Perimenopausal Age Group Research Articles

Role of Chromohysteroscopy in Patients of Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) is the most common clinical problem in gynecology with hysteroscopy permitting the direct visualization of uterine cavity to diagnose various intra-uterine lesions. Scientists have incorporated the usage of dyes to stain specific lesions in endometrium which is called as chromohysteroscopy. The present study was conducted on 100 women of perimenopausal age group (40–55 years) with the aim to strengthen the importance of chromohysteroscopy in patients of AUB and to widen its applicability in detecting subtle endometrial changes which can be missed on routine hysteroscopy. On hysteroscopy, endometrium in 88 patients appeared to be normal, and 12 patients had abnormal endometrium (eight hyperplasic, three atrophic, one diffuse polypoidal). Out of these 12, only four patients had confirmed pathology on histopathological examinations (HPE) (two simple hyperplasia, one atrophic endometrium, one carcinoma endometrium). Thus, hysteroscopy had sensitivity of only 26.67% and specificity of 90.59% with PPV of 33.32 and PPV of 87.50 in predicting diffuse endometrial changes. Out of eight HE on hysteroscopy, only two (25%) were confirmed on histopathological examination. On chromohysteroscopy, out of 100 patients, 15 patients had dark stained endometrium, and among these, 12 patients had confirmed endometrial abnormalities on HPE (seven simple hyperplasia, four inflammatory endometrium, one carcinoma endometrium). Thus, chromohysteroscopy has sensitivity of 80.00% in detecting endometrial pathologies. Methylene blue is relatively very safe dye with fewer complications and has more predilections for hyperplastic and inflammatory endometrium. It does not require any sophisticated instrumentation or clinical skills during its usage and can be successfully employed along with hysteroscopy to predict hidden pathological areas during hysteroscopy without any harm.

Transvaginal Ultrasonography and Hysteroscopy in Evaluation of Abnormal Uterine Bleeding- A Cross-sectional Study

Introduction: In perimenopausal age group particularly, 70% of all gynaecological consultations are for Abnormal Uterine Bleeding (AUB). About 30% of women seek medical assistance for AUB during their reproductive age group and about one third of hysterectomies are carried out for AUB alone. Aim: To determine the sensitivity, specificity, positive predictive value and negative predictive value of Transvaginal Ultrasonography (TVS) versus hysteroscopy in detecting uterine abnormalities Materials and Methods: A cross-sectional study in patients with AUB, admitted to the Department of Obstetrics and Gynaecology at RGGWCH, Puducherry between February 2016 and February 2017 who met the inclusion criteria were included. Sample size was 85 cases. After taking detailed history and physical examination the patient was investigated to rule out organic causes of AUB and then TVS and hysteroscopy were done. Any intrauterine pathology was looked for and endometrial sampling was taken from the abnormal sites for Histopathological Examination (HPE). Both TVS and hysteroscopy results were compared with histopathology which is the gold standard. Results: The sensitivity of TVS in diagnosis of uterine fibroid in comparison to hysteroscopy was 94.74% and the specificity was 71.21%. The sensitivity of hysteroscopy in diagnosis of endometrial hyperplasia in comparison to HPE was 75% and the specificity was 87.01%. The sensitivity of TVS in diagnosis of endometrial hyperplasia in comparison to HPE was 37.5% and the specificity was 90.91%. The sensitivity of hysteroscopy in diagnosis of polyp in comparison to HPE was 100% and the specificity was 97.3%. The sensitivity and specificity of TVS in diagnosis of polyp in comparison to HPE were 9.09% and 93.24%, respectively. Conclusion: TVS had a high sensitivity to detect fibroids but its value in detecting hyperplasia and polyps was in question in this study. But hysteroscopy had a maximum sensitivity to detect polyps and high sensitivity to detect endometrial hyperplasia compared to histopathology which is a gold standard investigation.

