{"paper_id":"078fe049-b4ab-419a-8494-8e79db9a44a1","body_text":"Orginal Article  | JOGCR. 2026; 11(5): 435-441 \n     Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \n Journal of Obstetrics, Gynecology and Cancer Research | ISSN: 2476-5848 \n \n \nCauses of Perimenopause Bleeding and Association with Thyroid \nDysfunction: A Cross-Sectional Study \n \nBanan Natiq Turkey, Milal Muhammad Al-Jeborry*, Hanan Khudheir Hussein \n \nCollege of Medicine, University of Babylon, Babylon, Iraq \nArticle Info  ABSTRACT \n  \n 10.24200/jogcr.11.5.435 \n \n \n \nBackground & Objective: Perimenopause period is the transitional period 2-8 years \nbefore and one year after the last menstrual period. The most common complaint in this \nperiod includes abnormal uterine bleeding; the cause may be structural and non -\nstructural, thyroid hormone known to affect reproductive biology. This study was \nconducted with aim to evaluate the correlation between thyroid disorder and different \ncauses of abnormal uterine bleeding in perimenopause women. \nMaterials & Methods: This cross-sectional study was conducted in Iraq \\Babylon \nprovince from September 2023 to April 2025. The sample population were 49 women \naged 40 -51years old who complain from abnormal uterine bleeding. TFT, CBC; \ntransvaginal ultrasound and endometrial biopsy was performed for the patients. Data \nwere analyzed using SPSS software (version 26). P≤ 0.05 was considered statistically \nsignificant. \nResults: The mean age of participants was 44 years old, with 53.1% (26 women) \nbetween 40 and 45, 31(63.3%) multiparous, 38(77.6%) euthyroid, 1(2%) hyperthyroid, \nand 10(20.4%) subclinical hypothyroid. There was a significant relationship between \nthyroid function and  irregular bleeding ( P<0.05). Among women, 19(38.8%) had \nmenorrhagia, 16(32.7%) poly menorrhoea , 10(20.5%) intermittent bleeding, and \n4(8.1%) oligo menorrhoea. AUB was caused by dysfunctional uterine bleeding in \n24(49%), endometrial hyperplasia (with or without atypia) in 9(18.4%), adenomyosis \nin 6(12.2%), fibroid in 5(10.2%), and ovarian cyst in 1(2%). Thyroid function did not \nalter abnormal uterine haemorrhage causes. \nConclusion: Most women presented with menorrhagia and poly menorrhea between \nthe age 40-45 years with dysfunctional uterine bleeding being the most common cause, \nand there was strong association between thyroid dysfunction and abnormal uterine \nbleeding. \nKeywords: Perimenopause, Bleeding, Thyroid, Dysfunction  \n \nReceived: 2025/07/11 \nAccepted: 2025/09/07 \nPublished Online: 07 Apr. 2026 \n \n \n \n \n \nCorresponding Information:  \nMilal Muhammad Al-Jeborry, \nCollege of Medicine, University of Babylon, \nBabylon, Iraq  \n \nEmail: qaisajam1981@yahoo.com \n \n \nCopyright © 2025, This is an original open -access article distributed under the terms of the Creative Commons Attribution-noncommercial \n4.0 International License which permits copy and redistribution of the material just in noncommercial usages with proper citation . \n \n \n1. Introduction\nPerimenopause is a transitional phase that typically \nspans 2 to 8 years before the final menstrual period and \nextends to one year after it. During this period, women \noften experience Abnormal Uterine Bleeding (AUB), \nwhich may be either physiological or pathological in \norigin. Such bleeding can significantly impact a \nwoman’s quality of life and provoke considerable \nanxiety. In certain cases, these abnormalities may \nindicate serious conditions such as endometrial  \nhyperplasia or even endometrial cancer (1,2). AUB is \ndefined as any change in the regularity, duration, \nfrequency, or volume of menstrual