The majority of participants were in the 21–30 age group. Oligomenorrhea was the predominant AUB presentation. Hypothyroidism was observed in 25.3% of cases, while hyperthyroidism was rare. Euthyroid status was common across bleeding patterns. Prevalence of thyroid disorders was 29%, emphasizing the multifactorial nature of menstrual health. The study emphasizes considering thyroid function in menstrual evaluations to improve patient care and avoid unnecessary surgeries. Women's reluctance to seek medical advice for abnormal uterine bleeding, driven by time concerns and fear of surgery, underscores the need for awareness and open conversations to enhance health outcomes.

INTRODUCTION

Among women who are capable of bearing children, thyroid problems are highly prevalent and hold a considerable amount of power on all aspects of the female reproductive system. This influence extends to important phases, such as the control of menstrual cycles, fertility, pregnancy, and the postpartum phase.⁽¹⁾

An irregular menstrual cycle is a result of thyroid function disturbances that impact blood flow and cycle length. ^[2] After this point, any bleeding that deviates from the usual range in terms of volume, frequency, or length is referred to as abnormal uterine bleeding (AUB), which becomes a common worry for women of reproductive age. AUB, which affects 9–14% of women from menarche to menopause, involves not just physical discomfort but also has social repercussions. This could turn out to be embarrassing and lower one's life's standard. in general. The reported prevalence of AUB in India stands at almost 17.9%, highlighting the significant societal cost connected to this illness.^[3]

In addition, thyroid problems seem to affect women more often leading to a multiplicity of difficulties for them, including aberrant sexual development, irregular menstruation, infertility, and an early onset of menopause. Before clinically apparent hypothyroidism or hyperthyroidism, there is typically a complex interaction between thyroid malfunction and menstruation problems. A common thyroid condition called hypothyroidism can cause a variety of problems with reproduction, including irregular menstruation, infertility, and abnormal sexual development.

The connection between alterations in menstrual cycle duration and blood flow and hypothyroidism is highlighted by historical records dating back to the 1950s. Subclinical menorrhagia, which affects up to 9.5% of women, may be linked to subclinical hypothyroidism, which is characterized by mild symptoms. In a similar way delayed menstruation has been connected to hyperthyroidism before puberty. ^[4]

Production and control of thyroid hormones:

Thyroid hormone production and control start in the brain. Thyrotropin-releasing hormone (TRH) is secreted into the hypothalamic-pituitary portal system by the hypothalamus, initiating this regulating process. The anterior pituitary gland's cells release thyroid-stimulating hormone (TSH) in response to stimulation from TRH. The periventricular nucleus (PVN) cell bodies in the hypothalamus manufacture the peptide hormone TRH. The hypothalamic-pituitary-thyroid axis is based on this complex interaction, which makes sure that thyroid hormones are released and regulated in a coordinated manner to preserve general homeostasis.⁽⁵⁾

Before Thyrotropin-Releasing Hormone (TRH) reaches the anterior pituitary, it is concentrated in the pituitary portal circulation thanks to signals sent by neurons originating in cell bodies. The tropic hormone TRH stimulates other endocrine glands, which has an indirect effect on cells. TRH interacts with receptors in the anterior pituitary, starting a signaling cascade that involves G proteins. This activation results in the synthesis of messengers that release calcium reserves, activate protein kinase C, and ultimately start the thyroid-stimulating hormone (TSH) transcription. Furthermore, through the hypothalamic-pituitary-prolactin axis, TRH has non-tropic actions on the pituitary gland, directly inducing the production of prolactin in milk-secreting cells. Prolactin can cause breast tissue growth and lactation; it is affected by several chemicals, including estrogen and serotonin. When TSH is released into the blood, it attaches itself to thyroid follicular cells' thyroid-releasing hormone receptors, initiating a protein kinase A (PKA), intracellular cAMP, and adenylyl cyclase that phosphorylates proteins and modifies their activity.⁽⁵⁾