Abnormal uterine bleeding: A study of its clinical spectrum and incidence of histopathological patterns of endometrium as a function of age with parity

Introduction: Abnormal uterine bleeding (AUB) is a common complaint affecting majority of pre and postmenopausal women. Endometirum is a dynamic tissue and is affected by a wide range of histopathological lesions. The causes of AUB is a function of age. Aim and Objective: to study the histopathological pattern in cases of AUB in reference age, parity and bleeding pattern. Patients were categorized into reproductive (50 years). Materials and Methods: A total of three hundred patients presenting with AUB are included in this study. Observation and Results: In this study patient ranged from 20 to 70 years and the mean age of the cohort was 43.46±8.07. Major parity category noted in the cohort was para-2 in 89 patients (29.67%). Major bleeding pattern observed in the cohort was menorrhagia (32.33%); followed by metrorrhagia (19.67%), menometrorrhagia (16.33%), postmenopausal bleeding (12.67%), polymenorrhoea (9.67%), polymenorrhagia (5%) and continuous bleeding (1%). Histopathological pattern observed in AUB patients was proliferative phase endometrium (31.33%), secretory phase endometrium (21.67%), menstrual endometrium (1.33%). atrophic endometrium (6%), disordered proliferation (3.33%), mixed pattern (1%), polyp (10.67%), metaplasia (9.67%), hyperplasia (8.67%), endometritis (2.67%), adenocarcinoma (1.67%) and insufficient (2%). Conclusion: The causes of AUB are function of age; perimenopausal age group is the most common affected. Dilatation & Curettage is cost effective, useful procedure but organic lesions such as leiomyoma and adenomyosis can be missed. AUB is a common disorder affecting females and is a challenge to the treating gynaecologist. Keywords: Endometrium, Premenopausal, Postmenopausal, Hyperplasia, Polyp.

Spectrum of Endometrial lesions in patients presenting with abnormal uterine bleeding

Introduction: Most of the patients with bleeding per vaginum undergo either colposcopic evaluation or Pap smear for cervical pathology or Trans Vaginal Ultrasound and endometrial biopsy to diagnose the definite pathology affecting endometrium. This study was done to see the pattern of histopathological spectrum of endometrial biopsy and their clinical correlation in a tertiary care hospital. Materials and Methods: This was a retro-prospective study conducted at a tertiary care hospital in western Maharashtra. 1000 biopsy cases were studied. Light microscopy examination and clinical diagnoses were correlated. Results: out of 1000 patient’s maximum number belonged to perimenopausal age group followed by reproductive age group and then postmenopausal age group. In 483 cases normal histopathological pattern was observed, out of which 259 cases showed proliferative phase endometrium (25.9%) and 224 cases showed secretory phase (22.4%). 104 cases showed simple (10.4%) and 43 cases (4.3%) complex hyperplasia. Exogenous hormonal effect was seen in 148 cases (14.8%). The least pattern which was observed was endometrial carcinoma, seen in only 2.3% of patients. Conclusion: The study showed that carcinoma was most common in the post-menopausal age group. This group also had the maximum frequency of atrophic endometrium and complex hyperplasia. Proliferative endometrium was recorded highest in perimenopausal age group while reproductive age group showed highest frequency of secretory type endometrium. This study is in concordance with most other conducted studies on similar parameters. Keywords: Biopsy, Endometrium, Uterine bleeding.

Diagnostic Hysteroscopy in Abnormal Uterine Bleeding: A Prospective Analytical study

Localized lesions like a polyp or abnormal growth can be missed by traditional dilatation and curettage whereas such intrauterine abnormalities can be easily diagnosed by hysteroscopy as we can directly visualise the cervical canal and uterine cavity. The objective of our study was to assess the diagnostic accuracy of hysteroscopy in diagnosing the cause of AUB and to correlate hysteroscopy findings with histopathology. This prospective study was conducted in women with symptoms of AUB in the reproductive, perimenopausal and postmenopausal age group who had underwent hysteroscopy over a period of 2 years. Hysteroscopic findings and histopathology findings were compared. The main symptoms for which hysteroscopy was performed was postmenopausal bleeding (44.1%) followed by menorrhagia (33.8%). Hysteroscopy detection of abnormal findings had a sensitivity 90%, specificity 87.5%, positive predictive value 98.2% and negative predictive value 53.8%. To conclude hysteroscopy improves the accuracy of diagnosing intrauterine pathologies and also helps in treating some causes of AUB by simple procedures in the same sitting thereby avoiding major surgeries.