bleeding, affecting \napproximately 50% of perimenopause women (3). A \nnormal menstrual cycle is characterized by a frequency \nof 24 to 38 days, a duration of 4 to 8 days, and a total \nblood loss ranging from 5 to 80 ml per cycle. When \nthese parameters are disrupted, various underlying \ncauses must be considered. The most frequent cause is \nbleeding of endometrial origin due to hormonal \nfluctuations without any identifiable organic \npathology. However, organic causes may include \nbenign pelvic conditions such as fibroids, \nadenomyosis, cervic al or endometrial polyps, as well \nas infections, trauma, iatrogenic factors (e.g., hormone \nreplacement therapy, contraceptive use, or \nanticoagulants), malignancies of the cervix, \nendometrium, or ovaries, and systemic illnesses like \nhypertension, diabetes mellitus, and thyroid disorders \n(4). Among systemic disorders, thyroid dysfunction -\nboth hypothyroidism and hyperthyroidism -accounts \nfor approximately 30% to 40% of AUB cases (5). \nThyroid hormones play a critical role in regulating the \nmenstrual cycle. Thyroid-Stimulating Hormone (TSH) \nshares a common beta subunit with both Follicle-\n\n\nBanan Natiq Turkey, et al. 436 \n      Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \nStimulating Hormone (FSH) and Luteinizing Hormone \n(LH), and thyroid hormone receptors are also found in \nthe ovaries (6). The mechanisms through which thyroid \ndisorders lead to AUB include altered TSH response, \nincreased prolactin levels, changes in LH response, \neffects on the peripheral conversion of androgens to \nestrogens, alterations in Sex Hormone -Binding \nGlobulin (SHBG) levels, and disruptions in the \ncoagulation cascade -specifically reductions in factors \nVII, VIII, IX, and XI. Hypothyroidism, in particu lar, \nreduces SHBG production and alters estrogen \nmetabolism, thereby disrupting pituitary feedback \nmechanisms (7,3). Hyperthyroidism is associated with \nan increased gonadotropin response to Gonadotropin-\nReleasing Hormone  (GnRH) and elevated baseline \ngonadotropin levels. Although hypomenorrhea in \nhyperthyroid women may be attributed to changes in \ncoagulation factor VII, ovulation often still occurs, as \nconfirmed by endometrial biopsy findings (8). \nHyperprolactinemia, another endocrine disturbance, \ninterferes with follicular maturation and corpus luteum \nfunction. It inhibits the hypothalamic -pituitary axis by \nsuppressing the pulsatile release of GnRH, resulting in \ninadequate LH and FSH secretion, and ultimately \nleading to anovulation (7). The present study was \nconducted with aim to investigate the relationship \nbetween thyroid dysfunction and abnormal uterine \nbleeding in perimenopausal women.  \n \n2. Materials and Methods \nThis cross-sectional study was conducted in Iraq/ \nBabylon province from September 2023 to April 2025. \nThe study population were 49 women between 40 -51 \nyears old who complain from abnormal uterine \nbleeding. The exclusion criteria were bleeding \ndisorder, pregnancy, Diabetes Mellitus ( DM), \nhypertension, IUCD insertion, use hormonal \nreplacement therapy, cervical pathology. In patients \nwith thyroidectomy, the detailed history including age, \nparity, bleeding pattern, past medical & surgical \nhistory, and drug used was obtained. BMI w as \ncalculated as weight in kg divided on the height in \nsquare meters. Abdominal and pelvic examination was \ndone. TFT and CBC were measured; then transvaginal \nultrasound and endometrial biopsy was performed. \nFIGO (9) defines heavy menstrual bleeding as more \nthan 80 ml; however, our definition includes bleeding \nthat disrupts a woman's