title: Could body mass index be an indicator for endometrial biopsy in premenopausal women with heavy menstrual bleeding?
abstract: To evaluate the role of body mass index (BMI) in women with premenopausal heavy menstrual bleeding (HMB) to identify patients who should undergo endometrial biopsy.
  
  
  
  This prospective cohort study included 1120 premenopausal women who presented to the Gynecology Clinic, Bakirkoy Dr. Sadi Konuk Training and Research Hospital in Istanbul, Turkey, due to HMB and who underwent endometrial sampling. The abnormal endometrial histopathological results were analyzed by separating patients into groups of all abnormal findings (hyperplasia without atypia + hyperplasia with atypia + carcinoma) and hyperplasia with atypia + carcinoma. Sensitivity and specificity of the abnormal histopathological results were calculated in both groups using BMI cut-off values as 25, 30 and 35 and age cut-offs as 40 and 45 years.
  
  
  
  The rate of hyperplasia with atypia and carcinoma was sevenfold higher in women with a BMI ≥30 compared to those with a BMI ≤30 (95 % CI 2.4-17.9). In the analyses, BMI was a stronger risk factor in women younger than 45 years of age. The risk of endometrial carcinoma and atypical hyperplasia was twofold higher in patients older than 45 years when compared with patients younger than 45 years (95 % CI 1.1-5.1).
  
  
  
  All women with a BMI ≥30 and presenting premenopausal HMB should undergo endometrial biopsy regardless of age.
authors.affiliation: Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Guraslan
authors.affiliation: Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: Keziban
authors.initials: K
authors.lastname: Dogan
authors.affiliation: Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey. drcihankaya@gmail.com.
authors.forename: Cihan
authors.initials: C
authors.lastname: Kaya
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Teaching and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet Baki
authors.initials: MB
authors.lastname: Senturk
authors.affiliation: Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: Birgul
authors.initials: B
authors.lastname: Guraslan
authors.affiliation: Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: Caglar
authors.initials: C
authors.lastname: Helvacioglu
authors.affiliation: Department of Gynecologic Oncology, Kanuni Sultan Suleyman Teaching and Research Hospital, Istanbul, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Akbayir
authors.affiliation: Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, 34147, Istanbul, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Yasar
mesh_terms: D000328:Adult; D001706:Biopsy; D015992:Body Mass Index; D004714:Endometrial Hyperplasia / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000473:pathology*; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D008595:Menorrhagia; D008875:Middle Aged; D017697:Premenopause; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014421:Turkey
keywords: Body mass index; Endometrial carcinoma; Endometrial hyperplasia; Endometrial sampling; Premenopausal bleeding