Abnormal Uterine Bleeding in Perimenopausal Women: Relevance of Transvaginal Ultrasound, Office Endometrial Biopsy, Dilatation and Curettage—An Observational Study

Background: Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period (around 80 ml). Bleeding that occurs erratically or excessive menstrual bleeding is called abnormal uterine bleeding (AUB). The causes of AUB are many and varied. Initial investigations include transvaginal ultrasound and histopathologic assessment of the endometrium. Objective of this study was to evaluation of endometrial thickness with trans-vaginal ultrasound and its correlation with histopathology by dilatation and curettage in abnormal uterine bleeding. To determine the efficacy of transvaginal ultrasound in evaluating the endometrial thickness. To correlate the endometrial thickness by transvaginal ultrasound with endometrial histopathology in women with AUB.Methods: It is a retrospective observational study. All reproductive and perimenopausal age group women who underwent dilatation and curettage for abnormal uterine bleeding during the period June 2014-June 2016 was taken and analyzed and correlated with their endometrial thickness measured with Transvaginal ultrasound.Results: Around 478 patients who underwent endometrial sampling over a period of two years were analyzed. Maximum number of patients were in the fourth decade and the overweight category 36.6%. Proliferative endometrium was the most common histopathologic picture (44.76%). Detection of precancerous lesions were-5.87% and endometrial cancer was 1.05%.Conclusions: An ET of 8 mm and above gave 100% sensitivity and negative predictive value for precancerous and cancerous lesions.

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Study of endometrial histopathology in women with abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170442 ◽

2017 ◽

Vol 6 (3) ◽

pp. 824

Author(s):

Ushadevi Gopalan ◽

Sathiyakala Rajendiran ◽

Karnaboopathy Ranganathan

Keyword(s):

Histopathological Examination ◽

Tertiary Care ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Age Group ◽

Dilatation And Curettage ◽

Proliferative Endometrium ◽

A Prospective Study ◽

Secretory Endometrium

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.

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Evaluation of endometrial thickness with transvaginal ultrasonography in perimenopausal women presenting with abnormal uterine bleeding and correlation with its histopathological findings

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194882 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4496

Author(s):

Noor Ayesha Begum ◽

Lokesh Chandra H. C. ◽

Ravindra S. Pukale

Keyword(s):

Endometrial Thickness ◽

Uterine Cavity ◽

Invasive Procedure ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Transvaginal Ultrasonography ◽

Common Finding ◽

Histopathological Findings ◽

Perimenopausal Women

Background: Abnormal uterine bleeding is the most common presenting menstrual complaint in women of perimenopausal age group. Most frequently used diagnostics tests to investigate the causes of abnormal bleeding are Transvaginal ultrasonography (TVS) and endometrial biopsy. Uterine curettage is an invasive procedure and is performed with anaesthesia. TVS is a non-invasive method that has been used to evaluate the endometrium and uterine cavity. The objectives of this study were to measure and evaluate the role and accuracy of endometrial thickness by transvaginal ultrasonography study to detect endometrial pathology in perimenopausal women presenting with Abnormal Uterine Bleeding. To correlate the transvaginal sonographic results with the Histopathological findings to discriminate normal from pathological endometrium.Methods: Prospective study including 150 perimenopausal women with abnormal uterine bleeding. Endometrial thickness was measured by TVS and then D and C was performed for all the patients.Results: Out of 150 women, 128 (85.3%) had normal and 22 (15%) had an abnormal endometrium. 43.3% were of 41-45 years and 65.3% patients presented with complaint of heavy menstrual bleeding. Majority of the patients in the study group were para 2 or more. Fibroid uterus (24%) was the commonest uterine pathology detected on TVS. 53.3% of patients had endometrial thickness in the range 10-14.9 mm. Most common finding on HPE was secretory endometrium (44.6%). Endometrial carcinoma was found in 3%. Endometrial thickness <14mm was associated with least abnormal endometrial pathology.Conclusions: Endometrial thickness of less than 14 mm need not be indicated for D and C in perimenopausal abnormal uterine bleeding. In perimenopausal women with AUB, TVS should be the investigation of choice due to its convenience, accuracy and non- invasiveness.

