scholarly journals Abnormal Uterine Bleeding in Perimenopausal Age: Different causes and its relation with histopathology

2014 ◽  
Vol 13 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Nazlima Nargis ◽  
Iqbal Karim ◽  
Khondaker Bulbul Sarwar

Background: Abnormal uterine bleeding (AUB) is the most common reason for gynecological visits for perimenopausal bleeding and may account for more than 25% of all hysterectomies. Objective: This study was aimed to review the causes of abnormal uterine bleeding in perimenopausal women establishing the correlation with ultrasonographic and histopathological examinations. Study Method: This descriptive study was conducted in the department of gynecology and obstetrics, Ibn Sina Medical College, Dhaka during January to December 2012. Two hundred and eleven women were selected for this study, who admitted into the hospital with abnormal uterine bleeding in perimenopausal age. The clinical, ultrasonographic and histopathological findings of these women were evaluated in this study. Results: Menorrhagia was the major symptom (52.6%) irrespective of age and parity. All these women underwent D&C followed by either medical management or hysterectomy depending upon the diagnosis. The histopathological findings of endometrium were analyzed and confirmed as fibroid uterus (58.28%) and DUB (17.58%) correlated well with transvaginal sonography (TVS) and histopathological examination. Hysterectomy conferred other uterine lesions as adenomyosis (18.71%), endometrial polyp (4.81%) and malignancy (1.06%). Conclusion: Abnormal uterine bleeding in perimenopausal age group is a common but ill-defined entity which needs proper evaluation. Accurate diagnosis of the causative factors of AUB in this age group is of utmost importance so that appropriate management can be established early that leads the minimization of the patients’ sufferings. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18295 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.135-139

Author(s):  
Indu Rajagopal ◽  
Beena Mary Thomas ◽  
Vidyadhar N.K. Rama Rao

Background: Abnormal uterine bleeding (AUB) is a common presenting symptom in gynecological outpatient department. Endometrial sampling could be used as the first diagnostic step in AUB. Aim of our study was to evaluate the endometrial causes of AUB and to observe the incidence of various pathology in different age groups.Methods: A study was conducted on 167 patients who presented with AUB, during the period from July 2015- January 2017.All endometrial curettage and hysterectomy specimens received in the Department of Pathology, Kannur Medical College during  this  period  were included.Results: Maximum numbers of patients were in the perimenopausal age group and normal cycling endometrium was the commonest pattern observed (41.3%).Abnormal patterns noted were hyperplasia without atypia (20.9%), disordered proliferative pattern (16.1%) and endometrial carcinoma (1.7%).Conclusion: Histopathological examination of endometrium showed wide spectrum of lesions from normal endometrium to malignancy. Accurate analysis of endometrial sampling is important in the management of AUB.


Author(s):  
Guntupalli R. Swathi ◽  
Madhu K. Nataraja ◽  
Shukla S. Shetty

Background: Abnormal uterine bleeding is the most common complaint in gynaecology and an important source of morbidity. The ideal diagnostic tool to determine the cause for the same continues to be debated. Objective of this study was to compare accuracy of hysteroscopy and transvaginal sonography in diagnosis of endometrial pathology in abnormal uterine bleeding.Methods: A total 100 women attending gynaecological outpatient in hospital attached to J. J. M. Medical College, Davangere with abnormal uterine bleeding fitting into the inclusion criteria during November 2014 to August 2016, were admitted and evaluated with Transvaginal sonography (TVS) and hysteroscopy. Data was collected and analysed.Results: Among 100 patients of AUB in this study, majority of the patients were in perimenopausal age group. Menorrhagia is the most common presentation (45%) followed by postmenopausal bleeding (20%). Anaemia was detected in 79% of patients. Hysteroscopy was taken as gold standard and TVS findings were compared. The sensitivity of TVS in detecting polyps, submucous fibroid were 22.2%, 11% respectively and for the normal variants like proliferative and secretory it was 50% and 79.2% respectively. TVS showed good correlation with hysteroscope findings for normal variants of endometrium, but poor correlation for intracavitary pathologies.Conclusions: Hysteroscopy is a rapid, safe, well tolerated and highly accurate means of diagnosing the cause of abnormal uterine bleeding in perimenopausal age group. Thus, it is advised as a first line investigation in evaluation of AUB.