physical, emotional, and social \nwell-being, either independently or in conjunction with \nother symptoms, as per the NICE guideline (10). \nAbnormal uterine bleeding is defined as a ny bleeding \nthat is heavier, more frequent, or lasts longer than what \nis considered normal for the individual. \nReference Value Serum \nT4: 60-120 ng/mL \nSerum T3-0.8-16 ng/ml \nSerum TSH-0.5-5 mU/ml \nThen, a transvaginal ultrasound was done to \ndetermine the uterine and ovarian pathology. The \npatient, whose endometrial thickness exceeded 10.5 \nmm, underwent an endometrial biopsy for \nhistopathological study (11). \nData were analyzed using the Statistical Package for \nthe Social Sciences (SPSS) (version 26). Descriptive \nstatistics were expressed as frequencies and \npercentages. Chi-square tests and t -tests were used to \nshow the association between the variables. P≤0.05  \nwas considered as statistically significant. \n \n3. Results \nA total of 49 priemenopausal women with complaint \nfrom abnormal uterine bleeding were included in this \nstudy. The mean age of participants was 44 years old \n(minimum 40 years and maximum 50 years). \nMoreover, 26 women (53.1%) aged between 40 -45 \nyears and 46. 9% between 46 -52 years old. Among \nthese women, 5(10.2%) were nulliparous, 4 had one \nchild (8.2%), 9(18.4%) had 2 children, and 31(63.3%) \nwere multiparous (Table 1). Regarding the endometrial \nthickness, in 16 women (32.7%) was more than 10.5 \nmm and endometrial biopsy was done, and in \n33(67.3%) was less than 10.5 mm. \nTable 2 shows that thyroid status of women. There \nwas 38 women (77.6%) with euthyroidism, 1(2%) \nhyperthyroidism, and 10(20.4%) subclinical \nhypothyroidisms. \nTable 3  shows the most common symptoms of \nwomen was menorrhagia in 19(38.8%), poly \nmenorrhea in 16(32.7%), intermittent bleeding in \n10(20.5%) and the least presentation was oligo \nmenorrhea in 4(8.1%). \nThe duration of AUB in most patients (40.8%) was \nless than 6, months and between 6 -12 months in 16 \n(32.7%), and more than 12 months in 13(26.5%) (Table \n4). \nTable 5 shows that there was statistically significant \ncorrelation between the thyroid status and pattern of \nabnormal bleeding (P=0.006). \nTable 6  shows that there was no significant \ncorrelation between bleeding pattern and endometrial \nthickness (P=0.514). \nTable 7 shows that the most common cause of AUB \nwas dysfunctional uterine bleeding in 24 (49%), then \nendometrial hyperplasia (with or without atypia) in 9 \n(18.4%), and adenomyosis in 6 (12.2%).  \nTable 8  shows that there was no significant \ncorrelation between the causes of abnormal uterine \nbleeding and thyroid status (P=0.532). \n \n\n437 Perimenopause Bleeding and Association \n      Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \nTable 1. Parity of women with AUB \nParity No. Percentage (%) \nNulliparous 5 10.2 \nPara 1 4 8.2 \nPara 2 9 18.4 \nPara 3 and more 31 63.3 \nTotal 49 100.0 \n \n \nTable 2. Thyroid status among perimenopousal women \nThyroid status No.  Percent (%) \nEuthyroidism 38 77.6 \nHyperthyroidism 1 2.0 \nSubclinical hypothyroidism 10 20.4 \nTotal 49 100.0 \n \n \nTable 3. Distribution of symptoms among women \nBleeding pattern NO. Percent (%) \nPoly menorrhea 16 32.7 \nMenorrhagia 19 38.8 \nOligo menorrhea 4 8.1 \nIntermittent bleeding 10 20.4 \nTotal 44 100.0 \n \nTable 4. Duration of symptoms of patients with AUB \nDuration No. of cases Percentage % \n1-6 months 20 40.8 \n6-12 months 16 32.7 \nMore than 12 months 13 26.5 \nTotal 44 100.0 \n \nTable 5. Association between thyroid status and different forms of abnormal uterine bleeding \nBleeding pattern \nThyroid status \nTotal \nEuthyroidisim Hyperthyroidism Subclinical \nhypothyroidism \nIntermittent bleeding 8(16.3%) 1(2%) 1(2%) 10(20.4%) \nMenorrhagia 10(20.4%) 0 9(18.4) 19(38.8) \nOligo menorrhea 4(8.2%) 0 0 4(8.2%) \nPolymenorrhea 16(32.7%) 0 0 16(32.7%) \nTotal 38(77.6%) 1(2%) 10(20.4%) 49(100%) \nP-value  0.006   \n\nBanan Natiq Turkey, et al. 438 \n      Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \nTable 6. Association between bleeding pattern and endometrial thickness \nEndometrial thickness \nBleeding pattern \nTotal Intermittent \nbleeding \nMenorrhagi\na \nOligo menorrhea \nPolymenorrh\nea \n<10.5mm 7(14.3%) 12(24.5%) 4(8.2%) 10(20.4%) 33 \n>=10.5mm 3(6-1%) 7(14.3%) 0 6(12.2%) 16 \nTotal 10(20.4%) 19(38.8%) 4(8.2%) 16(32.7%) 49(100%) \nP-value   0.5   \n \nTable 7. Distribution of causes of AUB among women \nCause of bleeding No.  Percent (%) \nAdenomyosis 6 12.2 \nAdenomyosis + fibroid 1 2.0 \nEndometrial hyperplasia (with and without atypia ) 9 18.4 \nEndometrial hyperplasia + ovarian cyst 1 2.0 \nFibroid 5 10.2 \nDysfunctional uterine bleeding 24 49 \nOvarian cyst 1 2.0 \nPolyp 2 4.1 \nTotal 49 100.0 \n \n \nTable 8. Association between causes of AUB and thyroid status  \nCauses of AUB \nThyroid status Total \nEuthyroidisim Hyperthyroidism \nSubclinical \nhypothyroidism \n \nAdenomyosis No.(%) 5(10.2%) 0(0.0%) 1(2.0%) 6(12.2%) \nAdenomyosis + fibroid \nNo.(%) 1(2.0%) 0(0.0%) 0(0.0%) 1(2.0%) \nEndometrial hyperplasia + ovarian \ncyst No.(%) 1(2.0%) 0(0.0%) 0(0.0%) 1(2.0%) \nEndometrial hyperplasia \nNo.(%) 8(16.3%) 0(0.0%) 1(2.0%) 9(18.4%) \nFibroid  \nNo.(%) 2(4.1%) 1(2.0%) 2(4.1%) 5(10.2%) \nDysfunctional uterine bleeding \nNo.(%) 18(36.7%) 0(0.0%) 6(12.2%) 24(49.0%) \nOvarian cyst No.(%) 1(2.0%) 0(0.0%) 0(0.0%) 1(2.0%) \nPolyp  \nNo.(%) 2(4.1%) 0(0.0%) 0(0.0%) 2(4.1%) \nTotal  \nNo.(%) 38(77.6%) 1(2.0%) 10(20.4%) 49(100.0%) \nP-value   0.5   \n \n \n\n439 Perimenopause Bleeding and Association \n      Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \n4. Discussion \nAbnormal Uterine Bleeding (AUB) is a common \ncomplaint among women in the perimenopausal \nperiod, particularly those aged between 40 and 45 \nyears. This result aligns with the findings of Meena et \nal., (4) and Sahu HD et al. , (12), who reported similar \nage distributions, with a mean age of 44 years. In our \nstudy, most patients (63.3%) were Para 3  or more, a \nfinding consistent with Sahu HD et al. , (12), though \nhigher than that reported by Byna et al. , (13). \nMenorrhagia emerged as the most frequent clinical \npresentation among perimenopausal women, \naccounting for 38.8% of cases in the present study, \nwhich corresponds with the findings of Some studies \n(4,6,12,14). Polymenorrhagia was the next most \ncommon presentation (32.7%) of our study, which \nagrees with the results of Begum et al., (15). Regarding \nthyroid function, most women in our study were \neuthyroid (77.6%), followed by subclinical \nhypothyroid cases (20.4%). This distribution is \ncomparable to the findings by Byna et al. , (13), who \nreported 64.5% euthyroid, 21.8% hypothyroid, and \n12.72% hyperthyroid patients, as well as Sharma et al., \n(16), who reported 64% with euthyroid and 22% \nhypothyroid. Our study identified only 2% of patients \nwith hyperthyroidism, slightly lower than that (4%) \nreported by Sahu et al. , (12), which may be attributed \nto the smaller sample size and regional variation in our \nstudy population. In terms of healthcare -seeking \nbehavior, 40.8% of women in our study presented for \nmedical evaluation within six months of symptom \nonset, like the findings of Meena et al. , (4). \nImportantly, our study demonstrated a significant \ncorrelation