Abnormal uterine bleeding in perimenopausal women: Clinical histopathological and sonography correlation

Objective: Patient who underwent hysterectomy for Abnormal Uterine Bleeding their clinical findings were related to sonography and histopathology reports. Materials and Methods: This is retrospective observational study conducted in obstetric and gynaecology department. Patient who have undergone hysterectomy for AUB, their data retrived from case file and their ultrasonography reports and histopathological examination reports were compared. Results: 153 women who have under gone hysterectomy had complaint of menorrhagia and they belong to perimenopausal age group, most of them were between 40-45 years of age. Ultrasonography is suggestive of fibroid in most of the patients and it is most sensitive for diagnosis of uterine fibroid. Conclusion: Fibroid is a most common cause of AUB. Clinical, sonography and histopathological findings correlated well with the diagnosis. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license (https://creativecommons.org/licenses/by-nc/4.0/)


Introduction
Abnormality in frequency, regularity, duration or volume of bleeding in women of reproductive age is called Abnormal Uterine Bleeding (AUB). Quality of life is affected as it is associated with pain and discomfort. AUB leads to loss of productivity 1 and may result in surgical intervention including hysterectomy. 2 AUB affects 9 to 14% women between menarche and menopause. 3 In India, the reported prevalence is around 17.9%. 4 AUB patterns include menorrhagia, metrorrhagia, polymenorrhea, dysfunctional uterine bleeding and heavy menstrual bleeding.
To standardize nomenclature of AUB a system known by acronym PALM-COEIN was introduced in 2011 by FIGO. 5 Normal and abnormal parameters of menstruation parameters are characterized under FIGO nomenclature.

Exclusion criteria
1. Patient wanted medical management were excluded 2. Patient who under went hysterectomy for reason other than AUB were excluded (eg: endometriosis, mental retardation).

Results
153 women who underwent hysterectomy in them relation between Age and Parity was compared. Maximum patients are in between 40 and 45 years of age group (67.9%). It also depicts that chances of AUB increases with Parity. Majority of patients decides to undergo surgical intervention after 3-6 months of menstrual problem and menorrhagia is dominant symptom. In Indian population they either prefer medical management or donot take any treatment at all.

Discussion
Abnormal uterine bleeding is leading cause of hysterectomy in Perimenopausal women. In this study 153 perimenopausal women who underwent hysterectomy were evaluated. Majority of the women were between 40 to 45 years of age with higher parity and most common symptom was Menorrhagia (44.44%). The study of Jetley et al. 6 and Shobha, 7 in which clinical presentation as menorrhagia in AUB evaluation revealed 46.4% and 46.6%, respectively is comparable to this study. Ultrasonography is more sensitive for detection of uterine fibroid and less sensitive for Adenomyosis. Whereas, specicificity to diagnose Adenomyosis is comparatively better.
Maximum patient had undergone surgical treatment after suffering for 3 to 6 month (54.98%) which is similar to the study of Kathuria and Bhatnagar (50%). 8 Out of 76 ultrasonographic diagnosed uterine fibroid was 76 (49.67%) 69 were confirmed on histopathology report,  Fibroid  32  16  13  13  2  Bulky Uterus  14  6  9  2  0  Adenomyosis  19  3  4  2  0  Thickened  endometrium   3  3  2  2  4 Polyp -   and remaining 7 were adenomyosis. The sensitivity of USG for the diagnosis of uterine fibroid is 93.24%, and the specificity is 91.13%, which is comparable to Dueholm et al. 9 Among 42 cases of Adenomyosis which were diagnosed in histopathology report, only 26 were detected by ulrasonography. Sensitivity of ultrasound for diagnosis of Adenomyosis is low (61.9%), but specificity is same as compared to the studies of Siedler et al, Ascher et al, and Atri et al. [10][11][12] Hence, tissue characterization can be cosidedered as limitation of USG in diagnosis of adenomyosis.

Conclusion
Leiomyoma is major cause of abnormal uterine bleeding for which hysterectomy is done. Clinical, sonography and histopathological findings correlated well for diagnosis of fibroids. As sensitivity of USG to diagnose Adenomyosis is low therefore, USG alone cannot rule out the diagnosis other modalities should be considered if clinical findings were consistent with Adenomyosis.

Source of Funding
None.

Conflict of Interest
None.