2020 ◽  
Vol 5 (2) ◽  
pp. 1035-1039
Author(s):  
Neeta Kafle ◽  
Shilpi Shaukin ◽  
Santosh Upadhaya Kafle ◽  
Mrinalini Singh ◽  
Surya Bahadur Parajuli

Introduction: Abnormal uterine bleeding (AUB) is one of the commonest gynaecological problems. Etiology of AUB may be structural and functional and varies according to age group. Histological pattern of endometrial sampling along with clinical and radiological findings remains the diagnostic standard for clinical diagnosis of endometrial pathology which ultimately helps in deciding the management of the patients. Objectives: To determine histopathological pattern of endometrial biopsies in patients with AUB attending Birat Medical College Teaching Hospital. To determine the pattern of menstrual abnormality in patients with AUB in different age groups. Methodology: We conducted a prospective hospital based cross sectional study for a period of one year (1 April 2019 to March 31 2020). Histopathological findings of all endometrial biopsy samples in patients with AUB were examined. Patients were categorized into different age groups and the patterns of menstrual abnormality were also documented. Results: 166 patients presenting with AUB underwent endometrial biopsy. Most of them were of perimenopausal age group (42.77%). Menorrhagia was the most common presenting menstrual abnormality. Histopathological examination predominantly revealed normal cyclical endometrium. Hyperplasia was seen more frequently in patients > 40 years of age. Malignancy was diagnosed in 2.41%, all were adenocarcinoma and was seen in > 50 years age. Conclusion: AUB is a common gynaeco-pathological problem with varied clinical presentation and multiple causes. Functional endometrial changes account for the highest histological pattern. However hyperplasia and malignancy are important cause of AUB in perimenopausal and post menopausal age group's women.


Author(s):  
Sreelakshmi U. ◽  
Tushara Bindu V. ◽  
Subhashini T.

Background: Abnormal uterine bleeding is the most common and frequent presenting complaint in Gynaecology Outpatient Department in all age groups, especially in perimenopausal women. Objective of present study was clinicopathological evaluation and management of abnormal uterine bleeding in perimenopausal age group women.Methods: The present study was prospective analytical study conducted at Mallareddy Narayana Multi-speciality Hospital, reputed teaching hospital, in Obstetrics and gynaecology department in association with department of pathology from January 2015 to December 2016. Perimenopausal women in age group 45-55 years included in this study. Other age groups with abnormal uterine bleeding, isolated cervical or vaginal pathology, bleeding diathesis, and pregnancy related causes of bleeding excluded from this study. Endometrial tissue collected by sampling procedure such as dilatation and curettage. Proper counselling about management was given to all women related to medical and surgical interventional approaches.Results: A total of 135 women with abnormal uterine bleeding in perimenopausal age were examined after fulfilling criteria during study period of 2 years. The age of participants in mean±SD was 46.68±2.03 years (min 45 years and max 55 years). Maximum number of patients with abnormal uterine bleeding presented in age group of 45-50 years. The most common symptoms were heavy menstrual bleeding (83.7%), followed by frequent menstrual bleeding (26.6%). Proliferative endometrium was the most common histopathological (30.3%) study followed by secretory endometrium (27.4%). Surgical management was given to 94 patients.Conclusions: Heavy menstrual bleeding and frequent menstrual bleeding were mostly correlated with abnormal endometrial histopathological findings in this study. Gynaecologists should pay attention towards these abnormal bleeding patterns along with the evaluation of endometrial tissue for histopathological findings, which will help us to plan for successful management. 


Author(s):  
Neha Varun ◽  
Nidhi Gupta ◽  
Sana Khan

Background: Abnormal uterine bleeding (AUB) is one of the most commonly encountered gynecological problem and almost 33 % of women in gynecological outpatient department presented with abnormal uterine bleeding. Dilatation and curettage (D and C) have been the main diagnostic procedure in the evaluation of abnormal uterine bleeding patients for decades. The objective of the present study was to analyze the different types of endometrial histopathology of patients presented with the abnormal uterine bleeding and its correlation with the different types of abnormal uterine bleedingMethods: This is a retrospective study, conducted in a medical college in the Department of Obstetrics and Gynecology over a period of one year from June ’17 to June ’18. All cases of AUB more than 35 years of the age group who underwent D and C procedure were included in this study. Total 100 patients were analyzed.Results: Total 100 patients were analyzed. Age group ranges from 35-58 years and most common age group presenting with AUB was 35-39 years. The most common presenting complaint was menorrhagia 54% (54/100). Histopathology of endometrium showed non-organic causes in 80% (80/100) of AUB patients and the remaining 20% (20/100) had organic causes. Most common endometrial histopathology among non-organic causes was proliferative endometrium 43.75% (35/80) and the most common organic cause was endometrial polyp 40% (8/20). Endometrial hyperplasia was found in 30% (6/20) and endometrial carcinoma was found in 20% (4/20) of cases among organic causes.Conclusions: D and C is the useful and the cost-effective diagnostic procedure in the evaluation of AUB. Histopathological evaluation of endometrial samples is especially indicated in AUB patients to rule out carcinoma and preneoplastic conditions as histopathology is 100% diagnostic in cases of endometrial hyperplasia and carcinoma.


