Endometrial histopathology patterns in women with abnormal uterine bleeding
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20220173Keywords:
Abnormal uterine bleeding, Endometrial biopsy, Histopathology, Perimenopausal women, PALM-COEINAbstract
Background: Abnormal uterine bleeding is the most common gynaecological condition for which many women seek medical opinion. Evaluation of these women requires careful investigation into the cause and nature of bleeding with a main focus to exclude organic pathology, especially genital malignancies. Endometrial biopsy is one such intervention which is of immense value in categorizing the conditions. Aims and objectives of current study were to analyse endometrial histology patterns in women with AUB.
Methods: This was a retrospective study conducted on women with AUB who presented in the gynae OPD during the study period of one year and had endometrial biopsy as part of evaluation. Women between with AUB were included in the study after excluding pregnancy related bleeding. Detailed clinical history, examination findings, investigations and endometrial histopathology was noted.
Results: A total of 97 women with AUB who had undergone dilatation and curettage with endometrial biopsy were studied. Majority of women were in age group of 40-45 years and heavy menstrual bleeding was the commonest complaint, AUB (P) 17% and AUB (L) 39%, accounted for most of the clinical presentations. Endometrial histology showed varied patterns 27 % had secretory endometrium, 11% proliferative endometrium. There were 7 cases of endometrial hyperplasia without atypia and three cases of endometrial malignancy.
Conclusions: Histopathological evaluation of endometrium is the cornerstone of management of abnormal uterine bleeding. Endometrial patterns obtained can be useful in ruling out malignancy and help in formulating further management.
References
Sun Y, Wang Y, Mao L, Wen J, Bai W. Prevalence of abnormal uterine bleeding according to new International Federation of Gynecology and Obstetrics classification in Chinese women of reproductive age: A cross-sectional study. Medicine (Baltimore). 2018;97(31):e11457.
Munro MG, Critchley HO, Fraser IS. The flexible FIGO classification concept for underlying causes of abnormal uterine bleeding. Semin Reprod Med. 2011;29:391-9.
Albers JR, Hull SK, Wesley RM. Abnormal Uterine Bleeding. Am Fam Physician. 2004;69(8):1915-26.
Nicholson WK, Ellison SA, Grason H, Powe NR. Patterns of ambulatory care use for gynaecologic conditions: a national study. Am J Obstet Gynecol. 2001;184:523-30.
Whitaker L. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65.
Baird DD, Dunson DB, Hill MC. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188:100-7.
Brahma PK, Martel KM, Christman GM. Future directions in myoma research. Obstet Gynecol Clin North Am. 2006;33:199-224.
Indrani M, Rao PS, Nataraj S, Biswas M. An analysis of endometrial bleeding patterns in perimenopausal women. IJRCOG. 2017;6(7):415-9.
Agarwal P, Garg R, Rai N, Prakash P. Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc. 2016;4(1):22-6.
Talukdar B, Mahela S. Abnormal uterine bleeding in perimenopausal women: Correlation with sonographic findings and histopathological examination of hysterectomy specimens. J Midlife Health. 2016;7(2):73-77.
Jairajpuri ZJ, Rana S, Jetle S. Atypical uterine bleeding-Histopathological audit of endometrium A study of 638 cases. Al Ameen J Med Sci. 2013;6(1): 21-8.
Sreelakshmi U. Uterine bleeding in perimenopausal women. Int J Reprod Contracept Obstet Gynecol. 2018;7(1):192-7.
Bhosle A, Fonseca M. Evaluation and histopathological correlation of abnormal uterine bleeding in perimenopausal women. Bombay Hosp J. 2010;52(1):60-71.
Gopalan U, Rajendiran S, Karnaboopathy R. Study of endometrial histopathology in women with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):824-8.
Fetesku SA. Comorbidities in patients with endometrial hyperplasia. Lik Sprava. 2015;(1-2):157-9.
Tangitagawal S, Khunnarong J, Srijaprachoren S. Medical morbidities in endometrial cancer patients. Int J Gynecol Cancer. 2014;24(9):45-9.
Gordon P. Videos in clinical medicine. Endometrial biopsy. N Engl J Med. 2009;361(26):e61.
Sweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012;85(1):35-43.
Doraiswami S, Johnson T, Rao S, Rajkumar A, Vijayaraghavan J, Panicker VK. Study of endometrial pathology in abnormal uterine bleeding. J Obstet Gynecol India. 2011;61(4):426-30.
van Dongen H, de Kroon CD, Jacobi CE, Trimbos JB, Jansen FW. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG. 2007;114(6):664-75.
Khare A, Bansal R, Sharma P, Elhence N. Morphological spectrum of endometrium in patients presenting with Dysfunctional uterine bleeding. People’s J Scientific Res. 2012;5:13-6.
Baral R, Pudasaini S. Histopathological pattern of endometrial samples in abnormal uterine bleeding. J Pathol Nepal. 2011;1:13-6.
Golecha N, Porwal V. Abnormal uterine bleeding: A study of its clinical spectrum and incidence of histopathological patterns of endometrium as a function of age with parity. Indian J Obstet Gynecol Res. 2018;5(3):339-43.