Figure: The basic processes and proteins involved in the creation of thyroid hormones are depicted in this diagram. Using substrates like iodine and H2O2, the process entails iodinating the tyrosyl residues in the thyroglobulin precursor protein. This reaction occurs near the follicular lumen's apical membrane. ThOX 1 and 2 are involved in the reduction of O2 to H2O2 and the oxidation of reduced nicotine to dinucleotide phosphate (NADPH). Pendrin carries iodine into the lumen, where thyroid peroxidase (TPO) oxidizes it and moves to the thyroglobulin tyrosyl group. Following internalization and vesicle fusion, thyroid hormones (T3, T4) are then proteolytically liberated from thyroglobulin.⁽⁶⁾

Five essential processes direct the synthesis of thyroid hormones⁽⁵⁾

• The production of thyroglobulin: Thyroglobulin (TG), an iodine-free precursor protein kept in the follicular lumen, is produced by thyroid cells. TG is produced in the rough endoplasmic reticulum, packaged by the Golgi apparatus into vesicles, and subsequently enters the follicular lumen through exocytosis. 
• Uptake of Iodide: Kinase for proteins the basolateral Na+-I cotransporter regulated by Na+-K+-ATPase is enhanced by phosphorylation, which facilitates the transport of iodide from the bloodstream to the thyroid gland. Pendrin transporters carry iodide into the colloid from the basolateral side of the cell to the tip.
• Thyroglobulin Iodination: Thyroid peroxidase (TPO) is activated by protein kinase A and is involved in three different types of reactions: oxidation, assembly, and coupling. 

1. Oxidation: NADPH oxidase generates hydrogen peroxide, inducing TPO utilizes to convert iodide (I-) to iodine (I2).
2. Coupling Reaction: TPO produces monoiodotyrosine (MIT) and diiodotyrosine (DIT) by coupling the tyrosine residues of thyroglobulin with I2. Tetraiodothyronine (T4) and triiodothyronine (T3) are created when this mix. 

• Storage: Thyroglobulin is kept in the follicular lumen and is bound by thyroid hormones. 
• Release: The following procedures lead to the release of thyroid hormones: 

1. Iodinated thyroglobulin is endocytosed by thyroid cells. 
2. Endosomes with iodinated thyroglobulin merge with lysosomes.
3. Proteolytic enzymes within endolysosomes break thyroglobulin into MIT, DIT, T3, and T4.
4. The MCT8 transporter releases T3 (20%) and T4 (80%) into fenestrated capillaries. 

Iodine that has been reallocated into the intracellular iodide pool is recovered by deiodinase, which extracts iodine from DIT and MIT.⁽⁵⁾

Thyroid hormones play a crucial part in reproductive physiology:

Because of their effects on the Hypothalamus-Pituitary-Thyroid (HPT) and Hypothalamus-Pituitary-Gonadal (HPG) axis, thyroid hormones are important in the physiology of reproduction. The HPT axis is regulated by thyroid-stimulating hormone-releasing hormone (TRH), which in turn influences the HPG axis.⁽⁷⁾

TRH secretion is elevated in severe primary hypothyroidism patients. Notably, TRH plays a crucial function in mammogenesis and the production of milk by being a strong stimulant of prolactin release. Dopamine, a prolactin inhibitor, rises in response to heightened prolactin levels, which are frequently linked to hypothyroidism. In addition to directly inhibiting prolactin, this dopamine surge also modifies kisspeptin signaling, which in turn influences the gonadotropin-releasing hormone (GnRH). Dopamine and prolactin work together to affect the pituitary's reaction to gonadotropin, which in turn affects how reproductive processes are regulated.⁽⁷⁾

Gonadotropins, sex steroids, and other endocrine and paracrine substances interact in the female reproductive system to facilitate ovulation, fertilization, implantation, and pregnancy. Beyond their function in the synthesis and transportation of estrogen, thyroid hormones (TH) have additional impacts on the complex mechanisms of female reproductive physiology.⁽⁷⁾

The uterus and Fallopian tubes: Both the myometrium and the lining of the uterus are two essential parts of the uterus. The presence of thyroid hormone receptors (THR) in the human myometrium and endometrium indicates a potential scenario that thyroid hormones (TH) and uterine function are related. Without the presence of pregnancy or during menstruation, blastocyst implantation requires a well-regulated endometrium.⁽⁷⁾