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Investigation of abnormal uterine bleeding in perimenopausal women by hysteroscopy and endometrial biopsy

Gynecological Surgery ◽

10.1007/s10397-004-0076-2 ◽

2005 ◽

Vol 2 (1) ◽

pp. 51-55 ◽

Cited By ~ 3

Author(s):

I. Stamatellos ◽

P. Stamatopoulos ◽

D. Rousso ◽

E. Asimakopoulos ◽

C. Stamatopoulos ◽

...

Keyword(s):

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Perimenopausal Women

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A Comparison of Pipelle Endometrial Biopsy with Dilatation and Curettage for Evaluation of Endometrial Pathology in Abnormal Uterine Bleeding

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/222 ◽

2020 ◽

Vol 7 (21) ◽

pp. 1024-1028

Author(s):

Sunitha Mary Mathew

Keyword(s):

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Dilatation And Curettage ◽

Endometrial Pathology

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Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding

The Journal of South Asian Federation of Menopause Societies ◽

10.5005/jp-journals-10032-1120 ◽

2017 ◽

Vol 5 (2) ◽

pp. 123-128

Author(s):

Nikhitha Chandrashekar ◽

Jyothi GS ◽

Prasanna Shetty

Keyword(s):

Predictive Value ◽

Endometrial Hyperplasia ◽

Tertiary Care ◽

Abnormal Uterine Bleeding ◽

Endometrial Biopsy ◽

Uterine Bleeding ◽

Histopathological Analysis ◽

Care Hospital ◽

Dilatation And Curettage ◽

Risk Of Cancer

ABSTRACT Aim The objective of this study was to assess the adequacy of the sample aspirated in order to make a definite diagnosis of endometrial disease in abnormal uterine bleeding (AUB) and to draw comparisons between the histopathological findings of Pipelle endometrial aspiration biopsy and dilatation and curettage (D&C). Materials and methods Pipelle endometrial biopsy and D&C samples were collected from 100 patients with AUB in the Department of the Obstetrics and Gynecology and sent to the Department of Pathology of a tertiary care hospital for adequacy of the sample and for histopathological analysis. Results The Pipelle sample was adequate in 73% of the cases and inadequate in 27% compared with D&C, which showed 85% and 15%, respectively. About 53% of cases were comparable between D&C and Pipelle and 37% were discordant. For endometrial hyperplasia using Pipelle aspirator, the sensitivity was 58.8%, specificity was 91.6%, positive predictive value (PPV) was 58.8%, negative predictive value (NPV) was 91.6%, and concordance was 86%. For detection of endometrial carcinoma using Pipelle, the sensitivity was 50%, specificity was 99%, PPV was 50%, NPV was 99%, and concordance rate was 98%. Conclusion It is more convenient and cost-effective for patients to undergo pipelle biopsy to confirm normalcy and rule out endometrial hyperplasia rather than undergoing D&C initially. Out of the 27% of inadequate samples, 14.8% had fibroids and 11.1% had polyps, thus showing that tumors localized to a polyp or a small area of endometrium went undetected with Pipelle. Clinical significance Due to the high specificity and NPV and low sensitivity and PPV in diagnosing endometrial lesions and carcinomas, pipelle is suitable for women with a low risk of cancer. In cases where the diagnosis is hyperplasia on Pipelle, the patients are advised to undergo hysteroscopic-guided D&C following pipelle to confirm the diagnosis. This is also applicable for cases of polyps and fibroids. How to cite this article Chandrashekar N, Jyothi GS, Shetty P. Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc 2017;5(2):123-128.

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A prospective study of comparison between transvaginal sonogram and histopathological examination in perimenopausal women with abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194609 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4233

Author(s):

P. Rishma Priyanka ◽

C. Rama Mani ◽

A. Yamuna

Keyword(s):

Histopathological Examination ◽

Endometrial Thickness ◽

Uterine Cavity ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Transvaginal Sonography ◽

