Organic causes of abnormal uterine bleeding-A clinico-pathological study based on PALM category of FIGO classification

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. The problem is common worldwide but causes may vary from one region to another. In about 25% of the patients, the abnormal uterine bleeding is the result of a well-defined organic abnormality.

It was a five year study conducted at a tertiary care hospital, Mumbai. Total of 804 Women who underwent surgical resections and biopsies with complaints of AUB were included in the study and histopathological spectrum of structural pathology was determined.

Most common age group affected was 36–45 years. Uterine corpus was common site of pathology (80.2%), followed by cervix (17.4%) Isolated pathology was found in 88.9% cases while multiple pathology in 10.1% cases. Benign pathology formed largest group (82.34%), commonest being leiomyoma (71.6%). Malignancy seen in 14.8% cases, most common malignancy being squamous cell carcinoma (72.72%). Menorrhagia was commonest presentation (64.6%), followed by postmenopausal bleeding (20%) & polymenorrhagia (14.6%). In postmenopausal age group, malignancy was (46.3%) more as compared to age <40 years (8.7%). Rare cases presenting as AUB were encountered viz. serous cystadenoma, mature cystic teratoma and serous cystadenocarcinoma of ovary, malignant mixed mullerian tumor of uterus, metastasis to uterine corpus, and small round cell tumor of cervix.

Frequency of benign endometrial pathology as underlying organic cause of AUB is quite high. However, histopathological spectrum in patients with AUB is quite variable with respect to age with increased chances of detecting malignancy in elder females. Therefore Histopathological examination of endometrium should be done generously in women presenting with abnormal uterine bleeding especially after the age of 40 years to rule out malignancy.