scholarly journals Premenopausal abnormal uterine bleeding and risk of endometrial cancer

2016 ◽  
Vol 124 (3) ◽  
pp. 404-411 ◽  
Author(s):  
ME Pennant ◽  
R Mehta ◽  
P Moody ◽  
G Hackett ◽  
A Prentice ◽  
...  
Author(s):  
Bhavani L. Nair ◽  
Lency S. Kuriakose

Background: Abnormal uterine bleeding (AUB) is one of the common symptoms in the gynaecology outpatient department. About one third of women are affected at some time in their lives. The perimenopausal women show significant number of underlying organic pathology. The evaluation of endometrium and/or organ histopathology has the dual advantage of finding the cause of AUB and to rule out endometrial cancer or the potential for cancer in future like endometrial hyperplasia with atypia. The aim of the study was to determine the histopathological pattern of endometrial sampling in perimenopausal women with AUB and to follow them up for a period of six months after the procedure.Methods: The prospective observational study was conducted at the department of obstetrics and gynaecology at Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, Kerala, for a period of one year from December 2019 to December 2020. The study was conducted on 116 perimenopausal women 41-52 years who presented with AUB and had undergone endometrial sampling. These ladies were subsequently followed up for six months post procedure to assess the response to medical treatment or the need for any surgical intervention like hysterectomy.Results: A total 39.65% patients had heavy and prolonged menstrual bleeding and 18.16% patients had irregular bleeding. 14.65% patients had prolonged flow, 8.6% had heavy flow, 6.8% had infrequent with prolonged flow, 6% had prolonged, infrequent with heavy bleeding. Non-structural (COEIN) causes contributed to about 60.4% of AUB in perimenopausal women and 39.6% had structural (PALM) causes. 49% cases were secretory endometrium. 29.3% had disordered proliferative endometrium, 4.3% had proliferative endometrium, 5.2% each had polyp or hyperplasia without atypia. 18 (15.5%) cases underwent hysterectomy, 3 patients who had adenocarcinoma underwent staging laparotomy, 2 patients had LNG IUS insertion and 40 patients were on follow up requiring either no treatment and 53 (45.68%) patients were given antifibrinolytics or hormonal therapy.Conclusions: Heavy and prolonged menstrual bleeding was the most common presenting symptom. COEIN contributed to about 60.4% of cases. Evaluation of the endometrium showed that, secretory endometrium was commonest (49%) followed by disordered proliferative endometrium (29.3%). On follow up for six months, 15.5% patients underwent hysterectomy, 2 patients had insertion of levonorgestrel IUD, 45.68% patients had medical management with antifibrinolytics or hormones and were on follow up. The responsibility of gynaecologist in the management of AUB in perimenopausal women is to exclude hyperplasia of endometrium and endometrial cancer.


Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 884
Author(s):  
Chiara Belcaro ◽  
Federica Scrimin ◽  
Alessandro Mangogna ◽  
Emanuele Filippo Galati ◽  
Stefania Biffi ◽  
...  

Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system’s resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (n = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination.


2004 ◽  
Vol 85 (2) ◽  
pp. 145-150 ◽  
Author(s):  
T. Kimura ◽  
S. Kamiura ◽  
T. Yamamoto ◽  
H. Seino-Noda ◽  
H. Ohira ◽  
...  

Author(s):  
Kumarasamy Akalyaa ◽  
Pattacheravanda Nanaiah Shakuntala ◽  
Ramaiah Renuka

Background: As the rate of obesity is increasing in women in the recent years, the incidence of endometrial cancer increases as the body mass index (BMI) increases. Despite the clear evidence linking endometrial cancer and obesity, there is limited public awareness of this relationship. This study was undertaken to evaluate the association of BMI and endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB).Methods: An analytical case control study was conducted in 100 women between the age group of 40 to 55, with AUB in the Department of Obstetrics and Gynecology, ESIC-PGIMSR Bangalore between January 2018 and June 2019. The menstrual patterns and endometrial pattern by histopathology were analysed in women with BMI of 18.5 to 24.99 and ≥25.Results: The mean age of women participated in the study group of between 40- 55 years was 44.83. The mean duration of symptoms was 10.18 months in the cases group and 8.52 months in the control group. The menstrual patterns were comparable and there was no significant difference in both the groups. The mean endometrial thickness, mean BMI, hyperplasia with or without atypia were all higher in the cases group. The frequency of occurrence of atypical endometrial hyperplasia was higher in women with increasing BMI.Conclusions: We found increased BMI to be an important independent risk factor for the development of endometrial hyperplasia with atypia which is a precursor to endometrial carcinoma in premenopausal women with AUB. 


GYNECOLOGY ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 37-43
Author(s):  
Anna E. Protasova ◽  
Irina A. Solntseva ◽  
Ekaterina N. Vandeeva

The article provides an overview of the possible causes of bleeding from the genital tract in peri- and postmenopausal women. The correct approach to patients with abnormal uterine bleeding during menopausal hormone therapy is described. A modern analysis of data on the diagnosis and treatment of postmenopausal vaginal bleeding against the background of menopausal hormone therapy was carried out. The modern possibilities of endometrial diagnostics and treatment are shown.


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