Reproductive functions may be impacted by hyperthyroidism, a disorder marked by elevated thyroid hormone levels. The usual menstrual cycle may be disturbed, resulting in irregular menstrual cycles. Furthermore, hyperthyroidism raises the body's energy needs, which may affect the metabolic balance required for the best possible reproductive health. In the setting of reproductive physiology, these effects highlight the complex connection between the thyroid's function and the healthy operation of the uterus and the fallopian tubes.⁽⁷⁾

Thyroid disorders classification:

Hypothyroidism:

An inadequate generation of thyroid hormones leads to the common endocrine condition known as hypothyroidism. Hashimoto's disease, an autoimmune thyroid condition, is frequently the main reason in countries like the USA where iodine intake is abundant. The thyroid is attacked by the immune system in this condition, which makes it difficult for the thyroid to make enough hormones. Iodine deficiency continues to be the most common cause of hypothyroidism worldwide, highlighting the vital role iodine plays in thyroid.⁽⁸⁾

Relationship between Reproductive hormones (FSH, LH, and sex hormones) and Hypothyroidism:

The biochemical connection between thyroid disease and irregularities in the ovarian cycle and ovulation is not well understood. Elevated peripheral aromatization results from hypothyroidism's decreased androstenedione and estrone metabolic clearance. It also modifies the excretion of estrogen and androgen metabolites. Women with hypothyroidism have lower levels of SHBG plasma binding activity, which lowers their levels of E2 and testosterone overall but increases their unbound fractions. These alterations in steroid metabolism are undone by returning to a euthyroid condition. Gonadotropin levels usually stay normal in hypothyroidism.^[19]

Derived from primordial follicles at repose, ovarian follicles can atrophy or develop into antral follicles. Follicle fate is regulated by growth factors and hormones. The hypothalamus-pituitary-gonadal axis is disrupted by thyroid diseases in humans, and hypothyroidism is linked to oligomenorrhea. Oocyte quality is influenced by the T3 and T4-containing follicular fluid composition. Human thyroid hormone receptors.^[19]

Types of Hypothyroidism:

Primary and secondary (or central) hypothyroidism are the two types of hypothyroidism. Once the thyroid stimulating gland itself is unable to create enough thyroid hormone, primary hypothyroidism results. On the other side, secondary hypothyroidism, though less prevalent, involves adequate thyroid gland function but disease impacting the anterior pituitary gland or the hypothalamus underlining the intricacy of thyroid problems.⁽⁹⁾

Hypothyroidism management:

Normalizing blood levels of free thyroxine (T4) and thyroid-stimulating hormone (TSH) is the main goal of controlling hypothyroidism to address metabolic abnormalities. Levothyroxine (LT4) represents the prevalent thyroid hormone that is given for the body's overall health to supplement or replace its natural production.⁽⁸⁾

Thyroid hormone treatment can start at the anticipated total replacement dosage (1.6 ?g/kg/day) for young, healthy persons. It is required for pregnant women to need doses that are 25% greater. After four to six weeks, individuals who are older or who have ischemic cardiovascular disease should be started at a dosage that is a quarter to half of what is anticipated.⁽⁹⁾

To track the amounts of hormone secretion by the thyroid gland that is thyroid hormone  in the bloodstream,  necessitate regular blood tests. Periodically, your doctor might have to modify the dosage of your medicine. It may take some time to determine the proper number of thyroid hormones. Your doctor will take a blood sample to measure your TSH levels six to eight weeks after you start synthetic hormone therapy. After that, testing will be performed every six months.⁽¹⁰⁾

It's important to recognize the warning indications of excessive treatment for hypothyroidism since even minor symptoms like palpitations, feeling hot or shaky, and trouble falling asleep might point to a need for treatment modifications. Hand tremors, muscle weakness, anxiety, and mood swings are signs of severe overtreatment.⁽¹¹⁾

Hyperthyroidism: -

A disorder known as hyperthyroidism is typified by a thyroid gland that is excessively active that produces an excessive quantity of thyroid hormones. when you have hyperthyroidism. Numerous organ systems and a wide range of symptoms may be impacted by this increase in hormone production. The most prevalent cause of hyperthyroidism is Graves' disease, a disorder where the immune system attacks the thyroid, impacting its function, produces too many hormones. Thyroiditis, or inflammation of the thyroid gland, thyroid nodules (toxic adenoma), and overindulgence in iodine are additional causes.^[12][13]

       
           
       
MENSTRUAL DISORDERS: (AUB)

Problems that interfere with a woman's regular menstrual cycle are referred to as menstrual disorders. These may show up as severe cramps, heavy bleeding, or no bleeding at all during the typical menstrual cycle.

