Sonographic and histopathological correlation and evaluation of endometrium in perimenopausal women with abnormal uterine bleeding
Keywords:
Abnormal uterine bleeding, Histopathological examination, Transvaginal sonography, Menorrhagia, Endometrial thickness, Dilatation and curettageAbstract
Background: Abnormal Uterine Bleeding (AUB) in perimenopausal women accounts for about 70% of gynaecologic Outpatient Department visits. This assumes significance in view of the fact that AUB in this age group may be the only clinical sign of endometrial cancer. Objective of current study was to study the various types of menstrual abnormalities prevalent in perimenopausal women and to correlate the transvaginal ultrasonographic (TVUS) findings of endometrial thickness and pattern with the histopathological examination (HPE) of the Endometrium.
Methods: Retrospective study was carried out on 88 women in the perimenopausal age group (40 to 51 years). All the women were clinically evaluated. TVUS study of endometrial pattern and thickness was done followed by Dilatation and Curettage (D&C) and HPE of the endometrial curettings.
Results: From the sample set, 40% belonged to the age group of 48 to 51 years and 46.5% patients presented with menstrual complaints of menorrhagia, which accounts for the most common menstrual complaint. 70.5% of the patients in the study group were para 2 or less. Fibroid uterus was the commonest uterine pathology detected in 55.7% of the patients. 46.5% of patients had endometrial thickness in the range 5 to 9.9 mm. Most common finding on HPE was proliferative endometrium. 4.5% of cases revealed endometrial malignancy.
Conclusions: In perimenopausal women with AUB, TVUS should be the investigation of choice due to its convenience, accuracy and non-invasiveness. In patients with hyperplastic endometrium and/ or endometrial thickness greater than 8 mm, a histopathological study of the endometrium is warranted to rule out atypical changes or endometrial malignancy.
Metrics
References
Soules MR, Sherman S, Parrott E. Stages of reproductive aging workshop (STRAW). J. Womens Health, Gender Based Med. 2001;10:843¬¬-8.
Awwad JT, Toth TL, Schiff I. Abnormal uterine bleeding in the perimenopause. Int J Fertil. and Menopausal Stud. 1993;38(5):261-9.
Speroff L, Fritz MA. Menopause and the perimenopausal transition, clinical endocrinology. In: Speroff L, Fritz MA, eds. Clinical gynecologic endocrinology and infertility. 7th ed. Philadelphia, London: Lippincott Williams & Wilkins; 2005: 628.
Grimes DA. Diagnostic dilatation and curettage: a reappraisal. Am J Obstet Gynecol. 1982;142(1):1-6.
Goldstein SR. The endometrial echo revisited: have we created a monster? Am J Obstet Gynecol. 2004;191:1092-6.
Albert JR, Hull SK, Wesley RM. Abnormal uterine bleeding. Am Fam Phys. 2004;69:1915-26.
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.
Acharya V, Mehta S, Rander A. Evaluation of dysfunctional uterine bleeding by TVS, hysteroscopy and histopathology. J Obstet Gynecol India. 2003;53:170-7.
Aliya Aslam, Gazala. Role of TVS in cases of abnormal uterine bleeding. Profesional Med J. 2009;(16)1:127-34.
Machado LS, Mathew M, Al-Hassani A, Vaclavinkova V. Correlation of endometrial thickness, cycle day and histopathology in women with abnormal uterine bleeding. Saudi Med J. 2005;26(2):260-3.
American Cancer Society. The role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. ACOG Committee Opinion No. 440. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2009;114:409-11.
Getpook C., Wattanakumtornkul S. Endometrial thickness screening in premenopausal women with abnormal uterine bleeding. Journal of Obstetrics and Gynaecology Research. 2006;32:588-92.
Parihar Mandakini, Parihar Anand. Peri- and postmenopausal uterine bleeding transvaginal ultrasound with hysterosonography and diagnostic correlation with hysteroscopy. Donald School Journal of Ultrasound in Obstetrics & Gynecology. 2012;5(4):343-52.
Kurman RJ, Norris HJ. Endometrial hyperplasia and related cellular changes. Blaustein’s pathology of female genital tract. In: Wilkinson E, eds. Atlas of Tumor Pathology. Tumors of the Cervix, Vagina and Vulva, Third Series. 4th ed. New York, USA: Silverberg publication; 1994: 411-437.
Archana B, Michelle F. Evaluation and histopathological correlation of abnormal uterine bleeding in perimenopausal women. J Bombay Hospital. 2010;52:69-72.
Doraiswami S, Johnson T, Rao S, Rajkumar A Vijayaraghavan J, Panicker V. Study of Endometrial Pathology in Abnormal Uterine Bleeding. J Obstet Gynaecol India. 2011 August;61(4):426-30.
Harmanli OH, Shunmugham S, Shen T, Houck CL, Chatwani AJ. The negative predictive value of inadequate endometrial biopsy in diagnosing endometrial neoplasia. J Obstet Gynecol Surg 2004;20(1):13-6.
