title: Clinical pattern and spectrum of endometrial pathologies in patients with abnormal uterine bleeding in Pakistan: need to adopt a more conservative approach to treatment.
abstract: BACKGROUND
  Abnormal uterine bleeding (AUB) is one of the most common debilitating menstrual problems and has remained one of the most frequent indications for hysterectomy in developing countries. Approximately in 40% of hysterectomy specimens, no definite organic pathology could be established. The problem is common worldwide but causes may vary from one region to another. This study may help gynecologists in our population to improve their therapeutic strategies by promoting minimally invasive uterus sparing modalities such as endometrial ablation and hysteroscopic resection of early proliferative lesions.
  
  
  METHODS
  It was a prospective, cross-sectional study conducted at Liaquat National Hospital from 15(th) January 2010 till 14(th) July 2011 over a period of 18 months. Women who underwent dilatation and curettage for endometrial sampling with complaints of AUB were included in the study and histopathologic spectrum was determined.
  
  
  RESULTS
  Polymenorrhea was the most common presenting pattern (30%, 72/241) with reproductive age women being the most susceptible (49.3%,119/241). The commonest histopathological spectrum was normal menstrual pattern (34%, 82/241) and the commonest pathology was hormonal imbalance (27%, 65/241), followed by endometrial polyp (14%, 34/241), chronic endometritis (12%, 28/241), atrophic endometrium (6%, 15/241), endometrial hyperplasia (5%, 12/241), and endometrial carcinoma (2%, 5/241). Chronic endometritis was commonly seen in reproductive age (18%, 21/119); hormonal imbalance (45%, 35/77) and endometrial hyperplasia (6.5%, 5/77) in perimenopausal age; endometrial polyp (35.5%, 16/45) and endometrial carcinoma (9%, 4/45) in postmenopausal age.
  
  
  CONCLUSIONS
  Frequency of benign endometrial pathology is quite high in AUB, 236 participants (98%, 236/241). Histopathological spectrum in patients with AUB is quite variable with respect to age. The most common pattern of AUB was polymenorrhea. The most common pathology was hormonal imbalance. It is suggested that age was associated with more progressive lesions found in peri and postmenopausal age group such as endometrial hyperplasia and endometrial carcinoma. Yet endometrial polyp was the most common pathology found in postmenopausal women. Therefore, the management strategy should be individualized, as in most cases a restrictive approach is appropriate in order to avoid unnecessary hysterectomies.
authors.affiliation: Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan. mariam.abid@aku.edu.
authors.forename: Mariam
authors.initials: M
authors.lastname: Abid
authors.affiliation: Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan. doc_atif2000@yahoo.com.
authors.forename: Atif Ali
authors.initials: AA
authors.lastname: Hashmi
authors.affiliation: Department of Medical Oncology, Sindh Institute of Urology & Transplantation, Karachi, Pakistan. babarmalik@gmail.com.
authors.forename: Babar
authors.initials: B
authors.lastname: Malik
authors.affiliation: Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan. saroona.haroon@aku.edu.
authors.forename: Saroona
authors.initials: S
authors.lastname: Haroon
authors.affiliation: Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan. naveen.faridi@gmail.com.
authors.forename: Naveen
authors.initials: N
authors.lastname: Faridi
authors.affiliation: Intern, Liaquat National Hospital and Medical College, Karachi, Pakistan. muzzamil10@hotmail.com.
authors.forename: Muhammad Muzzammil
authors.initials: MM
authors.lastname: Edhi
authors.affiliation: Dhaka Medical College, Dhaka, Bangladesh. mehmoodkhan955@yahoo.com.
authors.forename: Mehmood
authors.initials: M
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy / Q000150:complications; D002277:Carcinoma / Q000150:complications*; D002648:Child; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004700:Endocrine System Diseases / Q000150:complications; D016889:Endometrial Neoplasms / Q000150:complications*; D004716:Endometritis / Q000150:complications; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000150:complications; D008595:Menorrhagia / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008796:Metrorrhagia / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D009839:Oligomenorrhea / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D010154:Pakistan; D011127:Polyps / Q000150:complications*; D017698:Postmenopause; D011446:Prospective Studies; D055815:Young Adult