Clinical pattern and spectrum of endometrial pathologies in patients with abnormal uterine bleeding in Pakistan: need to adopt a more conservative approach to treatment

Abstract

BackgroundAbnormal uterine bleeding (AUB) is one of the most common debilitating menstrual problems and has remained one of the most frequent indications for hysterectomy in developing countries. Approximately in 40% of hysterectomy specimens, no definite organic pathology could be established. The problem is common worldwide but causes may vary from one region to another. This study may help gynecologists in our population to improve their therapeutic strategies by promoting minimally invasive uterus sparing modalities such as endometrial ablation and hysteroscopic resection of early proliferative lesions.MethodsIt was a prospective, cross-sectional study conducted at Liaquat National Hospital from 15th January 2010 till 14th July 2011 over a period of 18 months. Women who underwent dilatation and curettage for endometrial sampling with complaints of AUB were included in the study and histopathologic spectrum was determined.ResultsPolymenorrhea was the most common presenting pattern (30%, 72/241) with reproductive age women being the most susceptible (49.3%,119/241). The commonest histopathological spectrum was normal menstrual pattern (34%, 82/241) and the commonest pathology was hormonal imbalance (27%, 65/241), followed by endometrial polyp (14%, 34/241), chronic endometritis (12%, 28/241), atrophic endometrium (6%, 15/241), endometrial hyperplasia (5%, 12/241), and endometrial carcinoma (2%, 5/241). Chronic endometritis was commonly seen in reproductive age (18%, 21/119); hormonal imbalance (45%, 35/77) and endometrial hyperplasia (6.5%, 5/77) in perimenopausal age; endometrial polyp (35.5%, 16/45) and endometrial carcinoma (9%, 4/45) in postmenopausal age.ConclusionFrequency of benign endometrial pathology is quite high in AUB, 236 participants (98%, 236/241). Histopathological spectrum in patients with AUB is quite variable with respect to age. The most common pattern of AUB was polymenorrhea. The most common pathology was hormonal imbalance. It is suggested that age was associated with more progressive lesions found in peri and postmenopausal age group such as endometrial hyperplasia and endometrial carcinoma. Yet endometrial polyp was the most common pathology found in postmenopausal women. Therefore, the management strategy should be individualized, as in most cases a restrictive approach is appropriate in order to avoid unnecessary hysterectomies.

Histopathological study of precursor and neoplastic lesions of endometrium in endometrial samplings

“…This was in concordance with other studies. 7,8 5.8% cases revealed malignant lesions, the clinical presentation in most of these cases was postmenopausal bleeding as revealed by other studies. 3,5 The malignant lesions included endometrial carcinoma (60%), carcinoma extending from cervix (30%) and carcinosarcoma (10%).…”

The role of Histopathology, Endometrium Thickness and Obstetric History in Abnormal Uterine Bleeding

“…Varying incidence of endometrial hyperplasia (EH) was reported in the literature. Mariam Abid reported 5%, Behnamfar et al 10% and Jyotsana 22.6% incidence of endometrial hyperplasia, [4,16,17 ]. In this study we reported the incidence of EH as 7.42% of total participants, 10% of postmenopausal women and 1.73% of women in the reproductive group.…”

“…TVUSG is an important diagnostic parameter in detecting structural causes of AUB such as fibroids, polyps, pelvic mass or endometrial hyperplasia [7]. Moreover, endometrial sampling for histopathological evaluation is needed especially in premenopausal or postmenopausal period for the differential diagnosis of AUB [3,4,9,10]. Nonstructural or dysfunctional uterine bleeding (DUB) due to hormonal irregularities are mainly seen in adolescents [5].…”

“…The correct diagnosis of the etiology of AUB is important to choose the correct treatment. Besides transvaginal ultrasonography, saline infusion sonohistography, hysteroscopy and coagulation tests, endometrial sampling and histopathological diagnosis are also necessary [3,4,9,10]. Endometrial sampling is especially required for women above 40 years of age in the evaluation process of AUB.…”

“…The incidence is 9-14% among reproductive women and it is responsible for 25% of gynecologic pathology [1][2][3][4]. AUB is classified as structural or non-structural (formerly called dysfunctional uterine bleeding) according to patient's history (severity, the incidence, the time and periodpre or postmenopausal), physical examination and imaging methods (ultrasonography, hysteroscopy or hydrosonography).…”