Histomorphological Profile of Endometrium in Perimenopausal Bleeding

Background: Perimenopausal bleeding is one of the commonest conditions for which patients come to the gynecological outpatient department. The prevalence increases with age peaking just before menopause. Anovulatory cycles causing excessive, uncontrolled and prolonged bleeding, irrespective of the etiology, are the commonest cause for such bleeding in the perimenopausal women. Perimenopause is 2-8 years proceeding and 1 year after menopause. It occurs in women between the ages of 40 to 50 years. Aim: To evaluate the histomorphological profile of Endometrial Biopsies of 200 women with perimenopausal bleeding coming to the Gynaecological outpatient Department Gandhi Hospital, from January to December, 2015. Materials and methods: Endometrial curettings were obtained from 200 women clinically diagnosed to have perimenopausal bleeding. The curettings were fixed in 10% formalin, which were then processed. The slides were stained with Haematoxylin and Eosin (H&E) and their histomorphological pattern was noted. Results: Out of a total of 387 cases with dysfunctional uterine bleeding (DUB), 200 cases had perimenopausal bleeding. Most of the patients were between 46 to 50 years of age. The most important cause of perimenopausal bleeding was proliferative endometrium seen in 85 cases, followed by secretory endometrium in 49 cases. We had 36 cases of fibroids, 16 cases of simple hyperplasia, 5 cases of endometrial polyps, 4 cases of complex hyperplasia without atypia, 3 cases of complex hyperplasia with atypia and 2 cases of endometrial carcinoma. Conclusion: Perimenopausal bleeding is common between the ages of 40 to 50 years, with a peak in the ages between 46 to 50 years. Though the commonest histomorphological profile of the endometrial curettings obtained from such patients was proliferative phase, there were cases of hyperplasia’s both simple and complex with atypia. There were 2 cases of endometrial carcinomas. Hence it is important to understand the cause of such bleeding and study the histomorphological pattern to diagnose hyperplasia’s which are premalignant lesions of the endometrium and endometrial carcinoma at an early stage and prevent its complications.