Histomorphological Study of Endometrium in Cases of Abnormal Uterine Bleeding in Endometrial Biopsies and Hysterectomy Specimens

Introduction: Abnormal Uterine Bleeding (AUB) is any uterine bleeding that is more than the normal volume (50-80 ml) or duration.FIGO in 2011 formulated and classified AUB as "PALM-COEIN" which is Polyp; Adenomyosis; Leiomyomas; Malignancy and hyperplasia; Coagulopathy; Ovulatory disorders; Endometrial factors; Iatrogenic causes; and Not classified.The prevalence of AUB is 3% to 30%, commonly in menarche and perimenopausal and endometrial hyperplasia and carcinoma in peri and postmenopausal women.The most common presentation of AUB is menorrhagia; also known as heavy menstrual bleed (HMB).These are classified as nonorganic and organic.This study is being done to evaluate the various histomorphological findings of endometrium in patients of AUB and to observe the frequency of various pathology in perimenopausal and postmenopausal age group in endometrial biopsies and hysterectomy specimens.Materials and Methods: A total of 103 patients presenting with abnormal uterine bleeding over a period of 8 months from August 2020 to April 2021 were included in the study.Among which maximum 75 were endometrial curettings and 28 were of hysterectomy specimens.Females above age of 40 years who had complained of AUB were included in the study and categorized into the following age groups: perimenopausal and postmenopausal.Data were entered in Microsoft Excel and managed in SPSS version 16.Analysis was done in the form of percentages and proportions and represented as tables and figures where necessary.Results: A total of 103 cases of AUB were taken; were categorized in perimenopausal and postmenopausal age group.Patients 'age ranged from 40 to more than 70 years.28 cases were obtained from hysterectomy specimens, rest 75 cases were obtained by endometrial curettage.Out of all cases of AUB non organic contributes maximum 52% followed by organic cause (48%) in patients presenting with AUB.Perimenopausal age group (80.9%) contributes maximum towards both nonorganic and organic cause (AUB) in 56.7% and 43.3% cases respectively followed by postmenopausal age group in 19.1% cases.Among functional cases of AUB, secretory endometrium and disordered proliferative endometrium were the most common patterns and were seen in 26 (25.8%) and 11 (10%) cases, respectively and among organic lesions causing AUB, leiomyoma and endometrial hyperplasia with or without atypia were the most common and seen in 16 (15.5%)and 18 (16.5%)cases.Conclusion: Endometrial sampling is now considered as first line diagnostic tool because of its diagnostic accuracy, safety, quickness and convenience.Histomorphological study of endometrium plays a important role in assisting in right treatment.The histopathological examination revealed significantly more cases of COEIN component of AUB.The PALM COEIN classification system helps us in understanding various etiological causes of AUB.