Differentiated selection of reversible and surgical reproductive strategies in women with thyroid dysfunction: clinical rationale and outcomes of a personalized approach

Abstract

DOI: 10.52705/2788-6190-2026-03-10
УДК 618.17-008.8:616.441-008.6:615.256.5:618.12-089.87

The objective: to evaluate the clinical outcomes of differentiated selection of reversible and surgical reproductive strategies in women with thyroid dysfunction, taking into account reproductive plans, menstrual function, concomitant gynecological conditions, and the specific circumstances of medical follow-up under martial law.
Materials and methods. The outcomes of clinical management were analyzed in 105 women of reproductive age with thyroid dysfunction. Depending on the selected reproductive strategy, the participants were divided into four groups: Group I comprised 26 women using combined hormonal contraception; Group II included 26 women using progestogen-only or intrauterine contraceptive methods; Group III consisted of 26 women who underwent elective bilateral salpingectomy for permanent contraception; and Group IV included 27 women who underwent salpingectomy for therapeutic indications related to fallopian tube pathology. The duration of reversible contraceptive use, tolerability, adherence, menstrual function, surgical outcomes, and subsequent achievement of reproductive goals were assessed. The follow-up period was 12 months.
Results. At 12 months, 19 (73.1 %) women in Group I and 23 (88.5 %) women in Group II (p = 0.291) continued using their initially selected reversible contraceptive method. Non-adherence to the prescribed regimen was recorded in 7 (26.9 %) and 2 (7.7 %) women, respectively. Both groups demonstrated a reduction in the frequency of menstrual irregularities, dysmenorrhea, and
premenstrual symptoms. In Group III, an early postoperative complication was recorded in one patient (3.8 %). At 12 months, 24 (92.3 %) women remained satisfied with their decision to undergo permanent contraception. In Group IV, hydrosalpinx was diagnosed in 22 (81.5 %) patients. Among the 12 women who initiated assisted reproductive technology treatment following surgery, clinical pregnancy was achieved in 7 (58.3 %), while ongoing pregnancy was documented in 6 (50.0 %).
Conclusions. Differentiated selection of reproductive strategies enables clinicians to address the diverse clinical needs of women with thyroid dysfunction. The outcomes of reversible contraceptive methods are characterized by continuation rates, tolerability, and effects on menstrual function; those of permanent contraception by surgical safety and satisfaction with the decision; and those of therapeutic salpingectomy by treatment of fallopian tube pathology and the subsequent possibility of achieving reproductive goals.