Menstruation, sometimes referred to as a "period," is the monthly flow of blood via the vagina and cervix from the uterus that happens between adolescence and menopause

Menstrual irregularities that fall under the study:

Amenorrhea:

The absence of a lengthier monthly periods than three months is the hallmark of amenorrhea. It falls into one of two categories: secondary amenorrhea, which is characterized by the progressive irregularity or cessation of formerly regular menstrual cycles, or primary amenorrhea, in which a woman does not begin menstruation during puberty.^[16]

Several reasons, such as the following, can cause amenorrhea:

1. 1. Ovulation Abnormality: Problems with ovulation might cause irregularities in the menstrual cycle.
   2. Thyroid Disease: Menstrual regularity may be affected by thyroid gland dysfunction.
   3. Excessive or Strenuous Exercise: Excessive physical exercise might cause amenorrhea by disrupting the hormonal balance.
   4. Weight-related Factors: The menstrual cycle may be impacted by obesity or underweight.
   5. eating disorders: Anorexia and bulimia, for example, might interfere with hormone function and result in amenorrhea.
   6. Congenital or Anatomical Abnormalities: The reproductive system may have structural problems.
   7. Endocrine System Issues: Menstrual regularity may be impacted by endocrine system imbalances.
   8. Medications or Hormonal therapies: Certain drugs or therapies, including hormonal birth control, might disrupt menstruation.

It's critical to pay attention to symptoms like milky discharge from the nipples, as they may be signs of underlying hormonal problems and should be evaluated by a doctor. Identifying and treating the underlying reason is vital for managing amenorrhea in a managerial setting.^[15]

Menorrhagia:

Menorrhagia is a common type of abnormal uterine bleeding that is characterized by heavy and continuous menstrual flow. In extreme situations, this condition can have a major impact on everyday living.

Menorrhagia has several causes, including:

1. 1. Hormonal Imbalance: Excessive and protracted menstrual bleeding might result from hormonal imbalances.
   2. Structural Abnormalities of the Uterus: Substances like polyps and uterine fibroids can cause menorrhagia.
   3. Thyroid Issues: The regularity and strength of menstrual cycles might be impacted by thyroid gland dysfunction.
   4. Blood Clotting Disorders: Prolonged and severe bleeding can be caused by illnesses that affect the body's natural clotting systems.
   5. IUD (Intrauterine Contraceptive Device) Complications: Using an IUD may cause increased bleeding in certain women.
   6. Liver or kidney disease: Menstrual patterns may be affected by underlying problems with the liver or kidneys.
   7. Infection: Abnormal bleeding may be a result of infections affecting the reproductive organs.
   8. Precancerous Lesions in the Endometrium: Menorrhagia may result from abnormal endometrial cell proliferation.
   9. Abortion: After an abortion, irregular menstruation, including menorrhagia, may happen.
   10. Leukaemia: Abnormal menstrual bleeding is also linked to this type of blood cancer.

A menstrual cycle that lasts more than seven days and spotting or bleeding in between periods are indicators of menorrhagia. Determining the precise cause is essential for managing and treating menorrhagia effectively.^[15]

Dysmenorrhea:

Menstrual pain, ranging from minor discomfort to intense cramps, is known as dysmenorrhea. It originates from uterine contractions that are affected by prostaglandins, which are substances that resemble hormones. The type of the issue dictates the cause.

• Primary Dysmenorrhea: Consists of discomfort associated with regular menstruation, frequently brought on by increased contractions of the uterus.
• Secondary Dysmenorrhea: Reproductive diseases such as adenomyosis, fibroids in the uterus, pelvic inflammatory illness, infections, tumors or pelvic polyps linked with heightened discomfort. Additionally, anomalous pregnancies such as ectopic pregnancy or loss may be involved.