Role of Suction Pipelle in Diagnosis of Endometrial Lesions in Patients with Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is a major clinical problem among women in the reproductive, perimenopausal and postmenopausal age groups. It may have a significant impact on woman physical, social, emotional and material quality of life. Along with the direct impact on the woman and her family, there are significant costs to both economy and health service. The AUB in women aged 40 and older, especially in peri and postmenopausal age group requires exclusive assessment, to exclude atypical endometrial hyperplasia and carcinoma. Objective: This study aimed to determine the efficacy of suction pipelle in diagnosis of endometrial lesions in cases of abnormal uterine bleeding. Patients and Methods: The current study was designed as cross-sectional study conducted in Zagazig University Maternity Hospitals, Al-Ahrar Teaching Hospital and the Department of Pathology, Zagazig University during the period from April 2018 to July 2019. The study was conducted on 92 patients presented with abnormal uterine bleeding. Results: The 2 methods were 100% matched in diagnosis of secretory endometrium, hormone-dependent endometrium, atypical hyperplasia and EEC grade 1. The pipelle succeeded to diagnose some cases of proliferative endometrial and simple hyperplasia, which were missed by D & C (18.5% and 17.4% by pipelle versus 16.3% and 13% by D & C respectively for proliferative endometrial hyperplasia and 8.7% and 17.4% by pipelle versus 16.3% and 19.6% by D&C for simple hyperplasia respectively). Conclusion: Pipelle had high sensitivity and specificity for diagnosis of proliferative endometrial, secretory endometrium, hormonedependent endometrium, simple endometrial hyperplasia, atypical hyperplasia and EEC grade 1.

Role of Suction Pipelle in Diagnosis of Endometrial Lesions in Patients with Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is a major clinical problem among women in the reproductive, perimenopausal and postmenopausal age groups. It may have a significant impact on woman physical, social, emotional and material quality of life. Along with the direct impact on the woman and her family, there are significant costs to both economy and health service. The AUB in women aged 40 and older, especially in peri and postmenopausal age group requires exclusive assessment, to exclude atypical endometrial hyperplasia and carcinoma. Objective: This study aimed to determine the efficacy of suction pipelle in diagnosis of endometrial lesions in cases of abnormal uterine bleeding. Patients and Methods: The current study was designed as cross-sectional study conducted in Zagazig University Maternity Hospitals, Al-Ahrar Teaching Hospital and the Department of Pathology, Zagazig University during the period from April 2018 to July 2019. The study was conducted on 92 patients presented with abnormal uterine bleeding. Results: The 2 methods were 100% matched in diagnosis of secretory endometrium, hormone-dependent endometrium, atypical hyperplasia and EEC grade 1. The pipelle succeeded to diagnose some cases of proliferative endometrial and simple hyperplasia, which were missed by D & C (18.5% and 17.4% by pipelle versus 16.3% and 13% by D & C respectively for proliferative endometrial hyperplasia and 8.7% and 17.4% by pipelle versus 16.3% and 19.6% by D&C for simple hyperplasia respectively). Conclusion: Pipelle had high sensitivity and specificity for diagnosis of proliferative endometrial, secretory endometrium, hormonedependent endometrium, simple endometrial hyperplasia, atypical hyperplasia and EEC grade 1.

