HISTOPATHOLOGICAL EVALUATION OF ENDOMETRIAL CURETTINGS IN PERIMENOPAUSAL WOMEN PRESENTING WITH ABNORMAL UTERINE BLEEDING (AUB)

BACKGROUND Abnormal Uterine Bleeding (AUB) includes both Dysfunctional Uterine Bleeding (DUB) where no demonstrable pathology is seen and bleeding from causes like polyp, leiomyoma, hyperplasia and carcinoma. AUB accounts for more than 70% of all gynaecological consultation in perimenopausal age group. Endometrial curettage is an important diagnostic tool to rule out organic cases like endometrial hyperplasia and endometrial carcinoma. MATERIALS AND METHODS The study was carried out at department of Pathology, Govt. Medical College, Jammu, over a period of 1 year from Feb 1, 2017 to Jan 31, 2018. The study was conducted on 60 endometrial samples obtained from perimenopausal women (41-50 years), presenting with abnormal uterine bleeding. RESULTS The most common clinical presentation was menorrhagia (51%), followed by metrorrhagia (25%), polymenorrhagia (13%), menometrorrhagia (8%) and oligomenorrhagia (3%). Among the total 60 cases, non-organic/ functional causes accounted for 63% (42 cases) of the total cases, while organic causes were seen in 37%(18 cases). The most common endometrial pattern seen among functional cases of AUB was proliferative endometrium in 27% (16 cases) ,followed by secretary endometrium in 15%( 9 cases) ,atrophic endometrium in 10%( 6 cases) and iatrogenic endometrium in 7% (4 cases) Among the organic causes, the commonest was simple hyperplasia without atypia comprising 12% (7 cases), followed by polyp 7%(4 cases).Complex hyperplasia without atypia and atypical hyperplasia comprised 5% (3 cases) each while chronic endometritis was seen in 5% cases(3 cases).Endometrial carcinoma was noted in 1% (2 cases), both cases were of adenocarcinoma. CONCLUSION Histopathological evaluation of endometrial curetting yielded various patterns ranging from physiological to pathological lesions of endometrium. Functional/non-organic causes were most frequently seen than organic causes. Amongst organic causes, hyperplasias were the predominant cause. As endometrial hyperplasia is a precursor of endometrial cancer, with overall risk of progression to cancer being 5-10%, its identification is important in perimenopausal patients presenting with AU