Amniotic Membrane–Covered Intrauterine Device for Tuberculosis-Associated Secondary Amenorrhea: Serial Endometrial Thickness and Menstrual Recovery in Two Cases

Abstract

Background: Amniotic membrane has been investigated as an adjunct to treatment of intrauterine adhesions, but its role in women with tuberculosis and secondary amenorrhea is uncertain. We describe serial endometrial thickness and menstrual outcomes after antituberculosis therapy and intrauterine placement of an amniotic membrane wrapped plastic intrauterine device (IUD) frame.

Case presentation: Two women, aged 32 and 36 years, presented in December 2025 with amenorrhea lasting three and nine months, respectively. Both had positive sputum molecular tests for tuberculosis and had received two months of rifampicin, isoniazid, pyrazinamide, and ethambutol at presentation. The first had undergone diagnostic laparoscopy and hysteroscopic polypectomy approximately one year before amenorrhea; polypectomy histopathology showed an endometrial polyp and chronic granulomatous inflammation suggestive of tuberculosis. The second had recurrent pregnancy loss, curettage, and hysteroscopic resection of a reported 1-cm uterine septum in December 2025; no histopathology result was available for that procedure. Both declined blood investigations. A membrane wrapped plastic IUD frame was placed after removal of the copper wire from its stem. Endometrial thickness increased from 3.0 to 6.5 mm over four months in the first patient and from 2.0 to 7.0 mm over three months in the second. Menstruation resumed at months 4 and 3, respectively, with duration and volume reported as comparable to previous cycles. The frames were removed at visits during menstruation. Both reported continued regular cycles for two further months. No adverse events were recorded.

Conclusion: Serial endometrial thickening and menstrual resumption were observed after combined care. Concurrent antituberculosis therapy, prior uterine procedures, incomplete diagnostic assessment, and the uncontrolled two-case design prevent attribution of benefit to the membrane or frame. These observations warrant further investigation without establishing efficacy, safety, or fertility restoration.