1
|
Karimi M, Alizadeh A, Mahmoodi M. Clinicopathological Pattern of Endometrial Specimens in Women with Abnormal Uterine Bleeding and Ultrasonography Correlation. ARCHIVES OF IRANIAN MEDICINE 2024; 27:216-222. [PMID: 38685848 PMCID: PMC11097308 DOI: 10.34172/aim.2024.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) refers to any symptomatic deviation from normal menstruation. AUB is a common gynecological disorder in non-pregnant women of reproductive age, accounting for approximately 33% of gynecological outpatient visits. The early diagnosis and management cause of AUB is important because of increased incidence of endometrial carcinoma with rapid growth. Transvaginal ultrasound is non-invasive imaging technique used to find endometrial carcinoma before referring patients for invasive techniques. Dilatation and curettage (D&C) and endometrial biopsy are surgical procedures that scrape the endometrial lining of the uterus for diagnosis and treatment. The aim of this study is to describe the clinicopathologic pattern of endometrial specimens in women with AUB and ultrasonographic correlation. METHODS Tissues from endometrial biopsy and curettage of 411 patients with AUB who referred to Shahid Mohammadi hospital were prospectively selected from 2021 to 2023. Patients were divided into three groups based on age and menstrual status including: premenopausal (18-39 years), perimenopausal (40-49 years) and postmenopausal (≥50 years). The results were correlated to patient's age and other data and evaluated with statistical analysis. RESULTS During the two-year study period, a total of 411 endometrial specimens with clinical diagnosis of AUB were submitted and the results were analyzed. The youngest patient presenting with AUB was 21 years old, while the oldest was 77 years old. The most common complaint was menorrhagia in 201 (48.0%) out of 411 patients. The most common pathology finding in three groups was polyp in 100 (24.3%) cases. Hormonal effect was the next commonly observed pattern seen in 70 (17.0%) cases. P value was calculated as 0.003 which was significant using chi-square for the trend seen in age. CONCLUSION Endometrial sampling is a useful tool for evaluation of women with AUB and referring patients for treatment. Histopathological evaluation of the endometrium is very useful in detecting the etiology of AUB. Transvaginal sonography has high sensitivity in detecting polyps.
Collapse
Affiliation(s)
- Mohadeseh Karimi
- Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Anahita Alizadeh
- Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Mahmoodi
- Department of Biostatistics, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| |
Collapse
|
2
|
Jose AA, Daniel M, Phansalkar MD. Hysteropathological Correlation in Abnormal Uterine Bleeding in a Tertiary Care Hospital in South India. J Obstet Gynaecol India 2024; 74:150-157. [PMID: 38707886 PMCID: PMC11065816 DOI: 10.1007/s13224-023-01888-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/15/2023] [Indexed: 05/07/2024] Open
Abstract
Background Abnormal uterine bleeding is a common problem mainly encountered in reproductive age group and post-menopausal women. Hysteroscopy is a safe, simple, well tolerated and reliable procedure for the diagnosis of AUB across all age groups. The aim of the study is to determine the association of hysteroscopy and histopathologic examination (HPE) findings in abnormal uterine bleeding. The secondary objective of the study are to enumerate the hysteroscopy findings in patients with AUB and to evaluate the pattern of AUB. Materials and Methods Observational cross-sectional study among 60 women in reproductive and post-menopausal age group presenting with features/symptoms suggestive of abnormal uterine bleeding were studied. All patients reporting in the outpatient department (OPD) and who are eligible to participate were included in the study, after obtaining written informed consent. Detailed history, Clinical examination, Ultrasound pelvis and endometrial thickness assessment is done. Hysteroscopic findings were compared against histopathological findings. Results The various patterns of bleeding documented in our study population were menorrhagia, metrorrhagia, menometrorrhagia, polymenorrhea, and post-menopausal bleeding. Out of these patterns, the commonest was menorrhagia at 50.0% and post-menopausal bleeding at 26.67%. In our study population, the various hysteroscopy findings were strawberry, tongue-shaped projections, pebble stones, polypoidal patterns, and cerebroid patterns. Out of these, the most common was a polypoidal pattern, strawberry pattern, and tongue-shaped projections with 45%, 31.67%, and 26.7%, respectively. The most common histopathology finding was secretory and proliferative constituting 35% and 26.67%, respectively. Carcinoma endometrium constitutes about 6.67% of the study population. The sensitivity, specificity, PPV, and NPV of strawberry appearance in hysteroscopy in comparison with secretory changes in histopathology were 52.38%, 79.49%, 57.89%, and 75.61%, respectively. The sensitivity, specificity, PPV, and NPV of tongue-shaped projections appearance in hysteroscopy in comparison with HPE findings was 60%, 76.36%, 18.75%, and 95.45%, respectively. The sensitivity, specificity, PPV, and NPV of polypoidal pattern in hysteroscopy in comparison with Endometrial hyperplasia in histopathology was 66.67%, 56.14%, 7.41%, and 96.97%, respectively. The sensitivity, specificity, PPV, and NPV of cerebroid appearance in hysteroscopy in comparison with carcinoma endometrium in histopathology were 75.0%, 100%, 100%, and 98.25%, respectively. This correlation of cerebroid pattern with carcinoma endometrium was highly significant. Among all correlations, the highly reliable was in Carcinoma endometrium followed by endometrial polyps. Conclusion Hysteroscopy has high sensitivity and specificity in diagnosing intrauterine pathology especially endometrial cancer followed by endometrial polyps. Among the various patterns of abnormal uterine bleeding, menorrhagia was the most common. A combination of hysteroscopy and endometrial sampling was found to increase diagnostic accuracy in patients with abnormal uterine bleeding and will effectively guide us in planning the appropriate management for these patients.