Histopathological Pattern of Endometrial Biopsies in Patients with Abnormal Uterine Bleeding Attending Birat Medical College Teaching Hospital

Introduction: Abnormal uterine bleeding (AUB) is one of the commonest gynaecological problems. Etiology of AUB may be structural and functional and varies according to age group. Histological pattern of endometrial sampling along with clinical and radiological findings remains the diagnostic standard for clinical diagnosis of endometrial pathology which ultimately helps in deciding the management of the patients.
 Objectives: To determine histopathological pattern of endometrial biopsies in patients with AUB attending Birat Medical College Teaching Hospital. To determine the pattern of menstrual abnormality in patients with AUB in different age groups.
 Methodology: We conducted a prospective hospital based cross sectional study for a period of one year (1 April 2019 to March 31 2020). Histopathological findings of all endometrial biopsy samples in patients with AUB were examined. Patients were categorized into different age groups and the patterns of menstrual abnormality were also documented.
 Results: 166 patients presenting with AUB underwent endometrial biopsy. Most of them were of perimenopausal age group (42.77%). Menorrhagia was the most common presenting menstrual abnormality. Histopathological examination predominantly revealed normal cyclical endometrium. Hyperplasia was seen more frequently in patients > 40 years of age. Malignancy was diagnosed in 2.41%, all were adenocarcinoma and was seen in > 50 years age.
 Conclusion: AUB is a common gynaeco-pathological problem with varied clinical presentation and multiple causes. Functional endometrial changes account for the highest histological pattern. However hyperplasia and malignancy are important cause of AUB in perimenopausal and post menopausal age group's women.

Abnormal uterine bleeding in perimenopausal women: Clinical histopathological and sonography correlation

Patient who underwent hysterectomy for Abnormal Uterine Bleeding their clinical findings were related to sonography and histopathology reports.This is retrospective observational study conducted in obstetric and gynaecology department. Patient who have undergone hysterectomy for AUB, their data retrived from case file and their ultrasonography reports and histopathological examination reports were compared.153 women who have under gone hysterectomy had complaint of menorrhagia and they belong to perimenopausal age group, most of them were between 40-45 years of age. Ultrasonography is suggestive of fibroid in most of the patients and it is most sensitive for diagnosis of uterine fibroid.Fibroid is a most common cause of AUB. Clinical, sonography and histopathological findings correlated well with the diagnosis.

A CASE OF FUNCTIONING NON COMMUNICATING RUDIMENTARY HORN WITH UNICORNUATE UTERUS: AN UNUSUAL CAUSE OF SECONDARY DYSMENORRHEA IN A PERIMENOPAUSAL WOMAN.

Mullerian duct malformations represent a miscellaneous group of congenital anomalies that result from the arrested development, abnormal formation or incomplete fusion of the paramesonephric ducts. Congenital Mullerian abnormalities usually present at adolescent age with menstrual irregulari¬ty, dysmenorrhea, infertility and recurrent pregnancy loss. The Unicornuate uterus is a rare uterine malformation which usually features a rudimentary accessory horn with or without functioning endometrium. We are presenting a case of perimenopausal multiparous patient who had history of secondary dysmenorrhea diagnosed with endometrioma on imaging studies, but on laparotomy incidentally found to have Unicornuate uterus with functioning noncommunicating rudimentary horn leading to hematometra and hematosalpinx. The objective of this clinical case report is to highlight this rare Mullerian malformation as a differential diagnosis of secondary dysmenorrhea, chronic pelvic pain or adnexal mass in perimenopausal age group females.

Histopathological study of endometrial Samplings

The present study was a two-year prospective cross-sectional study done to diagnose and categorize lesions of endometrium on endometrial sampling included a total of 153 cases, of which 111 were curettage samples, and 42 were biopsy samples. Of the 153 cases, the indication for performing endometrial sampling was AUB in 131 cases and infertility in22 cases. Primary infertility constituted 64% of all the facts of infertility.AUB was common in perimenopausal age group, and infertility was commonly seen in 20-30 years age group and characteristic in multiparous Precursor lesions were the most widely recognized diagnosis on histopathology in23.7. In the category of regular physiological pattern, 72.2% of cases were in the reproductive age group, —36.3 % cases presented with inability to conceive and clinical diagnosis of infertility. Tumour like lesions had a majority of cases (55.5%) in the perimenopausal group. Intermenstrual bleeding was the most widely recognized symptom of presentation.All the cases of malignant lesions were in the post-menopausal age group and all cases presented with post-menopausal bleeding. About 80% of cases were correctly diagnosed clinically. Endometrioid endometrial carcinoma was seen in 60% cases, followed by carcinoma extending from cervix in30 % cases and carcinosarcoma in 10% cases.

