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

Abid M, Hashmi AA, Malik B, Haroon S, Faridi N, Edhi MM, Khan M - BMC Womens Health (2014)

Bottom Line: The problem is common worldwide but causes may vary from one region to another.The most common pattern of AUB was polymenorrhea.The most common pathology was hormonal imbalance.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan. mariam.abid@aku.edu.

ABSTRACT

Background: Abnormal 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.

Methods: It was a prospective, cross-sectional study conducted at Liaquat National Hospital from 15(th) January 2010 till 14(th) 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.

Results: Polymenorrhea 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.

Conclusion: Frequency 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.

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Clinical pattern of abnormal uterine bleeding n= 241.
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Fig1: Clinical pattern of abnormal uterine bleeding n= 241.

Mentions: 72 participants (30%, 72/241) presented with polymenorrhea which was the most common pattern followed by irregular bleeding (26%, 64/241) (Figure 1). Major histological patterns observed were as follows, normal menstrual pattern in 82 participants (34%, 82/241), hormonal imbalance pattern in 65 (27%, 65/241), endometrial polyp in 34 (14%, 34/241), chronic endometritis in 28 (12%, 28/241), atrophic endometrium 15 (6%, 15/241), endometrial hyperplasia in 12 (5%, 12/241) and endometrial carcinoma was noted in 5 (2%, 5/241) participants (Table 1). Therefore endometrial pathologies were observed in 159 (66%, 159/241) participants (Figure 2), whereas normal menstrual pattern was seen in 82 (34%, 82/241) participants, of AUB.Figure 1


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

Abid M, Hashmi AA, Malik B, Haroon S, Faridi N, Edhi MM, Khan M - BMC Womens Health (2014)

Clinical pattern of abnormal uterine bleeding n= 241.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4231191&req=5

Fig1: Clinical pattern of abnormal uterine bleeding n= 241.
Mentions: 72 participants (30%, 72/241) presented with polymenorrhea which was the most common pattern followed by irregular bleeding (26%, 64/241) (Figure 1). Major histological patterns observed were as follows, normal menstrual pattern in 82 participants (34%, 82/241), hormonal imbalance pattern in 65 (27%, 65/241), endometrial polyp in 34 (14%, 34/241), chronic endometritis in 28 (12%, 28/241), atrophic endometrium 15 (6%, 15/241), endometrial hyperplasia in 12 (5%, 12/241) and endometrial carcinoma was noted in 5 (2%, 5/241) participants (Table 1). Therefore endometrial pathologies were observed in 159 (66%, 159/241) participants (Figure 2), whereas normal menstrual pattern was seen in 82 (34%, 82/241) participants, of AUB.Figure 1

Bottom Line: The problem is common worldwide but causes may vary from one region to another.The most common pattern of AUB was polymenorrhea.The most common pathology was hormonal imbalance.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan. mariam.abid@aku.edu.

ABSTRACT

Background: Abnormal 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.

Methods: It was a prospective, cross-sectional study conducted at Liaquat National Hospital from 15(th) January 2010 till 14(th) 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.

Results: Polymenorrhea 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.

Conclusion: Frequency 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.

Show MeSH
Related in: MedlinePlus