scholarly journals Study of endometrial pathology in women with abnormal uterine bleeding

Author(s):  
Jessy Varghese ◽  
Jeyashambavi J. ◽  
Deepa S.

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.

Author(s):  
Ushadevi Gopalan ◽  
Sathiyakala Rajendiran ◽  
Karnaboopathy Ranganathan

Background: Abnormal uterine bleeding is a major gynaecological problem accounting for 33% of Gynaec outpatients. The cause of the bleeding is established in only 50-60% of the cases. The aim of this study was to evaluate the various histopathological patterns in the endometrial biopsy of patients presenting with abnormal uterine bleeding and to determine the specific pathology in the different age groups.Methods: This was a prospective study done in a tertiary care teaching hospital for a period of 2 years. Total of 905 patients with abnormal uterine bleeding were included in the study and they were subjected to a Dilatation and Curettage. Histopathological examination of the endometrial biopsy was done and the various histopathological patterns identified and classified.Results: The age of patients ranged from 24-74 years. 54.7% were in the age group 40-49 years followed by 23.4% in the age group 30-39 years. The most frequent findings were proliferative findings in 47.3% followed by secretory endometrium in 16.1 % patients. Proliferative endometrium was more common in the age group 40-49 years as also disordered proliferation, secretory endometrium, cystoglandular hyperplasia and endometrial hyperplasia.Conclusions: Endometrial curettings and biopsy is an important diagnostic procedure for assessing all cases of abnormal uterine bleeding and to plan for successful management.


Author(s):  
Smriti S. Dwivedi ◽  
Malay Bajpai ◽  
Indu Bhushan ◽  
Arunima Satkirti

Background: Abnormal uterine bleeding is one of the common gynecological complaints of women of all age groups. Histopathological study of endometrial biopsy and curettage samples is an effective diagnostic modality that can be used to identify cause of AUB at its earliest. This study was done to investigate the various endometrial causes of AUB that frequently come to our hospital and their incidence in various age groups i.e. reproductive, perimenopausal and postmenopausal.Methods: This study was conducted on 108 patients who clinically presented with AUB and had their endometrial biopsy and curettage specimens sent to the histopathology department of our tertiary care hospital and teaching centre, located in Uttar Pradesh from June 2018 to May 2019. The endometrial patterns were observed, and their frequencies and percentages were computed and classified age group wise.Results: These studies included patients with age range from 19 to 77 years. The predominant age group with AUB was reproductive age group (<40 years). The most common histopathological finding in this study was normal menstrual pattern (48.15 %). The endometrial pathologies observed were hormonal imbalance and pill effect (22.22%), atrophic endometrium (10.19%), chronic endometritis (5.56%), benign endometrial polyp (4.63%), gestation products (3.70%), endometrial hyperplasia (3.70%), and endometrial carcinoma (1.85%). Conclusion: The most commonly known cause of AUB in reproductive age group is due to hormonal imbalance. Endometrial hyperplasia and carcinoma are usually more common in the perimenopausal and postmenopausal age groups. Overall, in patients with no organic cause of AUB, normal cyclical endometrial pattern is the most prevalent endometrial pattern observed.Conclusions: The most commonly known cause of AUB in reproductive age group is due to hormonal imbalance. Endometrial hyperplasia and carcinoma are usually more common in the perimenopausal and postmenopausal age groups. Overall, in patients with no organic cause of AUB, normal cyclical endometrial pattern is the most prevalent endometrial pattern observed.


