Body mass index trumps age in decision for endometrial biopsy: cohort study of symptomatic premenopausal women.
BACKGROUND
Clinical guidelines recommend that women with abnormal uterine bleeding with risk factors have an endometrial biopsy to exclude hyperplasia or cancer. Given the majority of endometrial cancer occurs in postmenopausal women, it has not been widely recognized that obesity is a significant risk factor for endometrial hyperplasia and cancer in young, symptomatic, premenopausal women.


OBJECTIVE
We sought to evaluate the effect of body mass index on risk of endometrial hyperplasia or cancer in premenopausal women with abnormal uterine bleeding.


METHODS
This was a retrospective cohort study in a single large urban secondary women's health service. Participants were 916 premenopausal women referred for abnormal uterine bleeding of any cause and had an endometrial biopsy from 2008 through 2014. The primary outcome was complex endometrial hyperplasia (with or without atypia) or endometrial cancer.


RESULTS
Almost 5% of participants had complex endometrial hyperplasia or cancer. After adjusting for clinical and demographic factors, women with a measured body mass index ≥30 kg/m2were 4 times more likely to develop complex hyperplasia or cancer (95% confidence interval, 1.36-11.74). Other risk factors were nulliparity (adjusted odds ratio, 3.08; 95% confidence interval, 1.43-6.64) and anemia (adjusted odds ratio, 2.23; 95% confidence interval, 1.14-4.35). Age, diabetes, and menstrual history were not significant.


CONCLUSIONS
Obesity is an important risk factor for complex endometrial hyperplasia or cancer in premenopausal women with abnormal uterine bleeding who had an endometrial biopsy in a secondary gynecology service. As over half of women with the outcome in this study were age <45 years, deciding to biopsy primarily based on age, as currently recommended in national guidelines, potentially misses many cases or delays diagnosis. Body mass index should be the first stratification in the decision to perform endometrial biopsy and/or to refer secondary gynecology services.
Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. Electronic address: m.wise@auckland.ac.nz.
Michelle R
MR
Wise
Department of Obstetrics and Gynecology, North Shore Hospital, Auckland, New Zealand.
Premjit
P
Gill
Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Sarah
S
Lensen
Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
John M D
JM
Thompson
Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Cynthia M
CM
Farquhar
D000328:Adult; D000367:Age Factors; D001706:Biopsy; D015992:Body Mass Index; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D004714:Endometrial Hyperplasia / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D016889:Endometrial Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology*; D017697:Premenopause; D012189:Retrospective Studies; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000453:epidemiology* / Q000209:etiology
biopsy; endometrial hyperplasia; endometrial neoplasms; menorrhagia; menstruation disturbances; obesity; premenopause