A Study of Histopathological Patterns of Endometrium and Hormonal Status in Perimenopausal Patients with Abnormal Uterine Bleeding

Dr. Geeta Painkra, Dr. Sunita Rai, Dr. Jyoti Priyadarshini Shrivastava, Dr. Sudha Iyengar

Abstract: Background: The endometrium is a dynamic hormonally sensitive and responsive tissue which constantly and rhythmically undergoes changes in the active reproductive life. Abnormal uterine bleeding defined as a bleeding pattern that differs in frequency, duration and amount, that observed during a normal menstrual cycle or after menopause. It affects 10 - 30% of reproductive age group and up to 50% of peri menopausal women. The most common presentations are menorrhagia, metrorrhagia, polymenorrhea, intermenstrual bleeding, peri and post - menopausal bleeding. Hormonal imbalance mainly estrogen and progesterone level are the main factor involved in the pathogenesis of abnormal uterine bleeding. This alteration is better studied by a combination of histopathological and hormonal profile and immunohistochemical evaluation of the endometrium. Aim and objectives: To study the histopathological patterns of endometrial biopsies and curettage, hysterectomy specimen and hormonal status [estradiol (E2) and progesterone (PRG) ] in perimenopausal patients with abnormal uterine bleeding. Material and methods: The study was prospective and includes 72 cases as sample size from August 2022 to February 2024 (18 months) in histopathology and special laboratory department of pathology, Gajra Raja Medical college Gwalior, MP. Observation and results: Total N=72 selected cases of AUB patient of perimenopausal age group were included in the study. Overall mean age 44.79 + 4.63 years. The most common age group in the study was 41?45 years (34.73) followed by ~ 40years (30.56%). The most common abnormal uterine bleeding pattern was menorrhagia during the study observation. The following types of histological patterns seen in the endometrium: Proliferative phase [PP] (33.3%), Secretory phase [SP] (16.7%), disordered Proliferative phase (5.6%), pill endometrium (13.9%), Endometrial hyperplasia (EH) without atypia (20.8%), endometrial hyperplasia (EH) with atypia (2.8%), endometrial carcinoma (4.2%), and senile atrophic endometrium (1.4%). The frequency of estrogen level and percentage is categorized into three groups: low (5.6%), normal (22.2%), high (72.2%) and AUC value was 0.722 and p - value 0.0003. Sensitivity and specificity of estrogen value was respectively 82.93% and 61.298%. In this study, progesterone level was categorized into three groups: low (6.9%), normal (54.2%), and high (38.9%). The progesterone level of AUC value was 0.504. Sensitivity and specificity of progesterone value was respectively 75.61% and 45.16%. Conclusion: In all patients with AUB, histopathological examination is mandatory. It is the most important diagnostic tool in the evaluation of AUB because it shows a wide range of patterns, from normal endometrium to malignancy. As a result, it assists the physician in planning therapy for successful AUB management and reduces the need for unnecessary hysterectomy. We concluded that the histopathological correlation with the clinical symptoms of AUB was good, and we classified the cases of AUB under FIGO classification (PALM - COEIN). We did find a cut - off value as well as sensitivity and specificity for the serum hormonal status of progesterone and oestrogen in all the histological patterns in people with AUB. The workup for these patients should include an assessment of oestrogen and progesterone level in serum in abnormal uterine bleeding, allowing one to determine the type of therapeutic management.

Keywords: Abnormal uterine bleeding (AUB); menorrhagia, metrorrhagia, polymenorrhea, intermenstrual bleeding, perimenopausal; post - menopausal; estrogen; progesterone; hysterectomy

How to Cite?: Dr. Geeta Painkra, Dr. Sunita Rai, Dr. Jyoti Priyadarshini Shrivastava, Dr. Sudha Iyengar, "A Study of Histopathological Patterns of Endometrium and Hormonal Status in Perimenopausal Patients with Abnormal Uterine Bleeding", Volume 14 Issue 5, May 2025, International Journal of Science and Research (IJSR), Pages: 670-676, https://www.ijsr.net/getabstract.php?paperid=MR25510164049, DOI: https://dx.doi.org/10.21275/MR25510164049