2014 ◽  
Vol 4 (8) ◽  
pp. 635-638
Author(s):  
N Katuwal ◽  
G Gurung ◽  
A Rana ◽  
A Jha

Background: Dysfunctional uterine bleeding is a form of abnormal uterine bleeding when there is absence of organic disease of the genital tract. The objective of this study was to find out the clinical and pathological aspect of women presenting with dysfunctional uterine bleeding.Materials and Methods: A descriptive study was conducted over a period of one year from April 14th 2010 to April 13th 2011 in the Department of Obstetrics and Gynaecology and Department of Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. A complete history, clinical examination, pelvic scan, hormonal status if required and endometrial biopsy were done to diagnose dysfunctional uterine bleeding.Results: A total of 120 cases were included. The age of the patients diagnosed dysfunctional uterine bleeding were ranging from 24 -63 years. Dysfunctional uterine bleeding was most common in the age group 40-44 yrs (30%) followed by 45-49 yrs (27.5%). Menorrhagia (41.7%) was the most common presenting sign. Majority histopathology of endometrium revealed anovulatory pattern (61.7%) followed by ovulatory (38.3%). Of the cases with an anovulatory pattern 48.6% was proliferative endometrium, 33.8% disordered proliferative endometrium, 6.8%atrophic, 5.4% weakly proliferative and 2.7% each of simple hyperplasia without atypia and complex hyperplasia with atypia. All cases with ovulatory pattern showed secretory endometrium.Conclusion: Dysfunctional uterine bleeding was the most common in the perimenopausal age group and chiefly in the form of an anovulatory endometrium. . Histopathological evaluation of endometrium helps exclude the local causes and establishes the diagnosis of dysfunctional uterine bleeding, its types, and clinical correlation to histopathological findings and finally helps to determine the mode of management.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11500 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 635-638


2019 ◽  
Vol 17 (2) ◽  
pp. 52-54
Author(s):  
Durga BC ◽  
Nirmala Sharma

Abnormal uterine bleeding is the third most common clinical presentation in gynecology OPD. Histopathological evaluation of the endometrial tissue plays a significant role in diagnosis and management of Abnormal Uterine Bleeding. Aim: To find out cause of abnormal uterine bleeding with the help of histopathological report of endometrial biopsy. Methodology: This is retrospective observational study done at NGMC from ( 1st June 2018 to -30th June 2019) of 100 patients endometrial biopsy sent for histopathological evaluation and diagnosis reports were correlated with age and bleeding pattern and patients were managed accordingly. Result: A total of 100 endometrial specimens submitted with clinical diagnosis of Abnormal Uterine Bleeding were studied. Patients age group ranged from 18 – 65 yrs and most of them were seen in the age group of 41–50 yrs (43%).The commonest complaint was menorrhagia i.e. 48% .The commonest endometrial pattern observed in the study was, proliferative phase endometrium (38%). Conclusion: Endometrial biopsy is one of the most useful diagnostic tools to find out cause of uterine bleeding in AUB cases and also helps in management of AUB patient.  


Author(s):  
Anitha S. ◽  
Pooja G. ◽  
Sowmya D.

Background: Abnormal uterine bleeding (AUB) is the commonest presenting symptom in gynaecology out- patient department. Endometrial sampling could be effectively used as the first diagnostic step in AUB. This study was done to evaluate histopathology of endometrium for identifying the endometrial causes of AUB. And also, to observe the incidence of various endometrial pathology in different age groups presenting with abnormal uterine bleeding.Methods: A one-year prospective study conducted in the department of obstetrics and gynaecologist in A. J. institute of medical sciences and research centre which included 200 cases of clinically diagnosed AUB patients. Histopathological examination of endometrial biopsies specimens was done, followed by clinical correlation.Results: The most common age group presenting with AUB was 41-50 years (43.84%). The commonest pattern in these patients was normal cycling endometrium (42.32%). The commonest pathology irrespective of the age group was disordered proliferative pattern (26.15%). Other causes identified atrophic endometrium (11.5%), benign endometrial polyp (5.38%), endometrial hyperplasia (5.41%), carcinomas (0.79%) and chronic endometritis (1.54%).Conclusions: The knowledge of endometrial pattern in a case of AUB helps to decide a plan of management. Endometrial sampling plays a very important role in management of AUB, especially in the age group of more than 40 years; i.e., the peri and post-menopausal age groups, where incidence of malignant or pre malignant conditions was noted to be the highest.


