Study of endometrial pathology in women with abnormal uterine bleeding
Keywords:Abnormal uterine bleeding, Endometrium, Dilation and curettage
Background: Abnormal uterine bleeding is one of the most common complaint that reproductive age women bring to their clinicians. Causes are varied and study of endometrium by dilatation and curettage with histopathological examination is an important aspect of treating patients with Abnormal uterine bleeding (AUB). The present study was done for evaluation of the histopathology of the endometrium for identifying endometrial causes of AUB.
Methods: A prospective study was conducted over a period of one year from July 2017 to July 2018 in the department of Obstetrics and Gynaecology in collaboration with the department of Pathology at Aarupadai Veedu Medical College, Puducherry. A complete clinical history, complete clinical examination, laboratory investigations, pelvic scan and endometrial biopsy were done to diagnose causes of AUB.
Results: A total of 152 cases are included. The age of the patients having AUB was ranging from 21 to 70 years. AUB was more common the age group in the age group 41-50 years (49%) followed by 31-40 years (36%). Majority were multiparous (74%). Menorrhagia (61%) was the commonest presentation. Majority of the cases showed a disordered proliferative endometrial pattern (34.2%), followed by secretory pattern (25%). 9.8% had polyp and 1.3% showed simple hyperplasia and 0.62% revealed complex hyperplasia without atypia and carcinoma endometrium.
Conclusions: Abnormal uterine bleeding was more common in the perimenopausal age group and majority had disordered proliferative endometrium and secretory changes. Endometrial sampling followed by histopathological examination helps us to diagnose the underlying pathology and will help in treating the patients appropriately including ruling out premalignant and malignant conditions of the uterus.
Marc A Fritz and Leon Speroff. Clinical Gynecologic Endocrinolgy and Infertility. 8th ed. Philadelphia: Lippincott Williams and Wilkins, 2011. Chapter 15: Abnormal Uterine bleeding; p.591-620.
Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in reproductive years. Fertil Steril. 2011;95(7):2204-08.
Munro MG, Critchley HO, Broder M., Fraser IS. FIGO working group on menstrual disorders. Int J Gynaecol Obstet. 2011;113(1):3-13.
Livingstone M, Fraser IS. Mechanism of abnormal uterine bleeding. Hum Reprod Update. 2002;8(1): 60-7.
Albers JR, Hull SK, Wesley RM. Abnormal uterine bleeding. Am Fam Physician. 2004;69(8):1915-26.
Jignasha Parmar J, Desai D. Study of endometrial pathology in abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2013;2(2):182-5.
Radhika G, Prayaga A. Abnormal uterine bleeding- utility of dilatation and curettage in identifying isolated endometrial pathology. J Evid Based Med Healthc. 2016;3(97):2349-562.
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.
Nayak AK, Hazra K, Manju KJ. Clinico-pathological evaluation of dysfunctional uterine bleeding. Int J Contemp Med Res. 2017;4(4):920-24.
Lotha L, Borah A. Clinicopathological evaluation of abnormal uterine bleeding in perimenopausal women. Int J Reprod Contracept Obstet Gynecol. 2016;5(9):3072-4.
Saraswathi D, Thanka J, Shalinee R, Aarthi R, Jaya V, Kumar PV. Study of Endometrial Pathology in Abnormal Uterine Bleeding. The Journal of Obstetrics and Gynecology of India. 2011; 61(4):426-30.
Abid M, Hashmi AA, Malik B, Haroon S, Faridi N, Edhi MM, et al. Clinical pattern and spectrum of endometrial pathologies in patients with abnormal uterine bleeding in Pakistan:
Malathi BG, Ashok M. Endometrial histopathology in abnormal uterine bleeding. IP Archives of Cytology and Histopathology Research. 2017; 2(4):70-4.
Gulia SP, Lavanya M, Chaudhury M, Kumar SPA. Study of endometrial pathology in cases of abnormal uterine bleeding A Meta-analysis of 435 cases. J Med Sc Tech; 2013;2(3):124-29.
Shah RJ, Dayal A, Kothari SL, Patel SM, Dalal B. Histopathological interpretation of endometrium in abnormal uterine bleeding. Int J Med Sci Public Health 2014;3(4):452-56.