between thyroid dysfunction and AUB. \nAmong those with subclinical hypothyroidism, 20.4% \npresented with menorrhagia and polymenorrhagia. \nThis pattern is consistent with that reported by Meena \net al., (4), who found that 20% of patients with AUB \nhad subclinical hypothyroidism. Meanwhile, 77.6% of \neuthyroid women in our study experienced AUB, most \ncommonly in the form of polymenorrhea, a slightly \nhigher proportion than that (64.5%) reported by Byna \net al., (13). Dysfunctional Uterine Bleeding (DUB) was \nidentified as the most prevalent underlying cause of \nAUB in our cohort, affecting 49% of patients. \nEndometrial hyperplasia (with or without atypia) was \npresent at 18%, and adenomyosis in 12.2%. These \nfindings differ from those of Sahu et al. , (12), who \nreported DUB in only 12% of cases and a higher \nincidence of adenomyosis (33.6%). This variation may \nstem from differences in the age range and \ndemographics of the populations studied. While Subedi \net al. , (17) found hypothyroidism as the commonly \nassociated with DUB, our results showed that 36.7% of \nwomen with DUB were euthyroid, and no significant \nassociation was found between specific causes of AUB \nand thyroid status.  \nA key limitation of our study is that it was conducted \nin a single center with a relatively small sample size, \ndespite covering an extended study period. This may \nlimit the generalizability of the findings and \nunderscores the need for larger, multicenter s tudies to \nfurther clarify the relationship between thyroid \ndysfunction and abnormal uterine bleeding. \n \n5. Conclusion \nMost common presentation of AUB was \nmenorrhagia and polymenorrhea in women during \nperimenopause period commonly aged between 40 -45 \nyears old with dysfunctional uterine bleeding being \nmost common cause fallowed by endometrial \nhyperplasia (with or without at ypia). Thyroid status \nwas correlated with AUB and subclinical \nhypothyroidism being the most common form of \nthyroid dysfunction. \n \n6. Declarations \nAcknowledgments \nThe authors would like to thank Babylon college of \nmedicine/university of Baghdad for supporting this \nresearch. \n \nEthical Considerations \nThis research has received ethical approval from Al-\nkindy College of medicine/university of Baghdad with \nthe number 322 in 25-2-2025.   \n \nAuthors' Contributions \nBT designed the idea of  the study, planned the \nexperiments, collected and analyzed the data, and \nwrote the first draft of the manuscript. MM finished \nanalyzing the data, reading the manuscript, and helped \nplan the study. HH read and made changes to the \nmanuscript. All authors read and approved the final \nversion of the article. \n \nConflict of Interest \nThe authors declared no conflict of interest. \n \nFund or Financial Support \nThe authors declared no fund. \n \n \n \n \n \n\nBanan Natiq Turkey, et al. 440 \n      Volume 11, May 2026       Journal of Obstetrics, Gynecology and Cancer Research \n \n1. Dreisler E, Frandsen CS, Ulrich L. \nPerimenopausal abnormal uterine bleeding. \nMaturitas. 2024 ;184:107944. \n[doi:10.1016/j.maturitas.2024.107944] \n2. Hameed Z, Abdulrazzaq M, Mahood A, Salem \nK, Hassooni Z, Abbas H. Histological and \nmolecular study of HOXA11 gene in \nendometrial carcinoma. J Obstet Gynecol \nCancer Res. 2024;9(5):562 -77. \n[doi:10.30699/jogcr.9.5.562] \n3. Shahbazian N, Zargar M, Barati M, Saadati N, \nDirekvand E. 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J Obstet Gynecol Cancer Res. 2026;11(5):435-441. \nDownload citation:                             RIS | EndNote | Mendeley |BibTeX |","source_license":"CC0","license_restricted":false}