Skip to main content
SpringerLink
Log in

Ultrasonic and Histopathological Evaluation to Exclude Premalignant and Malignant Lesions in Perimenopausal and Postmenopausal Women Presenting as Abnormal Uterine Bleeding

  • Original Article
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Introduction

Abnormal uterine bleeding may be defined as bleeding pattern that differs in frequency, duration and amount from a pattern observed during a normal menstrual cycle or after menopause.

Aim and Objective

The aim of this study was (1) to identify the different benign, premalignant and malignant conditions as the cause of abnormal uterine bleeding in perimenopausal and postmenopausal women and (2) to find out the different histopathological patterns of endometrium and cervix in these women.

Materials and Methods

This is a prospective study done in gynaecological oncology in 100 cases attending the OPD. Pap smear and cervical biopsy were done following clinical examination and then, the patients were sent for abdominal and pelvic ultrasound examination. Endometrial biopsy was done if endometrial thickness was increased with respect to age. The cut-off value of endometrial thickness in perimenopausal women was 11 mm, and for postmenopausal women, it was 4 mm, respectively. All the tissue specimens were sent for histopathological examination.

Result

A total of 100 women were evaluated in which 50% were in the perimenopausal age group and 50% in the menopausal age group. Cervical pathology was present in 47% of cases, organic cause of uterine body like fibroid and adenomyosis was present in 26% of women, and thickened endometrium was seen in 24% of cases and endometrial polyp in 3 cases only. In this study, the incidence of benign cases was 49%, premalignant 9% and malignant condition 42%, respectively. Out of 42 malignant cases, 37 (88.09%) were cervical cancer, 3 (7.14%) endometrial carcinoma, 1 (2.38%) vulval cancer and 1 sarcoma of uterus. With regard to histology of endometrium, 34.48% had simple hyperplasia without atypia, 20.68% hyperplasia with atypia and secretory endometrium, and 10.34% endometrial carcinoma. Histologically, 94.59% of cervical cancer was squamous cell carcinoma and 5.40% was adenocarcinoma.

Conclusion

Evaluation of cases of perimenopausal and postmenopausal bleeding differentiated premalignant and malignant lesions of the uterine body, endometrium and cervix. As our centre is a Regional Cancer Centre of Bihar, incidence of malignant lesions is higher in our centre.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Zeeba S, Jairajpuri S, Rana S, et al. Atypical uterine bleeding-histopathological audit of endometrium a study of 638 cases. AI Ameen J Med Sci. 2013;6(1):21–8.

    Google Scholar 

  2. Mahajan N, Aggarwal M, Bagga A. Health issues of menopausal women in North India. J Midlife Health. 2012;3:84–7.

    PubMed  PubMed Central  Google Scholar 

  3. Kumar P, Malhotra N. Clinical types of abnormal uterine bleeding. In: Kumar P, editor. Jeffcoate’s principle of gynecology. 7th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2008. p. 599.

    Google Scholar 

  4. Bhoomika D, Gauravi D. Histopathological study of endometrium in dysfunctional uterine bleeding. Int J Res Med. 2013;2(1):20–4.

    Google Scholar 

  5. Munro MG, Critchley HO, Fraser IS. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: Who needs them? Am J Obstet Gynecol. 2012;207:259–65.

    Article  Google Scholar 

  6. Bhosle A, Fonseca M. Evaluation and histopathological correlation of abnormal uterine bleeding in perimenopausal women. Bombay Hosp J. 2010;52(1):69–72.

    Google Scholar 

  7. Cornitescu Fl, Tanase F, Simionescu C, et al. Clinical, histopathological, and therapeutic considerations in non-neoplastic abnormal uterine bleeding in menopause transition. Rom J Morphol Embryol. 2011;52(3):759–65.

    CAS  PubMed  Google Scholar 

  8. Kaul I, Kalsi M, Anand AK, et al. MeniaTransvaginalsonographyversusHistopathologyinPostmenopausalBleeding: a prospective study. JK Sci. 2012;14(3):129–33.

