding. Therefore, thyroid function test should be done in all patients with menstrual irregularities to avoid unnecessary hormonal treatment and surgical intervention   Keywords: Dysfunctional uterine bleeding, Hypothyroidism, Hyperthyroidism, Thyroid disorder

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Abstract

In spite of availability of many conservative methods to treat various benign gynaecological disorders, hysterectomy remains the mainstay of treatment. This is a hospital based Cross sectional study on 200 cases of elective hysterectomies carried out in the department of Obstetrics & Gynaecology, Fakir Mohan Medical College and Hospital Balasore, Odisha, India, from November 2018 to October 2020. Findings related to age, clinical presentations, indications, route of surgery, concurrent removal of ovaries, complications and histopathological study of uterine specimen were recorded and statistically analyzed.48% were between the age group of 41-50 years. 52% presented with heavy menstrual bleeding. In 59% cases fibroid uterus was the indication for hysterectomy. 80% underwent abdominal hysterectomy and 20% vaginal hysterectomy. Both ovaries were removed in 55% cases. 3 % cases had intraopertive bleeding and 4% had wound gaping who required secondary suturing. Histopathological study of uterine specimen revealed endometrial hyperplasia in 14 % cases, non specific chronic cervicitis in 92% cases and leiomyoma in 59% cases. Heavy menstrual bleeding is the most common clinical presentation. Leiomyoma being the most common indication for hysterectomy. Abdominal route is preferred over vaginal route. Ovaries are preserved in several cases. Bleeding and wound gaping are the most common surgical complications. Proper selection of cases reduces the complication rate.   Keywords: Hysterectomy, Indication, Route, Preservation of ovaries, Complication

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