Histopathological Evaluation of Abnormal Uterine Bleeding in Women of Reproductive and Perimenopausal Age Groups

 Abnormal uterine bleeding (AUB) occurs in up to 30% of the women and is a major cause of hysterectomies. It can result from a broad spectrum of conditions ranging from physiological process to malignant lesions involving organic, systemic, and hormonal responses. The PALM component of the FIGO classification system (PALM-COEIN) deals with the structural causes, while the COEIN component deals with the non-structural causes. AUB is diagnosed by clinical examination and ultrasonography. Final diagnosis is always correlated with histopathological study. The objective of this study was clinico-histopathological evaluation of the cases of AUB, with respect to FIGO classification system in the women of reproductive and perimenopausal age group.

 Present study was a hospital-based prospective observational study conducted in the Department of Obstetrics and Gynecology of Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. It included 100 women, with complains of abnormal uterine bleeding, in the age group of 30 to 50 years and above, who were evaluated in over a period of one year, from January 2021 to December 2021. Age, parity, menstrual cycles, duration of symptoms and recurrence (if any), contraception, obstetric history, and history suggestive of Pelvic inflammatory disease (PID) were noted. General physical, systemic, and gynecological examinations of the patients were done. The findings of blood investigations, sonography, histopathology of endometrial biopsy specimens, and hysterectomised specimens were analysed.

 In our study, the maximum incidence of AUB was seen in reproductive and perimenopausal age groups between 35-40 years (38%) and 40-45 years (35%). The highest incidence of AUB was in multiparous women (44%). The most common pattern of AUB was heavy menstrual bleeding (menorrhagia) (69%). The most common type of AUB was chronic type of heavy menstrual bleeding (65%). In our study, the most common organic causes of AUB were fibroids (34%) and adenomyosis (18%). On histopathology, secretory endometrium was found in 52% cases and proliferative type in 21% of cases.

 Ultrasonography combined with endometrial biopsy proves to be the gold standard for diagnosis of AUB. The present study highlights the importance of endometrial biopsy and its interpretation which plays a pivotal role in the management of AUB.