Online ISSN: 2515-8260

Keywords : Abnormal uterine bleeding


A PROSPECTIVE STUDY OF ENDOMETRIAL CARCINOMA IN PATIENTS WITH ABNORMAL UTERINE BLEEDING

Dr. M pavani, Dr. Mohd. Anwar Miya, Dr. Hemalatha. P, Dr. S. Raghu Ram Mohan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 447-452

Background: The most frequent presenting symptom in the gynecology outpatient department is abnormal uterine bleeding (AUB). Endometrial sampling may be effectively the initial diagnostic step in AUB, though it frequently presents a difficult interpretation for pathologists in practice. This study was done to evaluate the histopathology of endometrium for the purpose of identifying the endometrial causes of AUB. Additionally, we tried to observe the incidence of various pathologies in different age groups presenting with abnormal uterine bleeding.
Materials and methods: This is a prospective study done on cases of AUB who underwent endometrial biopsy from August 2020 to August 2021 in the department of pathology at Kakatiya Medical College, Warangal, and Telangana, India. All the biopsies were routinely processed and a histopathological diagnosis was made. A statistical analysis between age of presentation and specific endometrial causes was done using the Chi-square test.
Results: The most common age group presenting with AUB was 35–72 years old. Out of 133 cases studied, 48% of cases were found to be proliferative endometrium, 28% of cases were of secretory endometrium, 2% of cases were of atrophic endometrium, 3% were of irregular maturation, 17% were of simple hyperplasia, and 2% were of endometrial carcinoma. Endometrial causes of AUB and age pattern was statistically significant with P value<0.05.
Conclusion: Endometrial lesions are associated with particular ages. AUB is more frequently dysfunctional in perimenopausal women, so when they are in the reproductive age range, they should first rule out pregnancy-related issues. This study's significantly high incidence of aberrant proliferative patterns suggests that these patients present at an early stage.

ULTRASOUND DIAGNOSIS OF DYSFUNCTIONAL UTERINE BLEEDING WITH HISTOPATHOLOGICAL CORRELATION

Dr M Radhika , Dr J Madhavi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2149-2159

Background: Abnormal uterine bleeding may be defined as bleeding pattern that differs in frequency, duration and amount from a pattern observed during a normal menstrual cycle or after menopause.
Aims : To study accuracy of Transvaginal Sonography in relation to endometrial biopsy in depicting endometrial changes in DUB and to formulate an effective protocol for the first line evaluation of all cases of DUB at the out-patient level.
Materials and methods: This study on ultrasound diagnosis of DUB with histopathological correlation in 50 patients between 18-45 yrs. The study was aimed to study accuracy of TVS in relation to endometrial biopsy in depicting endometrial changes in DUB. TVS and endometrial sampling was done as outpatient procedure 2-3‘days prior to date of menstruation or on day of menstruation. The relevant clinical findings and investigations were recorded in the proforma which is enclosed. A master sheet showing all details of the cases is also enclosed.
Results: The incidence of DUB in age groups of 18-45 years is high. Menorrhagia was noted in 44% , Polymenorrhagia in 20% by histopathology. In cases of normal endometrium, proliferative endometrium noted in 52%, secretory endometrium in 12% , menstrual endometrium in 12% .Simple hyperplasia was noted in 14%, Cystoglandular hyperplasia in 6%. Out of 6 patients with ET 1 – 4.9 mm , endometrial parenchyma is menstrual on TVS and HPE . Out of 4 patients with ET 15 and above endometrium show hyperplasia on TVS and HPE . The sensitivity , specificity ,PPV and NPV of TVS findings in comparision to Histopathology as Proliferative phase :- 88.8% , 100% , 100% , 88.46% . Secretory phase :- 100% , 86%, 53% , 93% . Menstrual phase :-100% , 100% ,100%, 100%. Hyperplasia :- 70% , 100% ,100% ,93.02% . Surgery is done in 22% of cases , all are above 35 years.
Conclusions: Endo-vaginal scan when combined with endometrial sampling is an valuable tool for the preliminary screening, diagnosis, management all cases of DUB. Therefore, we strongly recommend the routine use of endovaginal scan with endometrial sampling in the clinical and laboratory evaluation of all cases.

