Sonographic and Histopathological Correlation and Evaluation of Endometrium in Perimenopausal Women with Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is one of the most frequent gynecological complaints among perimenopausal women and can be caused by a wide range of structural and functional abnormalities. The study aimed to investigate the types of menstrual abnormalities in perimenopausal women and to correlate transvaginal ultrasonography (TVUS) findings—specifically endometrial thickness and pattern—with histopathological examination (HPE) of the endometrium. Methods: This cross-sectional study, conducted at the Gynecology and Radiology Department of Indus Medical College, Tando Mohammad Khan, from January 2023 to December 2024, included 70 perimenopausal women (aged 20–40) with abnormal uterine bleeding (AUB). All patients underwent medical testing and preoperative assessments, with endometrial thickness measured via transvaginal ultrasound (TVUS) using a 7.5 MHz vaginal probe, recording the maximum double-layer thickness in the mid-sagittal plane near the fundus. Data were analyzed in SPSS v27 using descriptive statistics and chi-square tests, with p < 0.05 considered significant. Results: The most common histopathological findings were fibroids (32.9%), adenomyosis (20.0%), dysfunctional uterine bleeding (35.7%), and polyps (11.4%). Disordered proliferation was particularly observed in cases of menorrhagia (36.4%) and menometrorrhagia (31.8%). Secretory changes were predominant in metropathia (75.0%), while postcoital bleeding was frequently associated with carcinoma (33.3%). Mean endometrial thickness was highest in menorrhagia (10.32 ± 1.15 mm) and lowest in polymenorrhea cases (9.58 ± 1.35 mm). Conclusion: In perimenopausal women with AUB, TVUS is the preferred investigation due to its convenience, accuracy, and non-invasiveness. If hyperplastic endometrium or endometrial thickness >8 mm is found, endometrial histopathology is needed to exclude atypia or malignancy.