Histopathological study of endometrial abnormalities in women with abnormal uterine bleeding in a rural population

Manisha; Fayaz Khan H.; Bhuvneshwari Upadhyay; Anushka Gupta; Manju M.

doi:10.18203/2320-1770.ijrcog20263984

Authors

Manisha Department of Obstetrics and Gynecology, FH Medical College, Agra, Uttar Pradesh, India
Fayaz Khan H. Department of Obstetrics and Gynecology, FH Medical College, Agra, Uttar Pradesh, India
Bhuvneshwari Upadhyay Department of Obstetrics and Gynecology, FH Medical College, Agra, Uttar Pradesh, India
Anushka Gupta Department of Obstetrics and Gynecology, FH Medical College, Agra, Uttar Pradesh, India
Manju M. Department of Obstetrics and Gynecology, FH Medical College, Agra, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20263984

Keywords:

Abnormal uterine bleeding, Curettage, Endometrial hyperplasia, Histopathology, Rural health

Abstract

Background: Abnormal uterine bleeding (AUB) is one of the most frequently encountered gynecological complaints and may occur across different reproductive age groups. It can substantially impair quality of life and may arise from functional disturbances or structural abnormalities of the uterus and endometrium. Histopathological evaluation of endometrial tissue remains an important diagnostic modality for identifying the underlying pathology, particularly in resource-constrained rural settings where access to advanced diagnostic facilities may be limited. This study aimed to evaluate the histopathological patterns of endometrial abnormalities among women aged 19–65 years presenting with AUB in a rural population and to determine the frequency and spectrum of organic and non-organic endometrial findings.

Methods: This cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology, F.H. Medical College and Hospital, Agra, from September 2023 to February 2025. A total of 278 women aged 19-65 years presenting with AUB and undergoing endometrial sampling were included. Endometrial tissue was obtained through biopsy or dilatation and curettage, processed routinely, stained with hematoxylin and eosin, and examined by light microscopy. Data were analyzed using descriptive statistics.

Results: The highest proportion of patients belonged to the 31–35-year age group (30.93%). Menorrhagia was the most frequent bleeding pattern, accounting for 55% of cases. Among organic causes of AUB, endometrial hyperplasia was the predominant histopathological finding (76.60%), followed by endometritis (17.02%), endometrial carcinoma (4.26%), and endometrial polyps (2.13%). Among non-organic causes, secretory endometrium was the most frequent histopathological pattern (53.70%), followed by proliferative endometrium (44.44%), disordered proliferative endometrium (1.39%), and atrophic endometrium (0.46%).

Conclusions: Histopathological examination of endometrial tissue provides valuable diagnostic information in women presenting with AUB and facilitates the identification of benign, premalignant, and malignant endometrial abnormalities. It remains a practical and accessible diagnostic approach, particularly in rural and resource-limited healthcare settings.

References

Deliwala KJ, Deliwala DJ, Patel SV. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in non-gravid women. 2025.

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.

Mary GS, Tarin AS and Patrice MW. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Phys. 2012;85(1):35-43.

Siddiqui RP, Pandey V, Chandrakar S, Bhaskar V. The range of endometrial pathologies in patients with abnormal uterine bleeding at a tertiary care center in central India. MGM J Med Sci. 2024;11(3):420-8.

Kundu S, Acharya SS. Exploring the triggers of premature and early menopause in India: A comprehensive analysis based on National Family Health Survey, 2019-2021. Sci Rep. 2024;14(1):3040.

Pardeshi GS, Tambe MP, Chandanwale AS, Sharma RS, Wagh MS. Barriers and facilitators to seek treatment for gynecological morbidity among women from urban slums in Pune, India. Ind Jo Commu Fam Medi. 2017;3(2):52-60.

Kahveci B, Budak MS, Ege S, Obut M, Baglı I, Oğlak SC, Vardar MA. PALM-COEIN classification system of FIGO vs the classic terminology in patients with abnormal uterine bleeding. Ginekologia Polska. 2021;92(4):257-61.

Ramchandani L, Jatav J, Jain A, Jain R. Histopathological evaluation of uterine lesions in women with AUB in Vindhya region of Madhya Pradesh. Pan J Med Sci. 2023;12(3):662-7.

Vaidya S, Lakhey M, Vaidya S, Sharma PK, Hirachand S, Lama S, Kc S. Histopathological pattern of abnormal uterine bleeding in endometrial biopsies. Nepal Med Coll J. 2013;15(1):74-.

Al Nemer AM, Al Bayat MI, Al Qahtani NH. The accuracy of endometrial sampling for the diagnosis of patterns of endometrial pathology in women presenting with abnormal uterine bleeding: More conservative therapeutic approaches. Saudi Med J. 2019;40(8):815.

Shrestha D, Aryal S, Tiwari A, Sharma R. Abnormal uterine bleeding among women visiting gynecology out-patient department of a tertiary care hospital: a descriptive cross-sectional study. J Nepal Med Associat. 2022;60(246):121.

Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstetr Gynecol. 1996;175(3):766-9.

Muzaffar M, Akhtar KA, Yasmin S, Iqbal W, Khan MA. Menstrual irregularities with excessive blood loss: a clinico-pathological correlation. J Pak Med Associat. 2005;55(11):486-9.

Makhija D, Mathai AM, Naik R, Kumar S, Rai S, Pai MR, et al. Morphometric evaluation of endometrial blood vessels. Ind J Pathol Microbiol. 2008;51(3):346-50.

Albers JR, Hull SK, Wesley RM. Abnormal uterine bleeding. Am Fam Phys. 2004;69(8):1915-26.

Litta P, Merlin F, Saccardi C, Pozzan C, Sacco G, Fracas M, et al. Role of hysteroscopy with endometrial biopsy to rule out endometrial cancer in postmenopausal women with abnormal uterine bleeding. Maturitas. 2005;50(2):117-23.

Doraiswami S, Johnson T, Rao S, Rajkumar A, Vijayaraghavan J, Panicker VK. Study of endometrial pathology in abnormal uterine bleeding. J Obstetr Gynecol India. 2011;61(4):426-30.