Clinicopathological Spectrum of Abnormal Uterine Bleeding in Perimenopausal Women: A Histopathological Study
DOI:
https://doi.org/10.66328/ijprmh.2026.020203Keywords:
Abnormal uterine bleeding, Perimenopause, Endometrial biopsy, Endometrial hyperplasia, Endometrial carcinomaAbstract
Received: 07-06-2026
Revised: 17-06-2026
Accepted: 22-06-2026
Introduction: Abnormal uterine bleeding (AUB) is a common gynecological complaint among perimenopausal women and may represent a spectrum of endometrial changes ranging from physiological hormonal alterations to premalignant and malignant lesions. Histopathological evaluation remains the definitive diagnostic modality for identifying the underlying pathology and guiding management.
Materials and Methods: A hospital-based cross-sectional study was conducted on 320 perimenopausal women aged 40–55 years presenting with AUB who underwent endometrial sampling. Clinical, demographic, and ultrasonographic data were recorded. Endometrial specimens obtained through biopsy, curettage, or hysterectomy were processed and examined histopathologically according to contemporary WHO criteria. Associations between clinicopathological variables were analyzed using appropriate statistical tests and multivariable logistic regression.
Results: The mean age of participants was 47.8 ± 4.2 years. Heavy menstrual bleeding was the predominant presentation (40.6%). Histopathological examination revealed proliferative endometrium as the most frequent finding (28.8%), followed by secretory endometrium (15.0%) and disordered proliferative endometrium (13.1%). Endometrial hyperplasia without atypia and atypical hyperplasia/endometrial intraepithelial neoplasia were identified in 12.2% and 4.1% of cases, respectively. Endometrial carcinoma was diagnosed in 4.0% of women. Endometrial thickness >12 mm showed a significant association with premalignant and malignant lesions (p<0.001). Multivariable analysis identified age ≥50 years, obesity, diabetes mellitus, and endometrial thickness >12 mm as independent predictors of significant endometrial pathology.
Conclusion: Functional endometrial alterations constitute the majority of AUB cases in perimenopausal women; however, a substantial proportion harbor premalignant or malignant lesions. Endometrial sampling remains indispensable for early detection, particularly in women with advanced age, obesity, diabetes, and increased endometrial thickness.
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Copyright (c) 2026 Shazia Iqbal, Pratiksha Shrestha, Sumanjari Pradhan (Author)
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