Spectrum of Abnormal Uterine Bleeding: Clinical Pattern and Endometrial Pathology Aspects

Abstract

Abstract

Objective:

Abnormal uterine bleeding (AUB) is a common symptom for which women seek gynecologic consultations. This study was designed to analyze the endometrial pathologies in patients with AUB and to stratify the incidence of premalignant and malignant changes in these patients, according to their various age groups.

Materials and Methods:

One hundred and ninety-two women, who had AUB, with ages ranging from 23 to 75, underwent endometrial sampling from June 2014 to February 2017 at the All India Institute of Medical Sciences, in Rishikesh, Uttarakhand, India. Endometrial histopathology reports were analyzed.

Results:

The most common clinical presentation was heavy menstrual bleeding (67.2%), followed by irregular menstrual bleeding (28.9%), postmenopausal bleeding (14.5%), intermenstrual bleeding (9.9%), and shortened menstrual bleeding in 2.1%. Women in the perimenopausal-age group (40–50) represented 61.9% (n = 119) and reproductive-age women (23–39) represented 18.2% (n = 35) of the total women. A normal cycling pattern was most common (32.8%; n = 63), followed by disordered proliferative endometrium (28.1%; n = 54). Endometrial polyps were diagnosed in 10.9% (n = 21) of cases. The majority (66.7%) of the endometrial hyperplasia cases were in the perimenopausal-age group (10/15 cases). All of the cases of endometrial carcinoma (n = 3) were in women older than age 50.

Conclusions:

This study showed that the etiology of AUB changes with increasing age and the incidence of premalignant and malignant lesions progressively increase. A significant number of subjects showed underlying organic pathology, especially postmenopausal women, highlighting the importance of endometrial sampling in evaluation. Almost all cases of abnormal bleeding were due to benign causes. This study suggests the possibility of conservative therapy for most cases of abnormal menstrual bleeding. (J GYNECOL SURG 34:12)