From the Guidelines
For a 23-year-old female with hypothyroidism experiencing heavy periods with clots, I recommend optimizing thyroid hormone replacement therapy first, as untreated or undertreated hypothyroidism can cause menorrhagia, and then considering hormonal treatment options such as low-dose COCs or estrogen for short-term treatment (10–20 days) as suggested by 1. She should have her TSH levels checked to ensure they are within normal range (0.4-4.0 mIU/L).
Key Considerations
- The connection between hypothyroidism and heavy periods involves thyroid hormone's role in regulating menstrual cycles; insufficient thyroid hormone can lead to anovulation and estrogen breakthrough bleeding.
- If an underlying gynecologic problem is identified, such as interactions with other medications, an STD, pregnancy, or new pathologic uterine conditions (e.g., polyps or fibroids), treat the condition or refer for care as recommended by 1.
- Non-hormonal options include NSAIDs for short-term treatment (5–7 days) as suggested by 1, or nonsteroidal anti-inflammatory drugs like ibuprofen (600mg every 6 hours during menses).
- Iron supplementation (ferrous sulfate 325mg daily) is also recommended to prevent anemia.
Treatment Options
- Hormonal therapy options include combined oral contraceptives (such as levonorgestrel/ethinyl estradiol 150mcg/30mcg daily), or a levonorgestrel intrauterine device (Mirena).
- If bleeding persists despite thyroid optimization, further evaluation for other causes such as fibroids, polyps, or bleeding disorders may be necessary, and alternative contraceptive methods should be considered as recommended by 1.
From the Research
Heavy Menstrual Bleeding and Hypothyroidism
- Heavy menstrual bleeding (HMB) is a common issue in premenopausal women, and it can be caused by various factors, including hypothyroidism 2, 3.
- Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone, and it can affect women's menstrual cycles, leading to heavy periods and clotting 2, 3.
- The symptoms of hypothyroidism can develop slowly and may mimic those of other disorders, making diagnosis challenging 2, 4.
Treatment Options for Heavy Menstrual Bleeding
- Non-steroidal anti-inflammatory drugs (NSAIDs) can be effective in reducing heavy menstrual bleeding, although they may be less effective than other treatments such as tranexamic acid, danazol, or the levonorgestrel-releasing intrauterine system (LNG IUS) 5, 6.
- NSAIDs work by reducing prostaglandin levels, which are elevated in women with excessive menstrual bleeding, and may also have a beneficial effect on dysmenorrhea 5, 6.
- The choice of treatment for HMB depends on various factors, including the severity of symptoms, medical history, and personal preferences 5, 6.
Management of Hypothyroidism
- The standard treatment for hypothyroidism is monotherapy with levothyroxine, which can help alleviate symptoms and normalize thyroid-stimulating hormone (TSH) levels 2, 4.
- The dosage of levothyroxine may need to be adjusted based on individual factors, such as age, weight, and medical history 4.
- Regular follow-up and monitoring of TSH levels are essential to ensure effective management of hypothyroidism 2, 4.