Histopathological evaluation of endometrial sampling in perimenopausal women with abnormal uterine bleeding

Bhavani L. Nair; Lency S. Kuriakose

doi:10.18203/2320-1770.ijrcog20212977

Authors

Bhavani L. Nair Department of Obstetrics and Gynecology, Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, Kerala, India
Lency S. Kuriakose Department of Obstetrics and Gynecology, Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20212977

Keywords:

Perimenopausal AUB, Endometrial sampling, palm-coein

Abstract

Background: Abnormal uterine bleeding (AUB) is one of the common symptoms in the gynaecology outpatient department. About one third of women are affected at some time in their lives. The perimenopausal women show significant number of underlying organic pathology. The evaluation of endometrium and/or organ histopathology has the dual advantage of finding the cause of AUB and to rule out endometrial cancer or the potential for cancer in future like endometrial hyperplasia with atypia. The aim of the study was to determine the histopathological pattern of endometrial sampling in perimenopausal women with AUB and to follow them up for a period of six months after the procedure.

Methods: The prospective observational study was conducted at the department of obstetrics and gynaecology at Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, Kerala, for a period of one year from December 2019 to December 2020. The study was conducted on 116 perimenopausal women 41-52 years who presented with AUB and had undergone endometrial sampling. These ladies were subsequently followed up for six months post procedure to assess the response to medical treatment or the need for any surgical intervention like hysterectomy.

Results: A total 39.65% patients had heavy and prolonged menstrual bleeding and 18.16% patients had irregular bleeding. 14.65% patients had prolonged flow, 8.6% had heavy flow, 6.8% had infrequent with prolonged flow, 6% had prolonged, infrequent with heavy bleeding. Non-structural (COEIN) causes contributed to about 60.4% of AUB in perimenopausal women and 39.6% had structural (PALM) causes. 49% cases were secretory endometrium. 29.3% had disordered proliferative endometrium, 4.3% had proliferative endometrium, 5.2% each had polyp or hyperplasia without atypia. 18 (15.5%) cases underwent hysterectomy, 3 patients who had adenocarcinoma underwent staging laparotomy, 2 patients had LNG IUS insertion and 40 patients were on follow up requiring either no treatment and 53 (45.68%) patients were given antifibrinolytics or hormonal therapy.

Conclusions: Heavy and prolonged menstrual bleeding was the most common presenting symptom. COEIN contributed to about 60.4% of cases. Evaluation of the endometrium showed that, secretory endometrium was commonest (49%) followed by disordered proliferative endometrium (29.3%). On follow up for six months, 15.5% patients underwent hysterectomy, 2 patients had insertion of levonorgestrel IUD, 45.68% patients had medical management with antifibrinolytics or hormones and were on follow up. The responsibility of gynaecologist in the management of AUB in perimenopausal women is to exclude hyperplasia of endometrium and endometrial cancer.

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Author Biography

Lency S. Kuriakose, Department of Obstetrics and Gynecology, Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, Kerala, India

OBSTETRICS AND GYNAECOLOGY , ASSISTANT PROFESSOR.

References

Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health. 2007;10(3):183-94.

Oehler MK, Rees MC. Menorrhagia: an update. Acta Obstet Gynecol Scand. 2003;82(5):405-22.

Munro MG, Critchley HOD, Fraser IS, FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393-408.

NICE. Heavy menstrual bleeding: Assessment and management (NG 88), 2018. Available at: https://www.nice.org.uk/guidance/ng88. Accessed on 02 June 2021.

WHO Scientific Group on Research on the Menopause in the 1990. Research on the menopause in the 1990s: report of a WHO scientific group, 2020. Available at: https://apps.who.int/iris/handle/10665/41. Accessed on 02 June 2021.

Mishra D, Sultan S. FIGO's PALM-COEIN Classification of Abnormal Uterine Bleeding: A Clinico-histopathological Correlation in Indian Setting. J Obstet Gynaecol India. 2017;67(2):119-25.

Vercellini P, Cortesi I, Oldani S, Moschetta M, Giorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod. 1997;12(8):1768-71.

Ash SJ, Farrell SA, Flowerdew G. Endometrial biopsy in DUB. J Reprod Med. 1996;41(12):892-6.

National Collaborating Centre for Women's and Children's Health (UK). Heavy Menstrual Bleeding. London: RCOG Press; 2007.

Seamark CJ. The demise of the D&C. J R Soc Med. 1998;91(2):76-9.

Telner DE, Jakubovicz D. Approach to diagnosis and management of abnormal uterine bleeding. Can Fam Physician. 2007;53(1):58-64.

Sreelakshmi U, Bindu VT, Subhashini T. Abnormal Uterine Bleeding in perimenopausal age group women: a study on clinicopathological evaluation and management. Int J Reprod Contracept Obstet Gynecol. 2018;7:192-7.

Kalambe M, Jungari M, Chaudhary A, Kalambe A, Shrivastava D. Palm Coein Figo Classification System for Causes of Abnormal Uterine Bleeding (AUB) in Non Gravid Women of Reproductive Age Group in a Peri Urban Tertiary Care Hospital. Int J Curr Res Rev. 2018;12(15):128-33.

Gupta A, Rathore AM, Manaktala U, Rudingwa P. Evaluation and histopathological correlation of abnormal uterine bleeding in perimenopausal women. Int J Biomed Advance Res. 2013;4(8):509.

Singh A, Choudhary A. A Study of PALM-COEIN Classification of Abnormal Uterine Bleeding (AUB) in Perimenopausal Women at a Tertiary Care Teaching Hospital. J Med Sci Clinic Res. 2018; 6(6):287-92.

Chitra T, Manjani S, Madhumittha R. Histopathology of endometrial curettings in perimenopausal women with abnormal uterine bleeding. J Evolution Med Dent Sci. 2016;5(24):1285-90.

Vani BS, Vani R, Jijiya BP. Histopathological evaluation of endometrial biopsies and curettings in abnormal uterine bleeding. Trop J Path Micro. 2019;5(4):190-7.

Chang R, Chen H. Disordered proliferative, 2021. Available at: https://www.pathology out-lines .com/topic/uterusdisordered proliferative. Accessed on 02 June 2021.

Sharma A, Lastra RR. Endometrial hyperplasia, 2021. Available at: https://www.pathologyoutlines.com /topic/uterusendometrialhyperplasiageneral.HTML. Accessed on 02 June 2021.