From the Guidelines

Tuberculosis (TB) can cause amenorrhea in female patients.

The relationship between TB and amenorrhea is based on the fact that genitourinary TB (GUTB) can affect female reproductive organs, leading to menstrual irregularities, including amenorrhea 1.
GUTB is a secondary infection, usually resulting from the haematogenous spread of chronic latent TB infection (LTBI), and can affect all genitourinary organs.
Female patients with GUTB may present with non-specific symptoms, including menstrual irregularities, pelvic pain, and infertility issues.
The diagnosis of GUTB is challenging and relies on a high index of suspicion, along with microbiological, molecular, and histological testing, as well as imaging findings.
The first-line treatment for GUTB is combination drug therapy, involving an initial intensive phase with isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by a continuation phase with isoniazid and rifampicin 1.

From the Research

Tuberculosis (TB) has been found to have a significant impact on menstrual patterns, with studies showing a higher incidence of menstrual abnormalities, including secondary amenorrhea, in women with TB compared to healthy controls 2, 3.
A study published in 2010 found that 26.5% of women with pulmonary TB experienced secondary amenorrhea, which was significantly higher than the 2% reported in the control group 2.
Another study published in 2020 found that menstrual abnormalities, including amenorrhea, were more common in women with genital TB (GTB) than in those with pulmonary TB (PTB) or extra-pulmonary non-genital TB (EPTB) 3.
TB endometritis, a condition where the endometrium is infected with TB, can cause secondary amenorrhea and infertility, highlighting the importance of early diagnosis and treatment 4, 5.
The treatment of TB with anti-tuberculosis drugs has been shown to improve menstrual irregularities, including amenorrhea, in some women 2, 4.
However, the relationship between TB and amenorrhea is complex, and more research is needed to fully understand the mechanisms by which TB affects menstrual patterns and fertility 3, 6.

The exact mechanisms by which TB affects menstrual patterns and fertility are not fully understood, but it is thought that the infection may cause inflammation and scarring in the reproductive tract, leading to menstrual irregularities and infertility 2, 6.
Women with TB are at increased risk of developing menstrual abnormalities, including amenorrhea, particularly if they have genital TB or are infected with HIV 3, 6.
The use of anti-tuberculosis drugs may also affect menstrual patterns and fertility, although the exact mechanisms are not well understood 6.

Early diagnosis and treatment of TB are critical to preventing long-term reproductive health problems, including amenorrhea and infertility 2, 4.
A comprehensive approach to diagnosis and treatment, including medical history, clinical examination, and laboratory tests, is necessary to identify and manage TB-related reproductive health problems 3, 6.
Women with TB should be counseled about the potential risks to their reproductive health and the importance of early diagnosis and treatment 2, 6.