Collapse
Affiliation(s)
- Ashwin Antony Jose
- Department of Obstetrics & Gynaecology, Indira Gandhi Medical College and Research Institute, A Government of Puducherry Institution, Puducherry, India
| | - Mary Daniel
- Department of Obstetrics & Gynaecology, Pondicherry Institute of Medical Sciences, (A Unit of the Madras Medical Mission), Puducherry, India
| | - Manjiri Dilip Phansalkar
- Department of Pathology, Pondicherry Institute of Medical Sciences, (A Unit of the Madras Medical Mission), Puducherry, India
| |
Collapse
|
3
|
Al Shukri M, Said M, Nair A, Mathew M, Gowri V. Is there a difference in the clinical profile and outcome of women using levonorgestrel IUD for abnormal uterine bleeding and those using it for contraception?: A comparative cross-sectional study. Turk J Obstet Gynecol 2024; 21:7-14. [PMID: 38440962 PMCID: PMC10920973 DOI: 10.4274/tjod.galenos.2024.51460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/07/2024] [Indexed: 03/06/2024] Open
Abstract
Objective The most common indications for Levonorgestrel intrauterine device (LNG-IUD) are contraception and management of abnormal uterine bleeding (AUB). This study was conducted with the aim of exploring the differences in the clinical profile and outcome of women using LNG-IUD for contraception and AUB. Materials and Methods This was a retrospective comparative cross-sectional study of women who underwent LNG-IUD (52 mg) between 2012 and 2017. Their electronic health records were reviewed until the last documented follow-up or until December 2021. Results A total of 235 women had LNG-IUD with an age range of 21 to 62 years and a mean of (37.98 years±6.76). Of these women, 153/235 (65.1%) had it for contraception and 82/235 (34.89%) had it for AUB. The follow-up was 1-94 months with (mean ± SEM) follow-up for the AUB group of (21.48±2.31) months and for contraception group was (20.74±1.76) months (p-value of 0.80). There was a significant difference between the two groups in the age and body mass index (BMI), where women who had LNG-IUD for AUB were older (mean of 42.54±6.49 years, p-value <0.001) and had higher BMI (31.88±7.52 kg/m2, p-value =0.011). All LNG-IUDs that were indicated for contraception were inserted in an outpatient setting. However, 68.3% in the AUB, the insertion was in the operating theater in conjunction with hysteroscopy. After combining both expulsion and removal of LNG-IUD during the follow-up period, there was no significant difference between the 2 groups in the overall retention rate during the follow-up (p-value =0.998). Conclusion this study shows that women using LNG-IUD for the management of AUB are older and have a higher BMI compared with those using it for contraception. AUB women experienced more expulsion compared with the contraception group, but there was no difference between the 2 groups in the overall survival/retention of LNG-IUD.
