Clinicopathological Profile of Disordered Proliferative Endometrium in Anovulatory Abnormal Uterine Bleeding and Determinants of Response to Levonorgestrel-Releasing Intrauterine System Therapy

Abstract Disordered proliferative endometrium is an under-recognized endometrial lesion, with limited evidence regarding its clinicopathological characteristics and predictors of treatment response. The present study aimed to characterize the clinical and histomorphological features of disordered proliferative endometrium, evaluate the response to treatment with a levonorgestrel-releasing intrauterine system, and identify the clinicopathological determinants of progesterone responsiveness. A 3-year cross-sectional study was conducted involving 124 women with histopathologically confirmed disordered proliferative endometrium. Clinical, demographic, radiological, and histopathological parameters were analysed, and the treatment response to the levonorgestrel-releasing intrauterine system was assessed after 3 months using pictorial blood assessment chart scores and symptom improvement. The median age at presentation was 42 years, with 59.7% of patients belonging to the perimenopausal age group (40–49 y). Heavy menstrual bleeding was the predominant presenting complaint (68.5%). Most patients were overweight or obese (64.5%), and 85.5% had anaemia. Hypertension (22.6%), hypothyroidism (13.7%), and diabetes mellitus (12.1%) were the most common associated comorbidities, while coexisting gynaecological pathologies were identified in 23.4% of cases. Histopathological examination consistently demonstrated focal glandular crowding and cystic glandular dilatation, with gland-to-stroma ratios ranging from 30:70 to 60:40; an irregular glandular architecture was observed in 93.5% of cases. Following levonorgestrel-releasing intrauterine system insertion, 69.4% of patients experienced significant clinical improvement. A higher body mass index was the only independent predictor of reduced treatment response. Disordered proliferative endometrium predominantly affects perimenopausal women with heavy menstrual bleeding and metabolic risk factors, exhibits characteristic histomorphological features, and responds well to progesterone therapy in most cases. Recognition of factors influencing the treatment response may facilitate individualized management and improve clinical outcomes.