tuberculosis ( tb ) continues to be a major health problem in developing 
 countries and compounded recently by dual infection of 
 hiv and tuberculosis . genital tuberculosis is accompanied with menstrual disorders 
 including hypomenorrhea , amenorrhea , and infertility . in one 
 study , oligomenorrhea and amenorrhea were seen in 54% and 
 14% of genital tuberculosis , respectively , but 
 estimation of menstrual dysfunctions in nongenital tuberculosis 
 has been less studied . active pulmonary tuberculosis without 
 demonstrable lesions of structural involvement of either the 
 ovaries or the genital tract is associated with amenorrhea and 
 infertility in human females . hence , menstrual 
 dysfunction is correlated with the severity of the disease being 
 more common in severe forms of disease . in a retrospective cohort study where exposure and outcome took 
 place in the past period , menstrual patterns were compared in 
 the patients with pulmonary or extrapulmonary but nongenital 
 tuberculosis with healthy nursing students and with themselves , 
 too ; menstrual pattern including duration , interval , and amount of 
 menstrual period , and also menstrual irregularity including 
 excessive or prolong bleeding , decreasing in amount ( hypomenorrhea ) , 
 or retardation and cessation of menstrual period and 
 also pelvic pain were compared before and after treatment . this 
 study was conducted over an 11-month period in masih daneshvari 
 teaching hospital affiliated to shaheed beheshti university of 
 medical sciences and health services in tehran where there is a referral 
 center for treatment of tb . case subjects were selected by convenient 
 nonrandomized sampling but control groups were selected by random 
 allocation among volunteers of nursing students . case and control 
 subjects were marched in age group . case subjects were defined as 
 the patients with proven tuberculosis by isolation of mycobacterium 
 and positive culture of sputum or any material plus positive chest 
 x - ray in pulmonary cases of tuberculosis . proven genital 
 tuberculosis including pelvic mass , infertility with pelvic 
 tuberculosis diagnosed by hysterosalpingography or positive 
 menstrual and endometrial culture was excluded from this study . control subjects were healthy nursing students that were checked 
 for tb and any other communicable disease by taking of chest 
 x - ray , routine laboratory tests , and ppd at the setting of college 
 admission . approximately 100 persons of these students by random 
 allocation accepted to participate and fill out the format 
 questionnaire . collected data were analyzed with spss software and p - value was 
 considered meaningful at equal to or less than 0.05 . approximately 90 cases had pulmonary tuberculosis and others had 
 lymphatic tuberculosis in 8 cases , skeletal in one case , and 
 peritoneal tb in one case . mean ages of the cases and controls were 27.5  8.4 and 26.9  5.5 years , respectively . menarche took place at the age of 13.77  1.25 years in cases 
 and 13.39  1.3 years , in control subjects . secondary amenorrhea with a mean duration of 10.59 months took 
 place in 22 cases of the patients but no one in control group . menstrual dysfunctions were compared in the patients , before and 
 after a mean period of 7.1 months of treatment with anti - tb drugs 
 including isoniazide , rifampine , etambutol , or streptomycin . tb is a leading cause of death among women of reproductive age and 
 is estimated to cause more deaths among this group than all causes 
 of maternal mortality . women are less likely than men to develop an infection , but are 
 less likely to be tested and treated . hypomenorrhea and secondary amenorrhea widely seen in the 
 patients with pulmonary tuberculosis may be resulting from 
 dysfunction ascribed to hypothalamus , pituitary , and premature 
 ovarian failure or even due to organic lesions in the uterine 
 endometrium in one study . another study reveals that 
 approximately 13% of women with pulmonary tuberculosis have 
 genital tuberculosis and this result will be found by repeated 
 histopathologic studies when clinical diagnosis is not possible . hypomenorrhea and secondary amenorrhea in the patients 
 with extra genital tuberculosis with no involvement of ovary or 
 genital tract are poorly understood which is in proportion to the 
 severity of the disease . there are some limitations in this study including undiagnosed 
 genital tuberculosis among the cases and also socioeconomic 
 differences between cases and controls , but these cases have been 
 compared with themselves before and after treatment , too . in endemic countries for tuberculosis including border areas of 
 iran , tuberculosis could be diagnosed when menstrual irregularity 
 with hypomenorrhea and prolong 
 interval periods are the whole tb manifestations . 
 however , it needed to be proved in next studies . timely 
 and appropriate treatment restores normal menstrual function in 
 some of these cases . comparison of menstrual patterns in the women , with 
 ( cases ) and without tuberculosis ( controls ) .
menstrual patterns differ even in nongenital tuberculosis . our 
 objective is to determine whether nongenital tuberculosis makes 
 menstrual dysfunction , before and sustain after treatment . 
 menstrual patterns were compared in women with pulmonary or extrapulmonary but nongenital tuberculosis with 
 healthy nursing students and also with themselves , before and 
 after treatment in a retrospective cohort study . 
 subjects were 
 selected by convenient nonrandomized sampling but 
 control groups were selected by random allocation among 
 volunteers of nursing students . case and control subjects were 
 matched in age group . 
 menstrual patterns including amount , 
 duration , interval , cessation of period , any menstrual 
 irregularity , and pelvic pain were evaluated . among 100 cases of 
 proven tuberculosis , 
 90 patients had pulmonary and 10 cases had 
 extrapulmonary tuberculosis . 
 secondary amenorrhea 
 ( p  .001 , rr : 22 ) , spotting during menstrual 
 period ( p  .0001 , rr : 4.5 ) , decreasing in amount ( p  .001 , rr : 7.8 ) , shorter duration of menstrual period 
 ( p  .001 , rr : 12 ) , and pelvic pain ( p  .001 , rr : 8.6 ) 
 were more prevalent and significantly different in the cases 
 compared to control subjects ( with ci:95% and p < .001 ) , but 
 excessive or prolong vaginal bleeding was not observed . 
 menstrual disorders occur even in nongenital tuberculosis , but it 
 is manifested with cessation or decrease in menstrual bleeding 
 flow and period .