The following variables raise the chance of dysmenorrhea:

- *Smoking*: Smoking women are women are at greater risk.

- *Excessive Alcohol Consumption*: Menstrual pain may be exacerbated by excessive alcohol consumption.

- *Being Overweight*: Women who weigh more may experience dysmenorrhea more frequently.

*Early Onset of Menstruation*: There is a higher chance of menstrual pain if menstruation begins before the age of eleven.

Effective management and treatment of dysmenorrhea depend on determining and treating the underlying cause.^[15]

Polymenorrhea:

Polymenorrhea is a condition when a woman experiences numerous menstruation periods, often lasting fewer than 21 days. Aside from fertility problems, this irregular menstrual cycle can cause symptoms like anaemia, pallor, and exhaustion.

Hormonal abnormalities, endometriosis, pelvic adhesions, and inadequate progesterone production are among the possible causes of polymenorrhea. Because the date of ovulation can be difficult to control, this irregular menstruation pattern might make it difficult to predict ovulation effectively, which can have an impact on fertility.

Oligomenorrhea:

The symptoms of oligomenorrhea include irregular or infrequent menstrual cycles, with periods lasting more than 35 days, less than 9 periods per year, or abnormally light bleeding. Oligomenorrhea may be brought on by hormonal shifts, diseases such as PCOS, severe weight fluctuations, eating disorders, mental stress, and vigorous physical exercise.

 Menstrual cycles that take place shorter than 25 days or exceeding 35 days, changes in blood flow, and the existence of blood clots are possible symptoms.^[15]

Treatment:

Medication is frequently the first line of treatment for irregular periods.

• Hormonal birth control is frequently prescribed to prevent irregular bleeding and regulate cycles. Examples of hormonal birth control devices include pills, rings, injections, and IUDs.

• Tranexamic acid is useful in managing severe bleeding, and ibuprofen is useful in treating cramping.
• If an infection is the reason for the premenopausal symptoms, antibiotics may be recommended in addition to hormone therapy.

Surgical options are contingent upon age, health, and infertility objectives. Various methods are employed during procedures like endometrial ablation to lessen bleeding, but birth control is still required.

• Uterine fibroids are removed via myomectomy, the blood supply to fibroids is cut off by uterine artery embolization, and in extreme circumstances, the removal of damaged tissue may be considered with a hysterectomy. The particular circumstances of each patient have an impact on surgical decisions.
• Plans for the patient's future pregnancy and unique circumstances have a role in surgical decisions.

Techniques for reducing stress include.

• yoga and meditation.
• Inhaling deeply.⁽¹⁴⁾

AIM AND OBJECTIVES

AIM:

 The study aims to evaluate the prevalence of thyroid disorders in women with abnormal uterine bleeding.

OBJECTIVES:

1. To assess the association between specific thyroid disorders (e.g., hypothyroidism, subclinical hypothyroidism, and hyperthyroidism) and abnormal uterine bleeding.

2. To investigate whether thyroid function tests, such as TSH and T4 levels, correlate with the severity of abnormal uterine bleeding. 

3. Identify any differences in the prevalence of thyroid disorders in women with abnormal uterine bleeding based on demographic factors (e.g., age and ethnicity)

4. To improve the quality of life (QoL) of patients with menstrual abnormalities having thyroid dysfunction.

METHODOLOGY

The study has been conducted as an observational study of the prevalence of thyroid dysfunction in women experiencing menstrual disorders. This study was carried out for six months and the enrolment began in July 2023 and ended in January 2024. For this study,134 patients were enrolled to assess their quality of life. These patients were all the Indian origin.

Study site:

The study and the survey were conducted at Fehmi Care Hospital, Yousufguda, Hyderabad, Telangana, India.

Study duration:

The study was conducted for a period of 6 months from July 2023 to January 2024.

Study design:

The study is a prospective observational study.