    Google Scholar 

  9. Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle-aged women with atypical uterine bleeding: a study of 219 cases. J Midlife Health. 2013;4:216–20.

    PubMed  PubMed Central  Google Scholar 

  10. Shobha PS. Sonographic and histopathological correlation and evaluation of endometrium in perimenopausal women with abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynaecol. 2014;3:113–7.

    Google Scholar 

  11. Kothapally K, Bhashyakarla U. Postmenopausal bleeding: clinicopathologic study in a teaching hospital of Andhra Pradesh. Int J Reprod Contracept Obstet Gynecol. 2013;2(3):344–8.

    Article  Google Scholar 

  12. Bharti B, Satish RP. Feasibility, and yield of endometrial biopsy using suction curette device for evaluation of abnormal pre and postmenopausal bleeding. J Obstet Gynecol India. 2008;58(4):322–6.

    Google Scholar 

  13. Khare A, Bansal R, Sarma S, et al. Morphological spectrum of endometrium in patients presenting with dysfunctional uterine bleeding. People J Sci Res. 2012;5:13–6.

    Article  Google Scholar 

  14. Desai K, Patole KP, Kathaley M. Endometrial evaluation by histopathology in abnormal uterine bleeding in perimenopausal and postmenopausal patients MVP. J Med ScI. 2014;1(2):75–9.

    Google Scholar 

  15. Nirupama V, Suneetha Y, Prabha Devi K. Post Menopausal bleeding: an analytic study of 100 cases. IJSR 2015;4(6):2588–90.

    Google Scholar 

  16. Ojiyi EC, Dike EI, Nzewuihe AC, et al. Epidemiology of cervical cancer at the Anambra State University Teaching Hospital, Awka. Trop J Med Sci. 2012;1:10–3.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gynecological Oncology, RCC, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, 800014, India

    Anita Kumari, Sangeeta Pankaj, Jaya Kumari, Syed Nazneen & Anjili Kumari

  2. Pathology, IGIMS, Patna, India

    Vijayanand Choudhary

  3. Radiology, IGIMS, Patna, India

    Sanjay Kumar Suman

  4. Biostatics, IGIMS, Patna, India

    Shishir Kumar

Authors
  1. Anita Kumari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sangeeta Pankaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vijayanand Choudhary
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jaya Kumari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Syed Nazneen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anjili Kumari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sanjay Kumar Suman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shishir Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sangeeta Pankaj.

Ethics declarations

Conflict of interest

We declare that this manuscript is original, and it has not been published anywhere before and is not currently being considered for publication elsewhere. We also confirm that the authors do not have any conflict of interest associated with publication of this work, and no significant financial support/funding for this work has been received to influence the outcome. The manuscript is read and approved, and consent is given by all the authors. We give our permission to reproduce any material of the article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Additional information

Dr. Anita Kumari is a senior resident in Gynecological Oncology, RCC, IGIMS, Patna; Dr. Sangeeta Pankaj is an Additional Professor in Gynecological Oncology, RCC, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna; Dr. Vijayanand Choudhary is an Additional Professor, Pathology, IGIMS, Patna; Dr. Jaya Kumari is a senior resident in Gynecological Oncology, RCC, IGIMS, Patna; Dr. Syed Nazneen is a senior resident in Gynecological Oncology, RCC, IGIMS, Patna; Dr. Anjili Kumari is a senior resident in Gynecological Oncology, RCC, IGIMS, Patna; Dr. Sanjay Kumar Suman is a HOD at Radiology, IGIMS, Patna; and Dr. Shishir Kumar is a Assistant Professor at Biostatics.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumari, A., Pankaj, S., Choudhary, V. et al. Ultrasonic and Histopathological Evaluation to Exclude Premalignant and Malignant Lesions in Perimenopausal and Postmenopausal Women Presenting as Abnormal Uterine Bleeding. J Obstet Gynecol India 69 (Suppl 2), 171–176 (2019). https://doi.org/10.1007/s13224-018-1166-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-018-1166-9

Keywords

Search

Navigation