Introduction
Abnormal uterine bleeding is described as bleeding with increased frequency, duration or quantity of blood during menstrual cycle. It is the most common condition seen now, which could be due to a simple hormonal imbalance to a structural cause like endometrial polyp or any neoplastic or non neoplastic conditions. It affects 10-30% of reproductive aged women and up to 50% of perimenopausal women.
Endometrial biopsies are acquired for a number of reasons that encompass bizarre uterine bleeding in certain age people, incomplete abortions, or suspected neoplasia and the endometrium can be sampled as pre operative manner to decide the phase of the cycle and for futther assessments or treatments.
In this study we aim to document the varied morphological patterns reported in our histopathology laboratory on patients presented with AUB from the non-gravid from the age group of 18 to 60 years and were compared with their thyroid values and the endometrial thickness through the ultrasonography.
Technique
It is a retrospective observation conducted at the specimen received within the branch of Pathology, Saveetha Institute of Medical and Technical Sciences for a length of six months from July 2018 to December 2018. A total range of eighty samples of endometrial biopsies and curettings were accesse. Samples had been constant in 10% formal saline and robotically processed and stained with H&E. Histopathological evaluation was carried out beneath light microscopy.
The demographic details such as age of the cases were collected from the histopathological records. The corresponding pathological findings were recorded. The ultrasongraphy readings regarding the endometrial thickness and the thyroid values were taken from the corresponding Radiology and Biochemistry departments for this study.
Patients have been categorised into reproductive age companies (18-40 yrs), perimenopausal (forty one-50), and postmenopausal (>50yrs). Perimenopause is defined by WHO as 2-8 years preceding menopause and 12 months after the final menses.1
Result
In this study the patients were taken from the age group of 18 to >50 years. The commonly affected group of patients related to AUB was 40-49 years with (63.7%) followed by 30-39 years with (21.3%) and 50-59 years with (15.4%).
The normal cyclic al endometrium was the commonest en dometrial finding in AUB with 42.5% constitutes proliferative endometrium and 23.7% were secretory endometrium and others like disordered proliferative phase, endometrial hyperplasia, atrophic endometrium ,endometrial polyp and endometrial carcinoma constitutes 15%, 15%, 3.8%, 2.5% and 1.2% respectively.
Most of the cases were euthyroid (65%) followed by the hypothyroid (26%) and the hyperthyroid (2%). The hypothyroid state showed more incidence of proliferative phase in the histopathological finding.
Endometrial thickness showed (63.7 %) 5-10 mm, (21.3%) <5 mm, (11.2%) 11-20mm and (3.8%) of 21-30 mm. ET of less than 5mm have been visible in 15 cases of regular endometrium and in 2 cases of disordered proliferative section and three cases of atrophic endometrium. ET of five-10mm were visible in 7 cases of disordered proliferative section, ,6 cases of endometrial hyperplasia and 1 case of endometrial polyp, 2 cases of
carcinoma and remaining normal. ET 11-20 mm showed 2 case of disordered proliferative phase,1 case of hyperplasia and remaining normal. ET 21-30 mm showed 1 of disordered proliferative cases and 2 of hyperplasia.
Table 1
| Age | Number | Percentage |
| 18-39 | 17 | 21.3 |
| 40-49 | 51 | 63.7 |
| 50-59 | 12 | 15.4 |
| Total | 80 | 100 |
Age wise distribution of cases.
Table 2
Histopathological findings of the endometrium
Table 3
| Thyroid profile | Number | Percentage |
| Euthyroid | 52 | 65 |
| Hypothyroid | 26 | 32.5 |
| Hyperthyroid | 2 | 2.5 |
| Total | 80 | 100 |
Distribution of cases based on thyroid profile.
Table 4
Endometrial thickness and Histopathology pattern
Discussion
AUB is the major gynecological problem in the present situation and also one of the causes of hysterectomy. It was determined by our study that the maximum common ag e group associated with abnormal uterine bleeding was 40-49 years and the similar incidence was stated by way of Muzaffar et al2 Yusuf et al3 and Doraiswami et al.4 This could be because of the transition to an anovulatory phase with decline in the quantity of ovarian follicles and the estradiol levels. This is comparable to the studies carried out by Agarwal et al,5 Vaidya et al,6 Salvi et al.7
Most of the cases in the study showed normal physiological patterns. The histopathological findings in the endometrial biopsy showed various patterns proliferative phase (42.5%) commonest followed by the secretory phase (23.7%) and the disordered proliferative phase (15%) are in concordance with Gorla et al8 and Byna et al.9 They reported 45.56%, 32.59%, 9.63% and 35.38%, 30.76% for proliferative phase, secretory phase and disordered proliferative phase respectively.
Endometrial polyp was found in 2 patients below 40 years of age with the history of hormonal intake for the management of infertility.10 Study of atrophic endometrium constituted 3.8% with most cases presenting in the postmenopausal age group. This is similar to another report by other researchers.10
Malignancy is a common differential diagnosis in women of peri and post menopausal age group presen ting with AUB. In this study, the endometrial hyperplasia without atypia (7.5%), endometrial hyperplasia with atypia (3.8%) and endometrial carcinoma (1.2%) compared with Gorla et al8 as they reported 9.6%,0.7% and 0.7%.
In this study it was observed that (65%) were euthyroid category, (32.5%) were hypothyroid category and only (2.5%) were hyperthyroid category compared to Singh et al11 with 65% euthyroid category, 26% hypothyroid category, 9% hyperthyroid category and Sharma et al12 with 64% euthyroid category, 22% hypothyroid category,14% hyperthyroid category. This showed similarity in the euthyroid and the hypothyroid but decrease in the hyperthyroid states. This shows that the thyroid state is one of the important causes of AUB. In the current study, we discovered proliferative endometrium (sixty one.nine%) is the maximum common presentation in thehypothyroi d instances accompanied by secretory endometrium (34.4%) and atrophic endometrium (4.8%). In thestudy through Kaur et al13, (64.3 %) hypothyroid sufferers had proliferative endometrium, (21. %) had endometrial hyperplasia, and the remaining (14.3 %) had secretory endometrium. Sharma et al12 observed 36.36% proliferative, 36.36 % secretory and 27.27 %atrophic endometrium in hypothyroid patients.
The most common endometrial thickness in this study was 5-10 mm with (63.7%) which correlates with (46.4%) of Pillai et al14 as most of the cases were taken from the premenopausal age group. Increased ET >15 mm showed 4 cases (5%) of hyperplasia compared with 8 cases (4.7%) of hyperplasia of Geethalakshmi et al.15 Hence the patients with abnormal USG showed abnormal endometrial pathology with more cases of endometrial hyperplasia and carcinoma.
Conclusion
In this study AUB were seen mostly in the postmenopausal age group cases and the ET >5mm should undergo endometrial biopsy to know the endometrial abnormalities like endometrial hyperplasia and carcinoma.
The thyroid profile is also important as there were higher incidence of AUB and endometrial abnormalities in the hypothyroid cases. This also helps to find the cause and treat it accordingly.
Source of Funding
None.
Conflict of Interest
None.
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