title: Morphological spectrum of endometrial pathology in middle-aged women with atypical uterine bleeding: A study of 219 cases.
abstract: BACKGROUND
  Perimenopause, also called the menopausal transition, is the interval in which a woman's body makes a natural shift from more-or-less regular cycles of ovulation and menstruation toward permanent infertility, or menopause.
  
  
  METHODS
  A retrospective age specific comparative analysis of 219 perimenopausal women presenting with abnormal uterine bleeding was done who underwent endometrial sampling during a 4-year period from January 2008 to April 2012 at the Hakeem Abdul Hameed Centenary Hospital. Endometrial tissue collected by sampling procedures such as dilatation and curettage (D and C), endometrial biopsy and fractional curettage had been sent to the pathology laboratory for evaluation.
  
  
  RESULTS
  The most common clinical presentation was represented by menorrhagia (46.4%) followed by metrorrhagia (20%), menometrorrhagia, polymenorrhea, polymenorrhagia among others. Evaluation of the endometrium revealed various patterns on histopathology, functional causes accounted for majority of the diagnosis. Secretory endometrium seen in 71 cases (32.4%) was the most common. While proliferative endometrium on histopathology was the second most common diagnosis; seen in 67 patients (30.5%). Endometrial hyperplasia was seen in 24 (10.9%) cases out of which simple hyperplasia without atypia was seen in 19, complex hyperplasia without atypia was seen in 4 and complex hyperplasia with atypia was seen in 1 case. The other diagnoses, which accounted for the rest of the functional causes of atypical uterine bleeding, were disordered proliferative endometrium 15 cases (6.8%), luteal phase defects 3 cases (1.3%).
  
  
  CONCLUSIONS
  Atypical uterine bleeding in perimenopausal women is most commonly dysfunctional in origin. In addition, a significant number show underlying organic pathologies thereby highlighting the importance of endometrial curetting and biopsy as a diagnostic procedure in the evaluation.
authors.affiliation: Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Jetley
authors.affiliation: Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, India.
authors.forename: Safia
authors.initials: S
authors.lastname: Rana
authors.affiliation: Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, India.
authors.forename: Zeeba Shamim
authors.initials: ZS
authors.lastname: Jairajpuri
keywords: Atypical; bleeding; endometrium; hyperplasia