Author(s):  
Zothansangi . ◽  
Vanremmawii . ◽  
Naveen P.

Background: Abnormal uterine bleeding (AUB) is one of the commonest complaints in the gynecology OPD. It is also one of the most common reason for hysterectomy among Mizo women. Endometrial biopsy is a gold standard and first step for diagnosis of AUB in a low resource setting like the North-east states of India. The aim of the study was to evaluate the histopathology of endometrium for proper management of AUB cases.Methods: This was a prospective study done to evaluate the histopathology of all the cases of AUB who attended gynaecology OPD, from the year 2018 to 2020. This study comprised of 668 AUB cases and material of the study was endometrial tissue of the cases of Abnormal uterine bleeding collected by dilatation and curettage, and sent for histopathological study to the department of pathology.Results: Most of the abnormal uterine bleeding patients was in the age group of 40 to 49 years, and the most common histopathological finding was proliferative endometrium, 35.5% followed by disordered proliferation, 21%. 14 cases of carcinoma endometrium were found among the age group above 40 years.Conclusions: The research evident that all the women above 40 years old need to undergo screening, keeping in mind the higher risk of carcinoma in the older age group of women.


Author(s):  
Simridhi Bindroo ◽  
Monika Garg ◽  
Tajinder Kaur

Background: Abnormal uterine bleeding (AUB) interferes with the quality of life of an otherwise healthy woman. Until the pathology underlying menorrhagia is, accurately diagnosed, proper therapy is hardly possible. The objective of the study was to analyze different histopathological patterns of endometrium in AUB and observe the incidence of various pathologies in different age groups and their relation to parity.Methods: This two-year prospective studywas done in the department of pathology in atertiary care centre, which included 250 cases of clinically diagnosed AUB patients were evaluated. Histopathological examination of endometrial biopsies and hysterectomy specimens were done, followed by clinical correlation.Results: Out of 250 cases of AUB, Premenopausal bleeding was seen in 216 cases (86.4%) and 34 cases (13.6%) had postmenopausal bleeding. The commonest finding observed in the study was proliferative phase endometrium (37.2%), followed by secretory endometrium (34%) and endometrial hyperplasia (16%). Disordered proliferative endometrium was seen in 2.4% of patients. Endometrial carcinoma was seen in 4 (1.6%) cases. Endometrial hyperplasia was seen mostly in the age group 41-50 years (27 cases). Two cases of endometrial carcinomas were presented after age 60 years.Conclusions: Our study revealed the highest incidence of AUB in the perimenopausal age group (41-50 years). Hence a thorough histopathological workup and clinical correlation are mandatory in cases of abnormal uterine bleeding.


Author(s):  
Ela Jha ◽  
Arun Kumar Jha ◽  
Annie Samuel

Background: Abnormal uterine bleeding constitutes a significant proportion of cases attending gynaecology outpatient department. It affects woman’s physical, emotional, social and maternal well-being, and hence it demands adequate management. It is a multifactorial entity; presented in various patterns, signs and symptoms. The PALM COEIN classification is the most recent method of categorizing AUB (abnormal uterine bleeding) based on structural and non-structural causes. The treatment of AUB depends on age, parity, symptom severity, investigation findings and cause. Various invasive and non-invasive investigations including USG, endometrial biopsy and hysteroscopy helps find different causes. Whatever be the etiology endometrium gets affected; hence AUB is likely managed through hormonal preparations, LNG-IUS, endometrium ablation/resection and ultimately hysterectomy as the last resort.Methods: A retrospective study comprising 216 patients in the age group of 30-50 years with complaints of AUB were recorded as per a structured proforma at department of obstetrics and gynaecology, MGM MCH over a period of one year (January 2018-19). The results of investigations, ultrasound scans, endometrial biopsy and histopathology of hysterectomised specimens were correlated. The endometrial biopsy and histopathology of the specimens was done at department of pathology, MGM MCH.Results: The most common age group showing AUB lies under 35-40 years (40.2%) and 40-45 years (33.7%). Menorrhagia was found to be the most common symptom (66.2%). As per PALM COEIN classification, the most common type in our study was of AUB-L (33.7%) and the associated histopathological pattern was of secretory type (50.4%).Conclusions: The features and patterns of AUB differ according to the age of patient, affecting mostly women in perimenopausal and late reproductive age group. There are various modalities for its diagnosis and management and PALM COEIN classification helps better understand the disease etiology.