HISTOMORPHOLOGICAL SPECTRUM OF ENDOMETRIAL AND CERVICAL LESIONS FOLLOWING CURETTAGE AND BIOPSY- A RETROSPECTIVE STUDY

Rashmikumari T. R, Priyanka Prasad Arvind, Astha Srivastava

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2121-2128

Background: Abnormal uterine bleeding (AUB) is the most common clinical presentation in premenopausal and postmenopausal period which could be due to either endometrial or cervical lesions. Early detection of precursor lesions and exclusion of malignancy is a diagnostic challenge for pathologists. Many studies were done on either endometrium or cervix alone, hence we took this study to evaluate both simultaneously before the hysterectomy. Objectives: To profile the histomorphological spectrum of endometrium and cervical lesions on curettage and biopsy concurrently before hysterectomy and correlation with hysterectomy specimens wherever available.
Materials and Methods: The present study was conducted on 153 cases of endometrial curetting’s and cervical biopsies received from Department of Gynaecology to Department of Pathology, RIMS, Raichur during a period of February 2020 to January 2022. Histopathology slides were retrieved from the archives of Department of Pathology. New slides were made from Paraffin embedded blocks wherever necessary and stained with Haematoxylin and Eosin. Histopathological examination of the hysterectomy specimens was conducted wherever available.
Results: Majority of the patients were in third decade of life with mean age of 41.3 years (P<0.0001) and the commonest clinical indication was AUB ((P<0.0001). Majority of the endometrium showed cyclical changes in both endometrial curettage and in hysterectomy specimens which showed a perfect positive coefficient correlation of 0.92 (P value = 0.028). Similarly, the cervical biopsy and cervix findings in hysterectomy specimen showed a highly significant P < 0.0001. The commonest histomorphological lesion in cervix was non-specific chronic cervicitis (NSCC).
Conclusion: Abnormal uterine bleeding is a major gynaecological problem in perimenopausal and post-menopausal women. It could be due to either endometrial / cervical lesions hence if it is evaluated simultaneously with a minimally invasive procedure as our study so that unnecessary radical surgeries can be avoided and medical/ conservative treatment could be offered.

INVESTIGATING THYROID DYSFUNCTION IN CASES OF ABNORMAL UTERINE BLEEDING AMONG GESTATIONAL PATIENTS

Prof. (Dr.) Seeba Hussain

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2964-2971

Introduction: A prevalent diagnosis with significant social and economic consequences, abnormal uterine bleeding (AUB) accounts for 20–30% of patients in the outpatient clinic. Heavy menstrual bleeding complaints have a large negative impact on quality of life, necessitate time away from work, necessitate surgical intervention, including hysterectomy, and eventually have a significant negative impact on the health care system. The majority of these issues can be avoided with prompt and effective management.
Methods: A ten month cross-sectional prospective study on 100 women (50 with abnormal uterine bleeding and 50 with a regular cycle were chosen as control cases) was carried out in the outpatient department at Katihar Medical College and Hospital. Both study groups had their general and menstrual histories, examinations, and thyroid function tests evaluated.
Results: Women who experienced abnormal uterine bleeding were significantly more likely to have high thyroid stimulating hormone levels (p=0.002). Low T4 levels were strongly related with women who experienced abnormal uterine bleeding (p=0.04). Women with abnormal uterine haemorrhage and hypothyroidism were shown to be significantly associated (p=0.003).
Conclusion: Maintaining a high index of suspicion and quickly screening for the existence of abnormal thyroid function are crucial for making an early diagnosis.

Body mass index and abnormal uterine bleeding in premenopausal women: A correlation

Dr. Himabindu Sangabathula, Dr. Yashovardhini Siddareddy, Dr. Modugu Lavanya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3170-3182