Sample size:

The sample size of the study population was calculated based on the prevalence of thyroid dysfunction in women experiencing menstrual disorders in the Indian population. An estimate of that magnitude with 95% confidence limits required a sample size of 140. With around 10% allowance for any dropouts, the calculated sample was 134.

Data collection:

The hospital authorities permitted us to collect the data from the participants after the study objectives were described to the participants. Consent in written form was secured from each patient The demographic data (age, gender, etc) in addition to the medical history, collected. The parameters included are TSH, T3, T4, hemoglobin, FSH, and LH. The diagnosis of thyroid disorders was based on parameters and clinical findings.

Sources of data:

The information was gathered using custom patient profile forms, which encompassed all the needed parameters for the study.

Selection criteria:

Inclusion criteria:

•Age:18 to 50 Yrs.

•All premenopausal women with menstrual disorders.

•Any type of menstrual disorders like:

1. Amenorrhea
2. Oligomenorrhea (Irregular cycles
3. Menorrhagia
4. Dysmenorrhea
5. Polymenorrhea

Exclusion criteria:

1. Pregnancy
2. Patients who were not able to give informed consent.
3. Patients who take anti-epileptics and anti-psychotics.
4. Women with thyroid carcinoma and bleeding disorders.

Statistical Analysis:

Statistical analysis was conducted utilizing IBM SPSS (version 24). Continuous and discrete variables the information is displayed as the average. +_Standard Deviation and frequency with percentage (N (%)), respectively. The data was shown as the mean accompanied by the standard deviation for the normal distribution/scale data and as the frequency with proportion (%) for categorical data. The study employed the Pearson correlation test to test between the different groups among the variables that were given in different categories. The age distribution and correlations between menstrual disorders and thyroid dysfunction were all compared using the Pearson correlation test and Chi-square tests.  All the statistical analysis is done at a 5% significance level or 95% confidence interval. P values less than 0.05 were regarded as statistically significant.

RESULTS AND DISCUSSION

The present study comprises 134 patients with Menstrual abnormalities presenting in the outpatient department at a specialty medical facility, from July 2023 to January 2024. The prevalence of Thyroid disorders in patients with menstrual disorders was deduced based on self-reports, clinical findings, and imaging studies are required.

1. Age distribution according to thyroid disorders:

From the table and figure, it can be deduced that among 134 patients, there was a large proportion of young people in the sample as most individuals fall within the 21-30 age range and other significant portion are aged between 31-40. Within the specified age range of 21-30, all thyroid abnormalities are prevalent (54.7%) with 52 cases of euthyroid, 7 cases of subclinical Hypothyroidism, 12 cases of Hypothyroidism, and 2 of Hyperthyroidism. Age group 31-40 has a distribution of thyroid disorders of 25.3% with about 24 normal cases with 2 Subclinical Hypothyroidism, 6 Hypothyroidism cases, and 1 Hyperthyroid case. However, there seems to be limited representation among younger individuals with thyroid disorders since only 5.2% exists with age less than 20 years. Hyperthyroidism is relatively rare and most prevalent in the 21-30 age group.

Table: 1: Age distribution according to thyroid disorders

       
           
       
       
           
       
2. Characteristics of atypical uterine bleeding patterns (AUB types):

Menstrual periods are absent in those with amenorrhoea. Among the research participants, 10 cases were reported with Amenorrhea. Dysmenorrhea involves painful menstruation. Among the research participants, there were 25 cases reported that followed this same pattern. Excessive or prolonged menstrual bleeding is a sign of menorrhagia. Among the research participants, there were 31 cases reported that followed this same pattern. Periods that are irregular or sporadic are indicative of oligomenorrhea. Among the research participants, there were 60 cases reported that followed this same pattern. Polymenorrhea involves frequent, short menstrual cycles. In your dataset, this precise pattern was observed in 8 recorded cases.

• Oligomenorrhea is the most common AUB type in the dataset, indicating a significant prevalence of infrequent menstrual periods.

• Dysmenorrhea and menorrhagia are also relatively common, suggesting a notable presence of painful and heavy menstrual bleeding in this population.
• Amenorrhea and polymenorrhea are observed in smaller numbers but still represent important variations in menstrual patterns.