Endometrial stromal sarcoma and variants: A study of four cases with review of literature and immunohistochemistry

Endometrial stromal Sarcoma (ESS) is a rare malignant neoplasm of uterus occurring in perimenopausal age group. The annual incidence of ESS is 1–2 per million women. ESSs are morphologically heterogeneous. The distinction between uterine smooth muscle tumors such as myxoid leiomyosarcoma and low-grade ESS can be difficult when stromal sarcomas have abundant myxoid stroma. A definitive diagnosis of stromal sarcoma can be made if myometrial invasion is present, but hysterectomy is usually required for definitive diagnosis. We report four cases of ESS encountered in a period of one year all of which was confirmed by immunohistochemistry.

A clinical study on abnormal uterine bleeding in premenopausal women

Background: Abnormal uterine bleeding is defined as any bleeding outside of normal menstrual cycle with excessive duration, frequency and amount of loss. AUB accounts about 70% in perimenopausal women in gynaecology OPD. Abnormal uterine bleeding is not a disease, it is a symptom. The aim of the study was to evaluate abnormal uterine bleeding in perimenopausal women and to study the various menstrual abnormalities and causes of AUB in perimenopausal women. Study design: This study was a hospital based cross sectional study which included 95 women in perimenopausal age group (40-51 years) with abnormal uterine bleeding. The history, clinical examination, USG and histopathological findings was collected. Clinical findings were classified by PALM-COEIN classification. All women underwent endometrial sampling to rule out endometrial pathology. Results: The mean age of the patients was 44.89(±2.93) years. Parity of more than 2 (46.3%) was most common. Menorrhagia (58.9%) was the most common bleeding pattern followed menometrorrhagia (23.2%). Leiomyomo 37 (38.9%) was the most common clinical finding followed by adenomyosis 29 (30.5%). Ultrasonographically fibroid uterus (37.8%) was the most common USG findings followed by Adenomyosis (30.5%). The most common endometrial thickness was 9-12mm (43.1%). Histopathological examination revealed secretory phase endometrium (35.8%) was the most common finding followed by proliferative endometrium (20%). Conclusion: Uterine fibroid was the leading cause of AUB. Clinical examination and ultrasound findings correlated well in the diagnosis of fibroids. Evaluation of the endometrium in perimenopausal women presenting with AUB is essential to rule out endometrial pathology.

Correlation Between Endometrial Thickness By Ultrasonography and Histopathology in Abnormal Uterine Bleeding

Background : Abnormal uterine bleeding (AUB) is the most common presenting complaint of patients in Gynaecology Outpatient department. Early diagnosis of endometrial hyperplasia through ultrasongraphic measurement of endometrial thickness and definite diagnosis by histopathologic examination will help the clinicians to give appropriate treatment to the patients. The objective of this study was to correlate the histopathology findings in abnormal uterine bleeding with endometrial thickness by ultrasonography. Methods : This was a prospective study done from Nov 2016 to June 2018.A total of 382 cases of AUB presenting above 40 years of age were included. Endometrial thickness was measured by ultrasonography. Histopathological findings were studied and compared with the endometrial thickness. Statistical analysis were done using chi square test. Results : A total of 382 cases were analysed. Maximum number of cases were from peri menopausal age group (68.32%). Majority of the cases were due to non organic causes(85.34%). 46.86% of patients had endometrial thickness of 5-10mm followed by endometrial thickness of 11-15mm in 39.01%. Disordered proliferative endometrium was the most common pattern (38.34%) in our study followed by secretory endometrium (35.58%) and menstrual endometrium (18.71%). These findings were found to be statistically significant. Conclusion : A thorough histopathological work up and clinical correlation is mandatory in cases of abnormal uterine bleeding above 40 years to find out organic lesions. Careful screening can detect precursor lesions like endometrial hyperplasia and early cases of endometrial carcinoma which has excellent prognosis and it will help in further management.