Main Concern ◽

Dilatation And Curettage ◽

Perimenopausal Women ◽

Histopathological Report

Background: Abnormal uterine bleeding is one of the most frequently encountered conditions in gynaecology practice and forms about 10% of all gynaecological admissions, the main concern in perimenopausal bleeding is that the bleeding could be the only external manifestation of many hidden serious pathologies of uterine-cavity. The objective of this study was to compare the results of transvaginal sonography (TVS) and drug and cosmetic (D and C) with histopathological examination (HPE) report of hysterectomy specimen in perimenopausal women with AUB.Methods: A prospective comparative study where 100 perimenopausal women with AUB were subjected to TVS then D and C and then the results were compared with histopathological report of the hysterectomized specimen.Results: With an endometrial thickness less than or equal to 15 mm the histopathology report is normal endometrium. When the endometrial thickness more than or equal to 15 mm the histopathology report is hyperplasia or carcinoma. Findings of TVS correlated well with histopathological report after hysterectomy. 14 cases of adenomyosis, 16 cases of myomatous polyp, and 6 cases of endometrial polyp missed by dilatation and curettage.Conclusions: TVS is a simple, non-invasive test to indirectly visualize the endometrial cavity and is useful as a first step diagnostic procedure in the evaluation of perimenopausal bleeding. Dilatation and curettage lags in detecting adenomyosis, endometrial and myomatous polyps, When TVS combined with dilatation and curettage, it can supplement the shortcomings of dilatation and curettage.

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Peri- and Postmenopausal Uterine Bleeding Transvaginal Ultrasound with Hysterosonography and Diagnostic Correlation with Hysteroscopy

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1212 ◽

2011 ◽

Vol 5 (4) ◽

pp. 343-352

Author(s):

Mandakini Parihar ◽

Anand Parihar

Keyword(s):

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Medical Science ◽

Abnormal Uterine Bleeding ◽

Final Diagnosis ◽

Uterine Bleeding ◽

Additional Information ◽

Final Treatment ◽

Perimenopausal Women ◽

Cystic Changes

ABSTRACT The recent years have seen medical science and technology expand by leaps and bounds. We have shifted focus from correction of the problem to prevention of the problem. Abnormal uterine bleeding is an important cause of ill health in perimenopausal women. In the perimenopausal years, there is an increase in the incidence of bleeding irregularities. This is because of an increase in the prevalence of benign and malignant uterine lesions. There has also been a significant increase in the number of women presenting with postmenopausal bleeding. At transvaginal ultrasonography (TVS), the finding of a thickened central endometrial complex, with or without cystic changes, is often nonspecific and may be caused by an endometrial polyp, submucosal fibroid, endometrial hyperplasia, carcinoma or cystic atrophy. In addition, because of an increased prevalence of adenomyosis or adenomyosis-like changes in women around this age group, proper transvaginal sonographic assessment of endometrial thickness and abnormalities is of utmost importance but maybe difficult in some women. When TVS cannot accurately measure the endometrial thickness or when there is a nonspecific thickened central endometrial complex, hysterosonography can provide additional information and can help in the diagnosis and final treatment. Hysterosonography, as an adjunct to TVS, allows identification of intracavitary lesions and focal and diffuse endometrial abnormalities and helps determine the abnormality. Final diagnosis confirmed by hysteroscopy. In this review, we discuss these common abnormalities and the correlation of TVS and hysterosonographic findings with hysteroscopic evaluation.

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VALUE OF ENDOMETRIAL THICKNESS MEASUREMENT FOR DIAGNOSING ENDOMETRIAL HYPERPLASIA IN PERIMENOPAUSAL WOMEN

10.36106/gjra/1603016 ◽

2020 ◽

pp. 1-3

Author(s):

Bishnu Prasad Das ◽

Chintumoni Gogoi

Keyword(s):

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Strong Association ◽

Abnormal Uterine Bleeding ◽

Thickness Measurement ◽

Endometrial Biopsy ◽

Transvaginal Sonography ◽

Dilatation And Curettage ◽

Perimenopausal Women ◽

Invasive Method

Objective- to determine the sonographic findings associated with endometrial hyperplasia (EH+) in perimenopausal women with abnormal uterine bleeding (AUB). Methods- a retrospective study, in which 150 subjects, perimenopausal women with AUB, underwent transvaginal sonography (TVS) and endometrial biopsy. The TVS findings were evaluated with regard to EH+. Result- Biopsy proven EH+ was seen in 18.67% of subjects. EH+ was not found in any patient with TVS showing endometrial thickness < 8 mm. Conclusion- There is a strong association between TVS endometrial thickness and endometrial biopsy findings. The risk of development of endometrial cancer is 29% in patients with complex atypical hyperplasia and 2% in patients with hyperplasia without atypia. Thus TVS should be in the first investigation in the management of AUB. Invasive method like dilatation and curettage (D&C) to be considered in cases with endometrial thickness > or = 8 mm.

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