Abnormal uterine bleeding in perimenopausal women: sonographic and histopathological correlation and evaluation of uterine endometrium


  • Rupali Modak Department of Obstetrics and Gynecology, R. G. Kar Medical College, Kolkata, West Bengal, India
  • Amitrajit Pal Department of Pharmacology, Grant Medical College, Mumbai, Maharashtra, India
  • Amitava Pal Department of Obstetrics and Gynecology, Burdwan Medical College, Purba Barddhaman, West Bengal, India
  • Kausik Bose Department of Pathology, Burdwan Medical College, Purba Barddhaman, West Bengal, India




Abnormal uterine bleeding, Endometrial thickness, Dilatation and curettage, Menorrhagia, Transvaginal sonography


Background: The objectives of the study was to establish the role of histopathological diagnosis of uterine endometrial lesions in patients of AUB at perimenopausal age and to correlate the transvaginal sonographic (TVS) finding with histopathological examination.

Methods: This prospective observational study was carried out over 1 and 1/2 years in the two apex level teaching hospitals in eastern India. A total of 197 women in the age group of 40-49 years and ≥50 years (up to 55 years) who presented with abnormal uterine bleeding were included in the study. After selecting the patient with eligibility criteria in the OPD, detailed clinical history, systemic and gynecological examinations and investigations were done as per proforma. TVS study of endometrial pattern and thickness was measured followed by dilatation and curettage (D and C) and HPE of the endometrial curetting was done.

Results: Menorrhagia (44.67%) was the most common clinical finding. Mean endometrial thickness measured by TVS was 7.04±2.11 mm in proliferative phase and 10.25±1.27 mm in the secretory phase. Proliferative endometrium (37.06%) was the most frequent finding in HPE followed by secretory endometrium (20.3%). Hyperplasia of endometrium was noted in 27 cases (100%) at 12-15 mm of endometrial thickness on TVS whereas endometrial hyperplasia with and without atypia and endometrial carcinoma was noted in 25 cases (92.59%) at the same thickness of 12-15 mm of uterine endometrium on HPE. Endometrial hyperplasia and polyp both had sensitivity of 84.21% and 71.43% respectively on TVS as compared with histopathology.

Conclusions: Increased endometrial thickness and echo pattern by TVS correlated well with abnormal endometrial tissue histopathology in perimenopausal women with AUB.


Soules MR, Sherman S, Parrott E. Stages of reproductive aging workshop (STRAW). J Womens Health Gender Based Med. 2001;10:843-8.

Awwad T, Toth TL, Schiff I. Abnormal uterine bleeding in the perimenopause. Int. J Fertil 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 and Wilkins; 2005:628.

Oriel KA, Schrager S. Abnormal uterine bleeding. Am Fam Phys Discus. 1999;60(5):1371-80.

Fraser IS, Langham S, Uhi-Hochgraeber K. Health related quality of life and economic burden of abnormal uterine bleeding. Expert Rev Obstet Gynecol. 2009;4(2):179-89.

Pillai SS. Sonographic and histological correlation and evaluation of endometrium in perimenopausal women with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2014;3:113-7.

Munro MG, Critchley HO, Fraser IS, FIGO menstrual disorder working group. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril. 2011;95(7):2204-8.

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

Jetley S, Rama S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle aged women with atypical uterine bleeding- a study of 219 cases. Midlife Health. 2013;4:216-20.

Thulasi P, Balakrishnan R, Shanthi M. Correlation of endometrial thickness by transvaginal sonography and histopathology in women with abnormal peri- menopausal and postmenopausal bleeding - A prospective study. Indian J Obstet Gynecol Res. 2018;5:44-8.

Najeeb R, Awan AS, Bakhtiar U, Akhtar S. Role of transvaginal sonography in assessment of abnormal uterine bleeding in perimenopausal agegroup. J Ayub Med Coll Abbottabad. 2010;22(1):87-90

Acharya V, Mehta S, Rander A. Evaluation of dysfunctional uterine bleeding by TVS, hysteroscopy and histopathology. J Obstet Gynecol India. 2003;53:170-7.

Gazala AA. Role of TVS in case of abnormal uterine bleeding. Prof Med J. 2009;1:127-34.

Singh M, Sachan R, Yadav A. Significance of endometrial thickness on transvaginal sonography in heavy menstrual bleeding. J Curr Sci Med. 2019;5:28-32.

Sharma J, Dhiman B, Sud N, Kaushik A. Synergistic approach in diagnosing endometrial disease in women with postmenopausal bleeding. Int J Reprod Contracept Obstet Gynecol. 2017;6:4081-89.

Epstein E, Ramirez A, Skoog L, Valentin L. Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding. Acta Obstet Gynecol Scand. 2001;80:1131-6.

Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol. 2003;188:401-8.

Bruchim I, Biron-Shental T, Altaras MM, Fishman A, Beyth Y, Tepper R, et al. Combination of endometrial thickness and time since menopause in predicting endometrial cancer in women with postmenopausal bleeding. J Clin Ultrasound. 2004;32(5):219-24.

Jain M, Chakroborty S. Evaluation of abnormal uterine bleeding with trans vaginal sonography. Int J Reprod Contracept Obstet Gynecol. 2017;6:2794-9.

Deshmukh V, Yelikar K, Devile M. Clinical study of endometrial pattern in dysfunctional uterine bleeding by transvaginal sonography and its histopathological correlation. J Evol Med Dent Sci. 2013;2:2440-5.

Choudhary J, Acharya V, Jain M. Evaluation of abnormal uterine bleeding with trans vaginal sonography and hysteroscopy in perimenopausal women, Int J Reprod Contracept Obstet Gynecol. 2017;6:3607-13.

Mukhopadhyay S, Bhattacharyya SK, Ganguly RP, Patra KK, Bhattacharya N, Barman SC. Comparative evaluation of perimenopausal abnormal uterine bleeding by transvaginal sonography, hysteroscopy and endometrial biopsy. J Indian Med Assoc. 2007;105:624-8.

Dasgupta S, Chakraborty B, Karim R, Aich RK, Mitra PK, Ghosh TK. Abnormal uterine bleeding in peri-menopausal age: diagnostic options and accuracy. J Obstet Gynaecol India. 2011;61(2):189-94.






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