STUDY TO CORRELATE CLINICAL AND HISTOPATHOLOGICAL FINDINGS OF ABNORMAL UTERINE BLEEDING ACCORDING TO FIGO’S PALM-COEIN CLASSIFICATION

Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. Abnormal uterine bleeding (AUB) is one of the common presenting complaints encountered by a Gynaecologist. The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has recently developed a classification system (PALM–COEIN) for causes of the AUB in non-gravid women. The present study was conducted with the aim to study and analyse the structural (PALM) and the functional (COEIN) component of the PALM–COEIN system of AUB in perimenopausal age group. A total of 200 perimenopausal women (aged 40 years and above till 1 year beyond menopause) who were admitted with complaints of abnormal uterine bleeding comprised the study population. Clinical diagnosis and allocation to PALM–COEIN was done. Endometrial biopsy and hysterectomy specimens (wherever applicable) were obtained and sent for histopathology. As per the histopathological findings, possible underlying causes were categorized. Clinical diagnosis was then correlated with histopathology-based final diagnosis. PALM and COEIN components contributed almost equally for AUB when assessed clinically. The histological examination revealed significantly more cases of PALM (structural or anatomical) component of AUB. The PALM COEIN classification system helps us in understanding various etiological causes of AUB and can be used by clinicians and researchers for international comparisons.
 Keywords: Abnormal uterine bleeding (AUB) , PALM–COEIN . Perimenopause

A study on correlation of hormone therapy and endometrial hyperplasia

A study on correlation of hormone therapy and endometrial hyperplasia - IJPP- Print ISSN No: - 2393-9079 Online ISSN No:- 2393-9087 Article DOI No:- 10.18231/j.ijpp.2019.033, Indian Journal of Pharmacy and Pharmacology-Indian J Pharm Pharmacol

Study of menstrual disorders in thyroid dysfunction

Background: Abnormal uterine bleeding is the most common problem seen in patients attending the gynecology OPD. Incidence of AUB is 9 to 14%. Thyroid dysfunction causes broad spectrum of reproductive disorders and is one of the causes noted for abnormal uterine bleeding. Thyroid disorders are 10 times more common in women. Therefore, this study is to assess the menstrual and endometrial patterns in women with thyroid disorders. Aims and objectives 1. To assess the menstrual patterns in women with thyroid disorders. 2. To assess the endometrial patterns in women with thyroid disorders. Methodology: This is a descriptive study conducted in department of OBG, ESIC-PGIMSR Bengaluru. 100 patients with signs and symptoms of thyroid dysfunction will be taken. Patients will be grouped into 3 categories- hyperthyroid, hypothyroid and Subclinical hypothyroidism. Menstrual pattern in these patients are studied. Selected patients in peri-menopausal age group with thyroid dysfunction will be subjected to endometrial biopsy. Results: Most common thyroid dysfunction is hypothyroidism seen in 60% of the patients. Most common menstrual irregularity is menorrhagia seen in 51% of the patients. In hypothyroidism patients menorrhagia is seen in 48.3%, in hyperthyroidism, menorrhagia is seen in 35.3% and in subclinical hypothyroidism it is seen in 69.6%of patients. Most common endometrial pattern is simple hyperplasia without atypia seen in 50% of the patients. Conclusion: The present study concludes that there is a strong association between thyroid dysfunction and menstrual irregularities. Thyroid profile should be used in the screening of all the women with abnormal uterine bleeding. If thyroid dysfunction is timely detected and corrected, then menstrual irregularities will settle and unnecessary interventions like endometrial curettage and surgery could be avoided.