Collapse
Affiliation(s)
- Maryam Al Shukri
- Department of Obstetrics and Gynecology; Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Maryam Said
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Asha Nair
- Department of Obstetrics and Gynecology; Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Mariam Mathew
- Department of Obstetrics and Gynecology; Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Vaidyanatahn Gowri
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
4
|
Esercan A, Demir I, Eskiyoruk I, Geckil O. Results of Endometrial Sampling in a Tertiary Hospital. Cureus 2023; 15:e37454. [PMID: 37064721 PMCID: PMC10099097 DOI: 10.7759/cureus.37454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 04/18/2023] Open
Abstract
AIM This study aims to investigate the results of endometrial sampling in a tertiary hospital according to age and symptoms. MATERIALS AND METHODS A total of 505 patients who underwent endometrial sampling due to various reasons in our tertiary hospital in the last six months were included in our study, and the pathological results of endometrial sampling were analyzed retrospectively. RESULTS The mean age of 505 patients was 45.03 + 7.40 (19-74) years, and 91.5% of the indications were premenopausal abnormal uterine bleeding and 8.5% were postmenopausal bleeding. The most common pathological result of all age groups was proliferative endometrium (37.6%), and the least was the endometrial intraepithelial neoplasia (0.2%). In 9.3% of patients, the result was insufficient material. Of the patients, 88.7% had no additional organic pathology. A total of 30 (5.9%) patients have undergone surgery after endometrial sampling. CONCLUSION It should be kept in mind that despite the pathological result may be insufficient rarely, endometrial sampling should be performed as the first choice in abnormal uterine bleeding.
Collapse
Affiliation(s)
- Alev Esercan
- Obstetrics and Gynecology, Şanlıurfa Education and Research Hospital, Şanlıurfa, TUR
| | - Ismail Demir
- Obstetrics and Gynecology, Şanlıurfa Education and Research Hospital, Şanlıurfa, TUR
| | - Ipek Eskiyoruk
- Obstetrics and Gynecology, Şanlıurfa Education and Research Hospital, Şanlıurfa, TUR
| | - Omer Geckil
- Obstetrics and Gynecology, Şanlıurfa Education and Research Hospital, Şanlıurfa, TUR
| |
Collapse
|
5
|
Vijayakumar S. Endometrial Patterns Among Rural Women Undergoing Gynecological Procedures in a Tertiary Care Hospital. Cureus 2023; 15:e35893. [PMID: 37033532 PMCID: PMC10081857 DOI: 10.7759/cureus.35893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
Introduction Women with endometrial diseases often present in outpatient departments, and outpatient procedures easily enable diagnosis. Histopathological patterns vary with age, menstrual cycle, drug use, and pathological state. Teaching hospitals are often located away from rural areas. Materials and methods An ambispective study was performed over 33 months in a rural medical college hospital by perusing the histopathological registers of the department. Details of history and endometrial samples (biopsy and hysterectomy) were obtained using biopsy numbers and requisition forms. Functional and organic histopathology findings were manually entered into a spreadsheet, and statistics were performed using Statistical Package for the Social Sciences (SPSS) for Windows version 22 (IBM SPSS Statistics, Armonk, NY, USA). Results There were 226 women, with total abdominal hysterectomies (TAH) performed in a significantly higher proportion of middle-aged women (range: 41-59 years). Of the middle-aged women, 70% presented with excessive menstrual bleeding, and a similar percentage of older women presented with uterovaginal (UV) prolapse. Hysterectomy specimens constituted most samples in this study. Proliferative endometrium was observed in 40% of patients and metaplasia (papillary syncytial, tubal, and squamous) in only 1.7%. Normal proliferative and secretory endometrium were observed in 91 (40.3%) and 41 (18.1%) patients, respectively. The presence of hyperplasia, decidualization, stromal breakdown, adenocarcinoma, adenomyosis, and endometrial polyps did not vary significantly among the three age groups (elderly, middle-aged, and young). Conclusion Most women in rural areas presented to the gynecologist with uterine bleeding; middle-aged women constituted most of those with gynecological complaints. Normal endometrium was observed in nearly half of the patients. Adenomyosis was the most common cause of uterine bleeding. Uterine endometrial malignancies were rare.
