Clinicopathological study of abnormal uterine bleeding in perimenopausal women

Background: Until recently, perimenopause has been little understood and ignored especially in developing the country like India. It is a distinct entity from menopause and in terms of symptomatology, it may be even more important than postmenopause. Aims and Objectives: (1) To ascertain the cause of abnormal uterine bleeding in perimenopausal women (40-55 years). (2) To study the spectrum of morphological changes in perimenopausal bleeding with high-risk factors predisposing to endometrial hyperplasia and malignancy. Materials and Methods: The study was undertaken in a large tertiary care teaching hospital over a period of 3 years. All the outdoor and indoor patients presenting with abnormal uterine bleeding with or without other clinical features in the perimenopausal age group (40-55 years) were included in the study. Women with menstrual cycles of 21-35 days with a duration of flow of 2-6 days were considered normal and were excluded from the study. Specimen considered for histopathological study included endometrial biopsy, dilation and curettage, fractional curettage, cervical biopsy, and or hysterectomy with or without salpingo-oophrectomy done for diagnostic or therapeutic purposes. Statistics Used: Totally, 100 cases were selected on the basis of simple random sampling and analyzed. Results: Most of the patients were in the age group of 40-45 (45%) with menorrhagia as the chief complaint. The bulk of the specimens were of total hysterectomy with bilateral salpingo-oophrectomy (43%). Functional endometrial changes were the most common cause in 40-50 years age group but endometrial carcinoma was the main cause of bleeding in the 51-55 years group indicating heightened occurrence of malignancy with increasing age