(BMI) increases, a trend that has been observed in recent years as the rate of obesity among women rises. Despite abundant evidence showing a connection between endometrial cancer and obesity, very few people are aware of it. In order to assess the relationship between body mass index (BMI) and endometrial pathology in premenopausal women with AUB at Nalgonda medical college, an analytical case control research was conducted.
Methods: 100 women between the ages of 40 and 55 who presented to the Department of Obstetrics and Gynecology at Nalgonda medical college between January 2020 and December 2021 were included in the study group for an analytical case control study. These women with BMIs of 18.5 to 24.99 and fewer than 25 had their menstrual patterns and endometrial patterns by histopathology examined.
Results: In the study group of women between the ages of 40 and 55, the average age was 44.83. In both groups, the average length of the symptoms was comparable. 8.52 months for the control group and 10.18 months for the patients group. There was no discernible variation between the two groups' menstrual patterns, which were equivalent. In comparison to the control group, the cases group had increased mean endometrial thickness, mean BMI, and hyperplasia with or without atypia. Although it was not statistically significant, atypical endometrial hyperplasia occurred more frequently in women with rising BMI.

Clinical profile and management of patients with abnormal uterine bleeding

Dr. Swapna Y, Dr. Juveria Fatima .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5356-5362

Background:Global prevalence of abnormal uterine bleeding (AUB) ranges from 3%-30% among women 15-45 years. It is necessary to rule out any pathological condition that may be responsible for AUB so that it can be corrected at the earliest.
Objective:To study and review various causes, diagnostic and treatment modalities in evaluating abnormal uterine bleeding
Methods:Hospital based cross sectional study was carried out among 240 women with AUB. History, examination, USG pelvis and relevant examination was carried out. PALM-COEIN criteria was used to classify AUB. Appropriate management was followed.
Results:Prevalence of AUB was 19%. Majority belonged to 31-40 years. 21.7% had hypertension. Majority (58.3%) presented with heavy menstrual bleeding. 60% had AUB for 3-6 months.Per speculum examination showed that 11.7% had polyp and 22.1% had cervical erosions. On per vaginal examination, 52.9% had bulky uterus. On USG examination, 23.8% were found to have fibroids.Most common histopathological diagnosis was proliferative phase in 19.6% of the cases.55% of the women were found to have polyp followed by leiomyoma in 25% of the cases as per PALM criteria while as per COEIN criteria, most common cause of AUB was endometrial in 21.3% of the cases followed by ovulatory in 13.8% of the cases.70% cases of AUB could be managed conservatively while surgery was required in 27.9% of the cases; however, five cases resolved without any sort of intervention.
Conclusion:Prevalence of AUB was high in the study population. Age 31-40 years, associated co-morbidities, obesity and lower-class women had higher prevalence of AUB. It can be managed conservatively in most of the cases.

SIGNIFICANCE OF HISTOPATHOLOGICAL EVALUATION IN THE DIAGNOSIS OF ENDOMETRIAL LESIONS IN PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN

Madhavi Bodepudi; Lakshmi P; Bharani K

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1111-1114

AIMS and Objectives: To study the incidence, clinical and histopathological correlation of various types of endometrial lesions in premenopausal and postmenopausal women. To study the clinicopathological spectrum and histopathological evaluation of endometrium in abnormal uterine bleeding in peri-menopausal and post-menopausal age groups. 

VALUE OF HYSTEROSCOPY AND GENETIC RESEARCH OF WOMEN WITH ABNORMAL UTERINE BLEEDING IN PERIMENOPAUSE

Zebo Zafarjonovna Askarova; Nasiba Raximbayevna Saparbayeva; Madina Zafarjanovna Kurbaniyazova; Dilfuza Abdullayevna Aliyeva

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 1, Pages 409-416

The perimenopause period is characterized by a gradual extinction of ovarian function, during which hypoluteinism is replaced by anovulation with relative hyperestrogenia and then hypoestrogenia. At any stage of perimenopause, there is a high probability of the formation of menstrual dysfunction, in particular, abnormal uterine bleeding (AUB). The frequency of AUB
in premenopause reaches 60-70% among gynecological diseases [5, 12, 18]. Today, hysteroscopy is becoming increasingly important as a method for detecting intrauterine pathology in patients with abnormal uterine bleeding. [11.13]. The pathology of the endometrium and uterine cavity is represented by hyperplastic processes, uterine body leiomyoma, developmental abnormalities (Müller's abnormalities), inflammatory and immunopathological conditions, tumor processes that are clinically manifested by abnormal bleeding, as well as changes in neighboring organs and systems resulting from tumor damage.