A Two Year Clinicopathological Study of Non - Gravid Women With Abnormal Uterine Bleeding in a Rural Tertiary Care Centre in Tamilnadu : In Concurrence With the Figo Recommendations

Abstract

CONTEXT: Abnormal uterine bleeding (AUB) is a very common symptom in gynecology practice which is associated with a plethora of pathologies. The new definitions, terminology and PALM-COEIN classification helps to standardize and streamline the causative factors of AUB. AIMS: To collect clinical and histopathology data based on the new terminologies and definitions for AUB, to stratify the causes of abnormal uterine bleeding based on the PALM-COEIN classification and to correlate the clinical and pathological features. MATERIALS AND METHODS: Medical records of all non-gravid women with AUB who underwent hysterectomy were collected from January 2014 to May 2015. Clinical details, coagulation profile, gross and microscopic findings of the hysterectomy histopathology samples were noted. Pregnant women and those who underwent procedures other than hysterectomy were excluded. The PALM-COEIN classification was used to categorize the causes of AUB. The data were analyzed and percentages of each category studied were calculated. RESULTS: A total of 174 cases were included in which 49% were in the 41-50 age groups. Heavy menstrual bleeding (HMB) was seen in 43.7% cases while 17.2% and 12.6% had irregular and frequent menstrual bleeding respectively. 53.4% had adenomyosis, 47.1% had leiomyoma, 17.2% had ovulatory disorders, 15% had polyps and 15% had endometrial hyperplasia/carcinoma. 48.9% of patients had a single pathology while 51.1% cases had several combinations of pathologies. CONCLUSION: The new standardized terminology, definitions and PALM-COEIN classification for AUB formulated by FIGO helps in uniform conduct of research and international comparison of data which was not possible earlier due to confusing terms. Maximum number of patients was in the 41-50 age groups. The most common clinical presentation was HMB. Adenomyosis was the most common pathology seen (AUB-A) followed by leiomyoma (AUB-L) and ovulatory disorders (AUB-O). Nearly half the patients had only a single pathology while the rest had multiple pathologies. In the latter, the precise cause of AUB could not be ascertained by histopathology alone. Further studies are required in this area.