Impact of pulmonary tuberculosis on menstrual pattern and fertility

INTRODUCTION AND STUDY OBJECTIVE: The association between pulmonary tuberculosis (TB) and female reproductive health problems is not well addressed. This study was done at Assiut University and Woman's Health University Hospitals to estimate the effect of pulmonary TB on menstrual patterns and fertility of women in childbearing age.

This study composed of 429 women with pulmonary TB of childbearing age (study group) and 100 age-matched healthy women (control group). A detailed medical history was obtained, and a clinical examination, routine investigations of pulmonary TB and transvaginal ultrasonography (TVS) were performed for all cases. Hysterosalpingography, combined laparoscopy and hysteroscopy were done for infertile women whenever indicated.

Menstrual abnormalities were reported in 66% of women in the study group. Secondary amenorrhea (112 cases, 26.5%, P < 0.001) and hypomenorrhea (86 cases, 20%, P < 0.001) were significantly higher in the study group than controls (2% and 3%, respectively). TVS diagnosed functional ovarian cysts in 85 patients in the study group (19.8%). After completing anti-tuberculosis treatment, 76% of women with menstrual abnormalities (162/213) resumed normal menstrual cycles. Among the 68 cases who sought fertility within 1 year after completion of treatment, TB peritubal and fine intrauterine adhesions were confirmed by laparoscopy and hysteroscopy in two and one infertile woman, respectively (0.7% of study group).

TB had marked reversible effect on the menstrual cycle but minimal association with genital TB and infertility. Pretreatment counseling of pulmonary TB women should include information on these reversible changes. Persistence of menstrual abnormalities or presence of infertility after completion of treatment should stimulate investigation for the possibility of genital tract involvement.