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EDITOR-Prentice in his review of menorrhagia states that there is little evidence to link hypothyroidism with excessive menstrual loss. 1 He supports this with reference to a retrospective analysis of the records of 50 patients with myxoedema. 2 In this cohort 28 women (56%) complained of menstrual disturbance, with the most common complaint being menorrhagia (occurring in 18 (36%) of the women). The acid test of causation is, however, whether treatment of the condition corrects the menstrual dysfunction. In this study (which reported the women's perceived loss) and more recent studies in which the menstrual loss was measured 3 treatment of hypothyroidism with thyroxine decreased menstrual blood loss.
Hypothyroidism may be greatly underdiagnosed as a cause of menorrhagia. Wilansky tested for thyrotrophin releasing hormone in 67 women with menorrhagia who had normal concentrations of thyroxine and thyroid stimulating hormone. 4 Fifteen (22%) had abnormal tests and were treated with thyroxine. Twenty four of the total cohort (who had not had surgery and remained without a definitive diagnosis) were followed up...