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Category: Volume 05 Issue 08 August 2017
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Title: Clinical, Sonological and Histopathological Spectrum of Abnormal Uterine Bleeding in Perimenopausal Women

Authors: Dr Beenakumari .R, Dr Bindu K .M, Dr Dona Susan

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.152

Abstract

Background: Abnormal uterine bleeding is a common problem for menstruating women, particularly at the beginning (adolescence) and end (Premenopausal) of their reproductive years .While rarely life threatening AUB exerts a large emotional and physical toll on women. Variations from the normal cyclical pattern in the premenopausal age may be due to physiological hormonal changes on one hand or may be due to neoplastic changes either benign or malignant, on the other hand. Therefore accurate diagnosis of the causative factor of AUB in this age group is of utmost importance, so that appropriate management can be established. And this study aims to understand the clinical, sonological and histopathological features of abnormal uterine bleeding in the perimenopausal age group.

Objective

  1. To identify the clinical pattern of AUB in perimenopausal women
  2. To understand the transvaginal ultrasonographic picture of the endometrium in perimenopausal women with AUB
  3. To study the histopathological features of endometrium in perimenopausal women with AUB

Methods: It is an observational study, Conducted for one year from June 2015-June 2016 in Department of Obstetrics and Gynecology, Govt: Medical College, Kottayam. Perimenopausal women attending the gynaecology OPD with complaints of abnormal uterine bleeding were studied. Their clinical, transvaginal ultra sound and endometrial histopathological characteristics were collected with the help of a preformed proforma. The findings thus obtained were analyzed with the help of SPSS software.

Results and Conclusions: The clinical pattern was studied under the following headings Regularity – the patterns in the descending order of frequency were regular menses (71.6%), irregular menses (25.8%) and amenorrhea (2.7%).

Frequency – the patterns were normal (59.1%), infrequent (25.8%) and frequent (12.7%) in the decreasing order of frequency

Heaviness - heavy and prolonged bleeding was the most common pattern (70.2%) followed by heavy (16.4%) and normal bleeding (10.7%).

Flow duration – prolonged flow duration was present in the majority (74.7%) followed by normal (21.8%) and shortened flow (0.9%).

Irregular nonmenstrual flow was present in a minority of those with AUB (10.2%).

The ultrasonographic appearance was studied under the following headings

Endometrial thickness – normal thickness was the commonest (54.2%) finding followed by thickness more than 12mm (43.6%) and thickness less than 5 mm was the least common finding (2.2%).

Endometrial echogenicity – a uniformly echogenic endometrium was present in all with hyperechoic pattern being the most common (85.3%). Three layered (12.4%) and hypoechoic (2.2%) patterns were also present.

Endo-myometrial junction – major proportion of sample had a regular endo-myometrial junction (94.2%). Irregular endo-myometrial junction was the other pattern seen (4.9%)

Uterine artery resistance index – high resistant flow pattern was seen in perimenopausal women with AUB with most having a value more than 0.8 (62.2% on right and 61.8% on left). The mean value for right RI was 0.81 and that for left RI was 0.8.

Uterine artery pulsatility index - The mean value of PI on right was 1.8 and that of left was1.9.

Histopathological spectrum – the histological appearances of endometrium of perimenopausal women ranged from proliferative (54.2%) and secretory endometrium (35.1%) through simple (0.9%) and complex hyperplasia without atypia (0.4%) to endometrial carcinoma (0.4%).

Keywords: Heavy and prolonged bleeding, endometrial echogenicity, proliferative, secretory.

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Corresponding Author

Dr Bindu K .M

Associate Professor, Department of Obstetrics & Gynaecology

Govt. Medical College, Kottayam