DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20170401

A study to correlate histopathological findings in patients with abnormal uterine bleeding

Mansi Shukla, Michelle N. Fonseca, Deepali Kharat, Pallavi Tekale

Abstract


Background: Abnormal uterine bleeding (AUB) is a common gynecological problem associated with considerable morbidity and significantly affects the patients. The aim of the study was to analyze the histopathological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups.

Methods: This is a retrospective study, conducted in the Department of Obstetrics and Gynaecology, in a tertiary care teaching hospital, Mumbai, India from March 2016 till date. All cases of AUB were included in the study. Data was entered in microsoft excel and managed in statistical package for the social sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary.

Results: A total of 120 cases were analyzed. Patients’ age ranged from 22-79 years. AUB was most common among the perimenopausal females (41-50years). The most common presenting symptom was heavy menstrual bleeding (53%). Dilatation and curettage (D&C) was performed in all cases and 96 underwent hysterectomy as final resort. Endometrial proliferative pattern was the most common histopathological finding and was seen in 27% patients, followed by endometrial hyperplasia in 13.5% patients, secretory endometrium (12.7%) and disordered proliferative endometrium were seen in 10.9% patients each. Malignancy was detected in 1.7% of cases and endometrial carcinoma was the most common lesion.

Conclusions: Endometrial sampling is especially indicated in women above the age of 35 years to rule out malignancy and preneoplasia. Among the females with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this study was endometrial proliferation.


Keywords


Abnormal uterine bleeding, Endometrial hyperplasia, Histopathology, Menorrhagia

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References


Practice bulletin number 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197-206.

American College of Obstetricians and Gynecologists. Management of anovulatory bleeding. ACOG Practice Bulletin No. 14. Washington, DC: ACOG: 2000.

Munro MG, Critchley HO, Broder MS, Fraser IS, for the FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet. 2011;113(1):3-13.

Munro MG, Critchley HO, Fraser IS. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? Am J Obstet Gynecol. 2012;207(4):259-65.

Kelekci S, Kaya E, Alan M, Alan Y, Bilge U, Mollamahmutoglu L. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertil Steril. 2005;84(3):682-6.

Guido RS, Shakir AK, Rulin MC, Christopherson WA. Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. J Reprod Med. 1995;40(8):553-5.

National Collaborating Centre for Women’s and Children’s Health, National Institute of Clinical Excellence. Heavy menstrual bleeding. Clinical guideline. London: RCOG Press; 2007.

DeVore GR, Owens O, Kase N. Use of intravenous Premarin in the treatment of dysfunctional uterine bleeding-a double-blind randomized control study. Obstet Gynecol. 1982;59:285-91.

Munro MG, Mainor N, Basu R, Brisinger M, Barreda L. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Obstet Gynecol. 2006;108:924-9.

James AH, Kouides PA, Abdul-Kadir R, Dietrich JE, Edlund M, Federici AB, et al. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):124-34.