Collapse
|
6
|
Muacevic A, Adler JR, Pradeep B, Bindu H, Kumaran S. A Histopathological Study of Endometrial Biopsy Samples in Abnormal Uterine Bleeding. Cureus 2022; 14:e31264. [PMID: 36505162 PMCID: PMC9731800 DOI: 10.7759/cureus.31264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) is the most common health issue in women, defined as any bleeding pattern that differs in frequency, duration, and amount. Endometrial sampling and its histopathological examination is the first-line test in patients presenting with AUB. The aim of this study was to analyze the histopathological patterns of endometrium in women with AUB and to find the predominant histopathologic pattern in the different age groups of women with AUB. METHODS The study was conducted at the Indira Gandhi Medical College and Research Institute, Puducherry, from January 2019 to December 2020. Endometrial biopsies of patients with AUB, in whom gestational causes were ruled out, were included in this study. RESULTS Out of the 160 cases analyzed, the maximum number of biopsies were from the age group of 41-50 years; the majority of patients presented with complaints of menorrhagia. The bleeding pattern was significantly associated with age groups (p=0.00). Of 160 cases, 104 cases were related to functional causes. The association of functional and organic causes with age group was not significant (p=0.67 and p=0.99, respectively). The most common histological pattern was the normal cyclical pattern showing proliferative (56) and secretory phase (30) in 86 cases. Of 42 cases of endometrial hyperplasia, 9 cases had atypical hyperplasia. The endometrial polyp was the other common organic lesion observed. Only two cases of endometrial carcinoma were reported during the present study period. CONCLUSION Although a regular cyclical pattern is observed commonly, endometrial sampling should be considered in the peri- and post-menopausal age groups wherein the incidence of endometrial hyperplasia and endometrial carcinoma is more common.
Collapse
|
7
|
Histopathological Evaluation of Abnormal Uterine Bleeding in Women of Reproductive and Perimenopausal Age Groups. JOURNAL OF RESEARCH IN APPLIED AND BASIC MEDICAL SCIENCES 2022. [DOI: 10.52547/rabms.8.4.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
8
|
Evaluation of the Safety and Efficacy of Ormeloxifene, a Selective Estrogen Receptor Modulator and Medroxyprogesterone Acetate in Women with Non-Structural Abnormal Uterine Bleeding: A Randomized Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111503. [PMID: 36363460 PMCID: PMC9692901 DOI: 10.3390/medicina58111503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
Background and objectives: Abnormal uterine bleeding is a significant clinical and gynaecological concern that necessitates its safe and effective treatment. The present study aims to compare the cost-effectiveness, safety, efficacy, and health-related quality of life of ormeloxifene with medroxyprogesterone acetate in women with non-structural abnormal uterine bleeding. Materials and Methods: A prospective, randomized, single-blinded clinical trial of 367 patients was carried out at a tertiary care hospital for a period of one year from 5 January 2019 to 4 January 2020. Patients were randomized into two groups for administering ormeloxifene and medroxyprogesterone acetate for a 3-month treatment duration and were evaluated by laboratorial investigations like anaemic status, bleeding duration, endometrial thickness, pictorial blood loss assessment chart (PBLAC) score, and patient’s medical and medication history. Health-related quality of life was assessed using short form survey-36 (SF-36) questionnaire scale. Cost-effectiveness was determined on the basis of the three-month treatment regimen. Results: The mean duration of bleeding reduced from 16.88 ± 6.46 to 7.76 ± 1.55 in the ormeloxifene group and from 15.91 ± 5.04 to 8.7 ± 1.91 (p < 0.001) in the medroxyprogesterone acetate. Similarly, mean haemoglobin increased from 8.56 ± 0.77 to 10.1 ± 0.087 g/dL and from 8.60 ±0.97 to 9.551 ± 0.90 g/dL (p < 0.001), and endometrial thickness showed a reduction from 8.52 ± 1.61 mm to 6.92 ± 1.68 mm and from 8.40 ± 2.09 mm to 7.85 ± 2.0 mm (p < 0.001) in the ormeloxifene and medroxyprogesterone acetate groups, respectively. PBLAC score reduced from 289.92 ± 42.39 to 128.11 ± 33.10 and from 287.38 ± 40.94 to 123.5 ± 29.57 (p < 0.001) in these groups, respectively. Health-related quality of life improved in the ormeloxifene group more than the medroxyprogesterone group, which was evidenced by SF-36 scale parameters (physical function, energy/fatigue and pain) that changed from 24.39, 12.99, 6.25 to 28.95, 18, 9 and from 25.41, 13.6, 7.1 to 27.02, 16, 8.3 in the ormeloxifene and medroxyprogesterone acetate groups, respectively. Conclusions: The study concludes that both medroxyprogesterone acetate and ormeloxifene are safe and efficacious in controlling abnormal uterine bleeding, but ormeloxifene was the better of the two in terms of cost effectiveness, reduction in pictorial blood loss assessment score, endometrial thickness, bleeding duration (days), increase in haemoglobin concentration (g/dL) and improvement in the quality of life.
