Endometrial study of abnormal uterine bleeding in perimenopausal women
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20240478Keywords:
Abnormal uterine bleeding, Endometrial intraepithelial neoplasia, Post-menopausal bleeding, Transvaginal sonography, Histopathological examinationAbstract
Background: AUB accounts for 70% of gynecological pathology. Prevalence of AUB is 3%-30% among reproductive aged women. Early diagnosis by endometrial biopsy is the most effective way to rule out malignancy in peri-menopausal women with AUB. TVS can be used as an aided diagnostic tool. Aims and objectives of this study is to evaluate endometrial causes of abnormal uterine bleeding in perimenopausal women and to correlate transvaginal sonography findings with histopathology by endometrial biopsy.
Methods: This prospective observational study was conducted on 80 perimenopausal women with abnormal uterine bleeding. Uterine pathology, endometrial thickness, was assessed by TVS. Endometrium was considered hyperplastic if thickness is ≥10 mm in perimenopausal women and was taken up for endometrial sampling. Endometrial biopsy by Pipelle’s curette was done as an outpatient procedure and sent for HPE.
Results: Total of 80 women with perimenopausal bleeding were examined during the study. Majority of the patients with AUB presented in 40-44 years age group and belonged to second parity. As per the TVS findings, 42 (52.5%) subjects had normal findings, 25 (31.3%) showed endometrial hyperplasia and remaining had other benign uterine pathology. Majority of women had ET 10 mm. The most common finding on histopathological examination was Proliferative endometrium.
Conclusions: Trans vaginal scan when incorporated along with bimanual pelvic examination and Pipelle’s aspiration can enhance our anatomic diagnosis. This study proves that transvaginal findings correlate well with the histopathology findings.
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References
Oehler MK, Rees MC. Menorrhagia: An update. Acta Obstet Gynecol Scand. 2003;82:405-22.
Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in abnormal uterine bleeding. Value Health. 2007;10:183-94.
ACOG committee. Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121:891-6.
Munro E. 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 Gynecol Obstet. 2018;3:1-16.
Berek JS. Adult Gynecology: Reproductive years. 16th ed. USA: Berek & Novaks; 2015.
Committee on Practice Bulletins Gynecology. Early pregnancy loss. Obstet Gynecol. 2015;125(5):1258-67.
The American College of Obstetricians and Gynecologists Committee Opinion no. 631. Endometrial intraepithelial neoplasia. Obstet Gynecol. 2015;125(5):1272-8.
Schorge A, John O, Williams J. Endometrial Cancer. In: Williams Gynecology. 4th ed. USA: The Mc-Graw Hill; 2010:700-2.
Jain M, Chakraborty S. Evaluation of abnormal uterine bleeding with transvaginal sonography. Int J Reprod Contracept Obstet Gynecol. 2017;6:23-9.
Varadarajan R, Sreekantha SM. Role of hysteroscopy in abnormal uterine bleeding in perimenopausal age group. J Evol Med Dent Sci. 2013;2(10):1504-9.
Verma U, Garg R, Singh S, Yadav P, Rani R. Diagnostic approach in perimenopausal women with abnormal uterine bleeding. J South Asian Feder Menopause Soc. 2014;2(1):12-4.
Pillai SS. Sonographic and histopathological correlation and evaluation of endometrium in perimenopausal women with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2014;3:113-7.
Patil R, Patil RK, Andola SK, Laheru V, Bhandar M. Histopathological spectrum of endometrium in dysfuctional uterine bleeding. Int J Biol Med Res. 2013;4(1):2798-801.
Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle aged women with atypical uterine bleeding a study of 219 cases. J Midlife Health. 2013;4:216-20.
Veena BT, Shivalingaiah N. Role of transvaginal sonography and diagnostic hysteroscopy in abnormal uterine bleeding. JCDR. 2014;8(12):6.
Bhosle A, Fonseca M. Evaluation and Histopathological Correlation of Abnormal Uterine Bleeding in Perimenopausal Women. Bombay Hospital J. 2010;52(1):69-72.
Berek JS. Uterine Cancer. 16th ed. USA: Berek & Novaks; 2015.
Epstein E, Ramirez A, Skoog L, Valentin L. Transvaginal sonography, saline contrast sonohysterography and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium >5 mm. Ultrasound Obstet Gynecol. 2001;18:157-62.
El-khayat W, Sleet ME, Mahdi EY. Comparative study of transvaginal sonography and hysteroscopy for the detection of pathological endometrial lesions in women with perimenopausal bleeding. Middle East Fertil Soc J. 2011;16(1):77-82.
Deckardt R, Lueken RP, Gallinat A, Möller CP, Busche D, Nugent W, et al. Comparison of transvaginal ultrasound, hysteroscopy, and dilatation and curettage in the diagnosis of abnormal vaginal bleeding and intrauterine pathology in perimenopausal and postmenopausal women. J Am Assoc Gynecol Laparoscop. 2002;9(3):277.
