Spectrum of endometrial pathologies in abnormal uterine bleeding: A retrospective descriptive study.

Abstract

Background

Abnormal uterine bleeding (AUB) is one of the most frequent gynecological complaints affecting women of all reproductive and perimenopausal ages. Histopathological evaluation of the endometrium remains the cornerstone for identifying the underlying causes, which may range from benign hormonal imbalance to premalignant or malignant lesions.

 Objectives

To describe the histopathological spectrum of endometrial lesions in women presenting with abnormal uterine bleeding (AUB) over two years

 Methods

This retrospective study included 50 cases of AUB evaluated over two years. Endometrial biopsy and curettage specimens were reviewed, and histopathological patterns were categorized as functional, structural, inflammatory, or neoplastic. Clinical data such as age, menopausal status, and bleeding pattern were retrieved from medical records and analyzed descriptively.

 Results

The mean age of participants was 42.3 ± 8.1 years, with the highest incidence (46%) in the 41–50-year age group. Menorrhagia (46%) was the most common clinical presentation. Histopathological examination revealed proliferative endometrium (20%), secretory endometrium (16%), endometrial hyperplasia (16%), and disordered proliferative pattern (12%) as the major findings. Structural lesions included endometrial polyps (8%) and carcinoma (4%), while atrophic and inflammatory changes accounted for 6% each. Hyperplasia was most frequent in the perimenopausal group, whereas carcinoma was confined to postmenopausal women.

 Conclusion

The predominance of functional and hyperplastic endometrial patterns in AUB underscores the hormonal etiology of bleeding in most women, particularly during the perimenopausal transition. Routine histopathological evaluation of endometrial samples is essential to detect precancerous and malignant conditions early.

 Recommendations

All women with persistent or recurrent AUB—especially those aged ≥40 years or postmenopausal should undergo endometrial sampling for definitive diagnosis. Integrating histopathological assessment with hormonal evaluation and imaging improves diagnostic accuracy and guides targeted management.