2014 ◽  
Vol 1 (2) ◽  
pp. 75 ◽  
Author(s):  
Kairavi Desai ◽  
Kiran Patole ◽  
Manasi Kathaley

<p><strong>Introduction:</strong> Abnormal Uterine Bleeding (AUB) is an important symptom of both benign and serious gynaecological diseases. Abnormal perimenopausal or postmenopausal bleeding is associated with endometrial carcinoma in approximately 10% of cases. The present study is designed to study the histopathological results of the endometrial biopsy in women with abnormal perimenopausal and postmenopausal uterine bleeding.</p><p><strong>Aims and Objectives:</strong> To study, the various histopathological patterns of endometrium, in patients with abnormal uterine bleeding, those are in perimenopausal and postmenopausal age group.<br /><br /> <strong>Materials and Methods:</strong> In all 100 patients were selected for the study after satisfying the specific inclusion and exclusion criteria. They underwent detailed history taking including the pattern of bleeding associated with general, systemic, and pelvic examination. They were subjected to routine laboratory investigations and pelvic ultrasound examination. Endometrial biopsy was done irrespective of endometrial thickness. Endometrial biopsy was done in OPD without anaesthesia. Biopsy was performed using a manual vacuum aspiration syringe, and the material collected was sent for histopathological examination. Endometrium was also obtained from patients undergoing diagnostic or therapeutic dilatation and curettage. Analysis of Histopathology report was done and results were obtained. Results: Most predominant findings of histopathological examination were the … •Proliferative Endometrium in 29% •Simple hyperplasia without atypia 28% •Secretory 20% •Followed by other patterns</p><p><strong>Conclusion:</strong> Study of endometrial histopathology in perimenopausal and postmenopausal women with abnormal uterine bleeding is helpful to diagnose hyperplasia and carcinoma of endometrium.</p>


2020 ◽  
Vol 18 (2) ◽  
pp. 248-252
Author(s):  
Sadikchha Chapagain ◽  
Ganesh Dangal

Background: Abnormal uterine bleeding is defined as any bleeding outside of normal menstruation pattern with excessive duration, frequency, and amount and it is a common problem among women of reproductive age group with varied presentations. The aim of the study was to correlate the histopathological finding in patients with abnormal dysfunctional uterine bleeding with the presenting clinical feature.Methods: A prospective cross sectional study was carried out at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu during the period of one year (February 2019 to January 2020). It included 77 perimenopausal women with abnormal uterine bleeding who presented in gynecology outpatient department and planned for dilatation and curettage. Then the participants were counselled and informed consent was taken. Histopathological reports reviewed and analysis done. Results: The most common age group of women presenting with abnormal uterine bleeding was 40 to 44 years and the commonest clinical feature was menorrhagia (31/77, 40.3%) followed by menometrorrhagia (18/77, 23.4%). Majority of women were multiparous, parity 3 to 4 (38/77, 49.4%). Proliferative endometrium (29/77, 37.7%) was most common histopathological findings followed by secretory endometrium (24/77, 31.2%). Proliferative endometrium was more commonly associated with menorrhagia and menometrorrhagia whereas secretory endometrium with metrorrhagia (P-value 0.000).Conclusions: Menorrhagia and Menometrorrhagia are the most common clinical presentation among perimenopausal women with AUB, whereas proliferative endometrium and secretory endometrium were the common histopathological findings respectively.Accurate diagnosis is crucial for a selection of relevant treatment and avoidance of unnecessary major surgical procedure. Keywords: Abnormal uterine bleeding; endometrium; histopathology; perimenopausal.


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