Background: Abnormal Uterine bleeding (AUB) defined as bleeding that does not fall within normal ranges of amount, duration, frequency or cyclicity of normal menstrual pattern. AUB is associated with significant morbidity among women of various age groups.

Objectives: 1) To observe histopathological spectrum of endometriumin AUB.

2) To analyse the incidence of various endometrial histopathology associated with AUB occurring in women of different age groups.

Methodology: One year two months retrospective study was done at Department of Pathology, MMC&RI which included 150 cases of clinically diagnosed AUB. Histopathological examination of endometrium obtained from biopsy and hysterectomy specimens were clinically correlated.

Results: Out of 150 cases of AUB, common histopathological observations made were proliferative endometrium (46.7%), Secretory endometrium (23.3%), Atrophic phase (11.3%), Endometrial Hyperplasia (10.7%), Endometrial Adenocarcinoma (5.3%), Serouscarcinoma (0.7%) and threebiopsy (2%) specimens were in adequate for evaluation.

Conclusion: Based on the present study incidence of AUB was high among peri-menopausal age group associated with proliferative endometriumon histopathology. Diagnostic histopathology plays a key role in management of AUB and to rule out early malignancy.

Keywords: Endometrium, Abnormal Uterine Bleeding (AUB), Hyperplasia, Endometrial carcinoma.

1. Fraser IS, Critchley HO, Munro MG, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Hum Reprod. 2007;22(3):635-43.
2. Talukdar B, Goswami RR, Mahela S, Ahmed NI. Histopathological pattern of endometrium in abnormal uterine bleeding of perimenopausal women. IJRCOG. 2016;4(5):1162-66. DOI:10.18203/2320-1770.ijrcog20160877.
3. Maybin JA, Munro MG, Fraser IS, Critchley HO. Re-definition and re-classification of menstrual disorders. Obstet Gynaecol Reprod 2013; 23:331-6.
4. Coulter A, Noone A, Goldacre M. General practitioners’ refferrals to specialist outpatient clinics. BMJ. 1989; 299:304-8.
5. Choudhury SA, Nath P. Abnormal uterine bleeding; its prevalence, causes and management in a tertiary care hospital. The New Indian Journal of OBGYN. 2020; 7(1): 52-7.
6. Munro MG, Critchley HO, Broder MS, et al. FIGO Working Group on Menstrual Disorders. FIGO classification system (PALMCOEIN) for causes of abnormal uterine bleeding in non-gravid women of reproductive age. Int J Gynaecol Obstet 2011;113:3–13.
7. Verma D, Verma A. Histopathological correlation of abnormal uterine bleeding in perimenopausal women. IJRCOG. 2016;5(7): 2343-5. DOI: http://dx.doi.org/10.18203/23201770.ijrcog20162124.
8. Khan R, Haiyat S, Maheswari V, Hakim S. The Clinico-Pathological Spectrum of Endometrial Lesions in Patients with Abnormal Uterine Bleeding in Accordance with PALM-COEIN Classification: A Prospective Study of 3 Years in a Tertiary Care Hospital of Western Uttar Pradesh. APALM. 2019;2(6):2394-6466. DOI: https://doi.org/10.21276/apalm.2317.
9. Saraswathi D, Thankar J, Shalinee R, Aarathi R, Jaya V, Kumar PV. Study of Endometrial Pathology in Abnormal uterine bleeding. J Obstet Gynaecol, India. 2011;6(14):426-30. DOI:10.1007/s13224-011-0047-2.
10. Liu Z, Doan QV, Blumenthal P, et al. A systematic review evaluating health-related quality of life, work impairment, and health care costs and utilization in abnormal uterine bleeding. Value Health 2007;10:173–82.
11. Gupta A, Rathore AM, Manaktala U, Rudingwa. Evaluation and histopathological correlation of abnormal uterine bleeding in perimenopausal women. IJBAR. 2013;4(80):509-13. DOI: 10.7439/IJBAR.V418.258.
12. Abid M, Hashmi AA, Malik B, Haroon S, Faridi N, Edhi MM. Clinical pattern and spectrum of endometrial pathologies in patients with abnormal uterine bleeding in Pakistan: need to adopt a more conservative approach to treatment. BMC Women’s Health. 2014;14(1):132-7. DOI: https://doi.org/10.1186/s12905-014-0132-7.
13. Khan A, Khandelwal R, Arya S, Pant H. Study of endometrial pathology in abnormal uterine bleeding. IJBAR. 2017;8(2):38-43. DOI: https://dx.doi.org/10.7439/ijbar.v8i2.3916.
14. Sajitha K, Padma SK, Shetty KJ, Kishan Prasad HL, Permi HS, Hegde P. Study of histopathological pattern of endometrium in abnormal uterine bleeding. CHRISMED J Health Res. 2014;2(1):76-81. DOI:10.41032348-3334.134265.
15. Mahapatra M, Mishra P. Clinicopathological evaluation of abnormal uterine bleeding. JHRR. 2015;2(1):45-9. DOI: 10.4103/2394-2010.160904
16. Lotha L, Borha A. Clinicopathological evaluation of abnormal uterine bleeding in perimenopausal women. IJRCOG. 2016;5(9): 3072-74. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162987.
17. Thapa S, Acharya I. Endometrial Histopathology in Abnormal Uterine Bleeding: A Retrospective Analysis. MJSBH. 2021;20(1):1-5.
18. Jairajpuri ZS, Rana S, Jetley S. Atypical uterine bleeding-Histopathological audit of endometrium: A study of 638 cases. AJMS. 2013;6(1):21-8.
19. Afghan S, Yasmeen A. Abnormal Uterine Bleeding (AUB) A Clinico-pathological Study of 150 Cases. Ann Pak Int Med Sci. 2013;9(4):201-204.
20. Varun N, Gupta N, Khan S. A retrospective study of endometrial histopathology in abnormal uterine bleeding patients. IJRCOG. 2018;7(10):4116-19. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184138.
21. Jetley S, Rana S, Jairaipuri ZS. Morphological spectrum of endometrial pathology in middle aged women with atypical uterine bleeding: A study of 219 cases. JMH.2013;4(4)216-20. DOI: 10.4103/0976-7800.122242.
22. Deka RR, Saikia T, Handique A, Sonowal B. Histopathological Spectrum of endometrial changes in women presenting with abnormal uterine bleeding with special reference to endometrial malignancies: A two years hospital based study. PJSR. 2012;5(2):13-6. DOI: 10.21276/aabs.
23. Bolde SA, Pudale SS, Pandit GA, Matkari PP. Histopathological study of endometrium in cases of abnormal uterine bleeding. IJRMS. 2014;2(4):1378-81. DOI: 10.5455/2320-6012.ijrms20141125.
24. Anupamasuresh Y, Suresh YV, Jain P. Abnormal uterine bleeding; a clinico histopathological analysis. IJRCOG. 2014;3(3): 656-61. DOI: 10.5455/2320-1770.ijrcog20140954.
25. Sharma P, Chaudhary M. Endometrial Histopathology in Abnormal Uterine Bleeding: A Retrospective Analysis. IJSR. 2019;8(11):2277-79. DOI: 10.36106/ijsr.
26. Dr Rupam Sinha et al. Endometrial Pathologies in Patients of Abnormal Uterine Bleeding (AUB). JMSCR Volume 07 Issue 04 April 2019.
27. Dr Priyanka Chaudhari et al International Journal of Medical Science and Current Research (IJMSCR)March-April 2021 | Vol 4 | Issue 2.

Dr Roopashree G

Senior Resident, Department of Pathology, Mysore Medical College and Research Centre, Mysore