, Suvarna Kale5 , Mayuri Dixit6

, Suvarna Kale5 , Mayuri Dixit6

Thyroid Function and Anti-TPO Antibody Status among Tribal Perimenopausal Women Near Bengaluru, Karnataka, India

Introduction: Higher prevalence of thyroid diseases are noted with increasing age. Symptoms of thyroid disorders often develop so insidiously, that they go unnoticed and there is also the risk of being misinterpreted for menopausal symptoms. Present study was executed in view of paucity of data regarding thyroid disorders among tribal perimenopausal age group and there was a need for timely intervention of this chronic non-communicable disorder among these women. Aim: To determine the thyroid function and anti-Thyroid Peroxidase Antibody (anti-TPO Ab) status among the tribal perimenopausal women. Materials and Methods: A descriptive, cross-sectional study was conducted for a period of six months from July 2017 to December 2017 among perimenopausal women in the age group of 40-55 years residing at Hakki Pikki Tribal Colony near Bengaluru, Karnataka, India. Thyroid Stimulating Hormone (TSH), Total T3 (Total Tri iodothyronine), Total T4(Total Tetraidiodothyronine) and anti-TPO antibody levels were estimated by Chemiluminescence Immuno Assay (CLIA). Data was analysed using Open Epi software to find out Mean±SD, p-value (Student’s t-test with significance set at p<0.05) and r-value (Pearson’s correlation coefficient). Results: Subclinical Hypothyroidism (SCH) was observed in 3 (7.32%) women and anti-TPO Ab positivity (anti-TPO antibody level >30 IU/mL) was found in 14 (34.14%) women amongst 41 perimenopausal subjects. Raised anti-TPO Ab was observed in all the 3 (100%) SCH women and 11 (26.82%) euthyroid women. Significant difference (p<0.001) between anti-TPO Ab values among SCH and euthyroid women with significant positive correlation (r-value 0.7023 and p<0.05) between TSH and anti-TPO Ab values in anti-TPO Ab positive women was noted. Conclusion: Anti-TPO Ab positivity was seen in 34% of perimenopausal women, out of them majority 79% was in euthyroid state and 21% had SCH. Hence in addition to routine thyroid profile, we suggest estimation of anti-TPO Ab levels in this age group.

Subclinical Hypothyroidism and Associated Cardiovascular Risk Factor in Perimenopausal Females.

Background:Perimenopause refers to the period around menopause (40-55 years). This includes the period before menopause and the first year after menopause. Perimenopausal age is an important stage in a women’s life. Many women are diagnosed with hypothyroidism at midlife. Hypothyroidism - both overt and subclinical are associated with increased risk of CVS diseases. Subclinical hypothyroidism is more important as this stage is usually ignored from treatment point of view and if early intervention is done in SCH worsening of metabolic derangement may be avoided.Objectives:The present study was aimed to know the prevalence of subclinical hypothyroidism and associated dyslipidemia in perimenopausal females.Material and Methods:In our retrospective study we took 100 perimenopausal females (40-55years) who were investigated for thyroid and lipid profile. Atherogenic indices like TC/HDL-c, LDL-c/HDL-c, TG/HDL-c ratios were calculated from the individual lipid profile parameters. The reference guidelines for lipid profile was according to NCEP ATP III.Result:Subclinical hypothyroidism was found to be present in 18% of perimenopausal females The mean TSH levels were found to be higher in SCH as compared to euthyroid females with a mean value of 7.56±3.54(μIU/ ml). Dyslipidemia was seen in patients with SCH. TSH levels were found to be positively correlated with total cholesterol.Conclusion:We conclude that subclinical hypothyroidism is present in 18% females of perimenopausal age group. Increased TSH levels are associated with hypertension, hypertriglyceridemia, and elevated TC/HDL-C ratio and non cholesterol HDL. In perimenopausal women the condition is usually underdiagnosed and ignored but subclinical hypothyroidism in these females should be screened and treated timely to decrease the risk of accelerated atherosclerosis and premature coronary artery disease in them.