Table:2: Pattern of bleeding

3. Age distribution according to menstrual disorders:

The figure and the table below depict the same. The highest prevalence of Amenorrhea is in the age group 21-30 with 5 cases. Amenorrhea is also present in the age group less than 20 with 1 case. The occurrence diminishes with increasing age, with only 1 case in the age group 41-50. The peak incidence of Dysmenorrhea characterized by painful menstruation is noted within the specific age range of 21-30 with 16 cases and remains significant within the age range of 31-40 with 4 cases. Generally, declines in older age, with only 5 cases reported in age group 41-50. Menorrhagia is most prevalent in the age group 21-30 with 12 cases and continues to show significant presence in the age group 31-40 with 12 cases. The frequency declines among the elderly age groups, with 7 cases in the age group 41-50. Oligomenorrhea, infrequent periods are most prevalent in the age group 21-30 with 38 cases and is observed in those under 20 with 7 cases. Its frequency decreases with increasing age, with 12 cases in the age group 31-40 and 3 cases in the age group 41-50. Polymenorrhea is highest in the age group 41-50 with 4 cases, and it is also observed in the age groups 31-40 and 21-30 with 2 cases.

Table 4: Correlation between hemoglobin and AUB type

p-value: 0.002.

Interpretation:

Amenorrhea: Low Haemoglobin: 8 cases, Normal Haemoglobin: 2 cases, Total Amenorrhea: 10 cases

Dysmenorrhea: Low hemoglobin: 6 cases, Normal hemoglobin: 19 cases, Total Dysmenorrhea: 25 cases

Menorrhagia: Low hemoglobin: 14 cases, Normal hemoglobin: 17 cases, Total Menorrhagia: 31 cases

Oligomenorrhea: Low hemoglobin: 40 cases, Normal hemoglobin: 20 cases, Total Oligomenorrhea: 60 cases

Polymenorrhea: Low hemoglobin: 3 cases, Normal hemoglobin: 5 cases, Total Polymenorrhea: 8 cases

Chi-Square Test Interpretation:

Pearson Chi-Square:

• Chi-Square value: 19.216
• Degrees of freedom (df): 5
• Asymptotic Significance (2-sided): 0.002

There is a statistically noteworthy connection between hemoglobin levels and AUB (types of abnormal uterine bleeding), as the p-value (0.002) is less than the conventional significance level of 0.05.

       The distribution of AUB type varies significantly based on hemoglobin levels. Oligomenorrhea occurs more frequently in individuals with low hemoglobin levels. There is a statistically noteworthy connection between hemoglobin levels and the types of abnormal uterine bleeding.

These results indicate that hemoglobin levels may be correlated with specific types of abnormal uterine bleeding.

Table 5: Oligomenorrhea & Thyroid dysfunction distribution:

                 p-value: 0.012

Oligomenorrhea is observed in 37.9% of patients without thyroid dysfunction & 61.5% of patients with thyroid dysfunction.

Prevalence of thyroid disorders among women experiencing abnormal uterine bleeding (AUB)

Prevalence is the quantity of disease at one particular point in time, and we can as tell it as the proportion of people who have the disease.

 Formula of Prevalence: Number of people with disease/Number of people in the population X 100

6.Levels of TSH distribution:

The dataset (table and figure) indicates that (25.3%) 34 individuals have high TSH levels. Elevated TSH levels are commonly linked to hypothyroidism, indicating that the thyroid gland might not be producing enough thyroid hormones. A smaller subset of the population, (2.2%) 3 individuals, has low TSH levels. TSH reduction is often associated with hyperthyroidism, where the gland responsible for thyroid produces an excessive number of thyroid hormones. Most of the population (72.3%) 97 individuals has TSH levels within the normal range. Normal TSH levels typically suggest a well-functioning thyroid gland.

The distribution of TSH levels indicates overall thyroid health in the population, with a significant portion having normal levels. High TSH levels suggest potential hypothyroidism, while low levels indicate a smaller subset with potential hyperthyroidism. This diversity underscores the need for monitoring TSH levels for a comprehensive assessment of thyroid health.

Table 6: Levels of TSH distribution

       
           
       
CONCLUSION