Histopathological study of endometrial abnormalities in women with abnormal uterine bleeding in a rural population

Background: Abnormal uterine bleeding (AUB) is one of the most frequently encountered gynecological complaints and may occur across different reproductive age groups. It can substantially impair quality of life and may arise from functional disturbances or structural abnormalities of the uterus and endometrium. Histopathological evaluation of endometrial tissue remains an important diagnostic modality for identifying the underlying pathology, particularly in resource-constrained rural settings where access to advanced diagnostic facilities may be limited. This study aimed to evaluate the histopathological patterns of endometrial abnormalities among women aged 19–65 years presenting with AUB in a rural population and to determine the frequency and spectrum of organic and non-organic endometrial findings. Methods: This cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology, F.H. Medical College and Hospital, Agra, from September 2023 to February 2025. A total of 278 women aged 19-65 years presenting with AUB and undergoing endometrial sampling were included. Endometrial tissue was obtained through biopsy or dilatation and curettage, processed routinely, stained with hematoxylin and eosin, and examined by light microscopy. Data were analyzed using descriptive statistics. Results: The highest proportion of patients belonged to the 31–35-year age group (30.93%). Menorrhagia was the most frequent bleeding pattern, accounting for 55% of cases. Among organic causes of AUB, endometrial hyperplasia was the predominant histopathological finding (76.60%), followed by endometritis (17.02%), endometrial carcinoma (4.26%), and endometrial polyps (2.13%). Among non-organic causes, secretory endometrium was the most frequent histopathological pattern (53.70%), followed by proliferative endometrium (44.44%), disordered proliferative endometrium (1.39%), and atrophic endometrium (0.46%). Conclusions: Histopathological examination of endometrial tissue provides valuable diagnostic information in women presenting with AUB and facilitates the identification of benign, premalignant, and malignant endometrial abnormalities. It remains a practical and accessible diagnostic approach, particularly in rural and resource-limited healthcare settings.