2021 ◽  
Vol 8 (12) ◽  
pp. 682-687
Author(s):  
Seema Pandey ◽  
Mamta Kumari ◽  
Amrita Chaurasia ◽  
Gyan Prakash

BACKGROUND Abnormal uterine bleeding is an important cause of morbidity in the female population, which can be attributed to several reasons. Trans-vaginal sonography and saline-infusion sonography are the mainstay of diagnosis and govern the further management of this condition. This study was conducted to evaluate the thickness and pattern of endometrium with transvaginal sonography and determine any abnormality in the uterine cavity which can be attributed to saline infusion sonography (SIS) in cases of abnormal uterine bleeding (AUB). METHODS The study was conducted among 122 women with complaints of abnormal uterine bleeding attending Outpatient Department and indoor cases of a tertiary care hospital over a period of twelve months. RESULTS The most common presenting complaint was heavy menstrual bleeding in 27.04 % cases. Maximum (44.26 %) cases had normal finding on transvaginal sonography; most common pathological finding was leiomyoma (22.31 %), and endometrial hyperplasia (15.5 %). More than one third (37.7 %) of patients had no abnormalities on saline infusion sonography; while 62.3 % had one or more pathologies; the most common lesion was fibroid in 25.4 % cases. Normal proliferative and secretary endometrium was found on histopathological examination in 50 % cases, while remaining half cases had one or more pathology, most common pathology detected was endometrial hyperplasia in 25.4 % cases. On trans-vaginal sonography (TVS), 11 cases of endometrial polyp were missed, which were detected after infusion of saline and confirmed by histopathological examination. The diagnostic indices of SIS were superior to TVS in diagnosis of any pathology. Sensitivity of TVS was 86.94 % and SIS was 91.94 %. Specificity of TVS (75.41 %) was greater than SIS (68.33 %). CONCLUSIONS TVS and SIS scanning techniques play a very important role in endometrial disorders in woman with AUB. KEYWORDS SIS, Transvaginal, AUB, Endometrium


Author(s):  
Malarvizhi Loganathan ◽  
Meera Krishnakumar

Background: This study was undertaken to study the endometrial histology in patients presenting with abnormal uterine bleeding in the absence of palpable pelvic pathology, which helps in choosing the right modality of treatment in a particular age group with a specific histological change. The study of endometrium in dysfunctional uterine bleeding was undertaken to correlate clinical presentations with histopathological studies and to correlate the distribution of histopathological findings in various age groups.Methods: The present study was conducted in the Department of Obstetrics and Gynaecology at Govt. Dharmapuri Medical College and Hospital during the period 01.07.2017 to 31.05.2018. Patients presenting to Govt. Dharmapuri Medical College and Hospital with abnormal uterine bleeding form the material of this study. Cases have been selected by using purposive sampling technique.Results: An ovulatory cycles were more common than ovulatory cycles in all age group. However, in patients with menorrhagia and polymenorrhagia majority had secretory endometrium (ovulatory cycles).Conclusions: Majority of the patients were found in the reproduction age group with the maximum percentage in multiparous women. Menorrhagia was the commonest mode of presentation in all age group. Most of the patients with proliferative and secretory endometrium had normal sized uterus and normal looking endometrium.


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.


2018 ◽  
Vol 3 (2) ◽  
pp. 423-426
Author(s):  
Sailesh Bahadur Pradhan ◽  
Mamata Sedhain ◽  
Sneh Acharya ◽  
Sailuja Maharjan ◽  
Samikchhya Regmi

Introduction: Uterus is subjected to many non-neoplastic and neoplastic diseases. Hysterectomy is the commonest gynecological surgery done for the management of the pathologies of the female reproductive system. Histopathological examination of hysterectomy specimens is done routinely which has both diagnostic and therapeutic significance.Objective: To study the common pathologies identified in hysterectomy specimens and to correlate them with the clinical findings.Methodology: A cross sectional study was carried out among all the hysterectomy specimens irrespective of primary lesion sent for histopathological examination from January 2016 to December 2017 in Department of Pathology, Kathmandu Medical College Teaching Hospital (KMCTH). Relevant history was taken from the requisition form. Ethical clearance was obtained from the Institutional Review Committee of KMCTH.Results: A total of 198 cases were studied. The most common pathology encountered was leiomyoma (60.0%) followed by adenomyosis (14.0%). Atrophic endometrium was seen in 24.3% cases. Chronic cervicitis was found in most of the cases (96.5%) along with endocervical polyp in 8.1% cases. Leiomyoma was found to be the most common indication for hysterectomy comprising 48.0% followed by abnormal uterine bleeding (24.75%) and utero-vaginal prolapse (18.25%). Hysterectomy was most commonly performed in the age group of 41 - 50 years and total abdominal hysterectomy with bilateral salpingo-oophorectomy was found to be the commonest procedure done comprising 8 0.0%.Conclusion: Leiomyoma was found to be the most common pathology in myometrium and chronic cervicitis in cervix. Abnormal uterine bleeding and vaginal prolapsed were also found to be common. Lesions which can be managed conservatively do need hysterectomy or not, is a matter of great concern. BJHS 2018;3(2)6:423-426.


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.


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