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Correspondence |

Impact of Pulmonary Tuberculosis on Menstrual Pattern and Fertility FREE TO VIEW

Wafaa A. Hassan, MD; Atef M. Darwish, MD, PhD
Author and Funding Information

Affiliations: Assiut University Hospital Assiut, Egypt,  Women's Health University Hospital Assiut, Egypt

Correspondence to: Wafaa A. Hassan, MD, Chest Department, Assiut University Hospital, Assiut, Egypt; e-mail: wafaagadallah@yahoo.com


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(1):326. doi:10.1378/chest.09-0594
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To the Editor:

The association of pulmonary tuberculosis (TB) and female reproductive health problems is not well addressed.13 This prospective case-control study4 was done at Assiut University and Women's Health University Hospitals to estimate the effect of pulmonary TB on menstrual patterns and fertility of women of child-bearing age. It was composed of 429 women with pulmonary TB of child-bearing 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 compared with subjects in the control group (Table 1). Patients with more extensive chest-radiologic shadows and prolonged course of pulmonary TB were more susceptible. TVS revealed functional ovarian cysts in 85 women in the study group (19.8%). After completing antituberculous treatment, 76% of the study group had resumed normal menstrual cycles. Among 68 women who sought fertility within 1 year after completion of the treatment, TB peritubal and fine intrauterine adhesions were confirmed by hysterosalpingography in 2 women and 1 infertile woman, respectively (0.7% of study group), whereas persistence of the simple ovarian cysts was observed in 2 women.

Table Graphic Jump Location
Table 1 Menstrual Patterns in Study and Control Groups

This study highlights the importance of proper cooperation between chest specialists and gynecologists for women with TB. Menstrual abnormalities without pathologic affection of the female genital tract represent the salient abnormality associated with pulmonary TB. Routine TVS for those women is recommended. Pretreatment counseling should provide a hint about these temporary reversible changes. Pulmonary TB carries an insignificant risk of female fertility. Persistence of menstrual dysfunction or the presence of infertility after completion of treatment should attract attention about the possibility of genital tract involvement.

Tripathy SN. Genital affection in pulmonary TB. Indian J Tuberc. 1991;38:191-196
 
Fallahian M, Ilkhani M. Menstrual disorders in nongenital tuberculosis. Infect Dis in Obstet Gynecol. 2006;18452:1-3. [CrossRef]
 
Sharma S. Menstrual dysfunction in non-genital tuberculosis. Int J Gynecol Obstet. 2002;79:245-247
 
Hassan WA, Darwish AM. Impact of pulmonary tuberculosis on menstrual pattern and fertility. Clin Respir J. 2009; (in press).
 

Figures

Tables

Table Graphic Jump Location
Table 1 Menstrual Patterns in Study and Control Groups

References

Tripathy SN. Genital affection in pulmonary TB. Indian J Tuberc. 1991;38:191-196
 
Fallahian M, Ilkhani M. Menstrual disorders in nongenital tuberculosis. Infect Dis in Obstet Gynecol. 2006;18452:1-3. [CrossRef]
 
Sharma S. Menstrual dysfunction in non-genital tuberculosis. Int J Gynecol Obstet. 2002;79:245-247
 
Hassan WA, Darwish AM. Impact of pulmonary tuberculosis on menstrual pattern and fertility. Clin Respir J. 2009; (in press).
 
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