Collapse
|
9
|
Xue H, Shen WJ, Zhang Y. Pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or thickened endometrium. World J Clin Cases 2022; 10:2159-2165. [PMID: 35321190 PMCID: PMC8895164 DOI: 10.12998/wjcc.v10.i7.2159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/11/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postmenopausal bleeding and an endometrial thickness ≥ 5 mm on sonograms of menopausal women can indicate the presence of endometrial lesions. Diagnostic hysteroscopy is a powerful method for endometrial diseases.
AIM To investigate the pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or asymptomatic thickened endometrium diagnosed by hysteroscopy.
METHODS A total of 187 postmenopausal women with bleeding or asymptomatic thickened endometrium underwent diagnostic hysteroscopy. The women were subsequently divided into three groups: Postmenopausal bleeding (PMB) group (n = 84), asymptomatic group (n = 94), and additional group (n = 9). Women in the additional group manifested abdominal pain and leukorrhagia.
RESULTS Among the 187 patients examined, 84 (44.9%) were diagnosed with PMB and 94 (50.3%) with asymptomatic thickened endometrium. Endometrial polyp was the most common endometrial abnormality, which was detected in 51.2%, 76.6% and 77.8% of the PMB, asymptomatic, and additional groups, respectively. In the PMB group, 7 (8.3%) women had hyperplasia with atypia and 14 (16.7%) had endometrial adenocarcinoma. Fewer malignant lesions were detected in the asymptomatic group. Endometrial hyperplasia without atypia was found in 8.3% of the PMB group and 7.4% of the asymptomatic group.
CONCLUSION Endometrial polyp was the most common pathology in the PMB group. Diagnostic hysteroscopy is recommended for women with PMB and asymptomatic thickened endometrium.
Collapse
Affiliation(s)
- Hui Xue
- Department of Gynecology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wen-Jing Shen
- Department of Gynecology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yi Zhang
- Department of Gynecology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| |
Collapse
|
10
|
Yu Q, Hu S, Hu S. Effect of mifepristone and lithospermum combination regimen on medical abortion in early pregnancy rats. J Obstet Gynaecol Res 2021; 47:3789-3796. [PMID: 34505328 DOI: 10.1111/jog.15007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the optimal dose of mifepristone and lithospermum combination regimen on medical abortion in early pregnancy rats without increasing side effects. STUDY DESIGN Sixty sexually mature female Sprague Dawley (SD) rats with early pregnancy were randomly allocated into 10 groups, including a control group (treated with 0.5% CMC-Na) and nine experiments (treated with 1 mg/kg mifepristone, and 90, 180, 270, and 540 mg/kg lithospermum, and 90/180/270/540 mg/kg lithospermum +1 mg/kg mifepristone, respectively). The hormone levels, factors associated with endometrial bleeding, oxidative stress, and apoptotic proteins in the endometrium, were then investigated. RESULTS The results demonstrated that 540 mg/kg lithospermum plus 1 mg/kg mifepristone treatment significantly improved the abortion rate when compared with the control group. Compared with the 1 mg/kg mifepristone, 540 mg/kg lithospermum plus 1 mg/kg mifepristone treatment did not induce significant increase in factors associated with abnormal endometrial bleeding, such as matrix metalloproteinase-9 (MMP9). However, mifepristone and lithospermum combination regimen promoted the expression level of malondialdehyde (MDA), activated caspase 3, caspase 9 and Bax, meanwhile, reduced the expression of superoxide dismutase (SOD) and Bcl-2. CONCLUSION These findings provided strong evidence that mifepristone and lithospermum combination regimen can obtain satisfactory abortion effect without increasing the expression level of bleeding-related factors.
Collapse
Affiliation(s)
- Qiong Yu
- Reproductive Medicine Center, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shihong Hu
- Emergency Department, The First People's Hospital of Jiande, The Second Affiliated Hospital (Jiande Branch), School of Medicine, Zhejiang University, Jiande, China
| | - Shifu Hu
- Obstetrics and Gynecology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
11
|
Ilyas A, Ilyas M, Ilyas A, Pasha SSK, Kumar A. Spectrum of endometrial pathology in patients with abnormal uterine bleeding: a rural population experience. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_33_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Boeckstaens S, Dewalheyns S, Heremans R, Vikram R, Timmerman D, Van den Bosch T, Verbakel JY. Signs and symptoms associated with uterine cancer in pre- and postmenopausal women. Heliyon 2020; 6:e05372. [PMID: 33204876 PMCID: PMC7649270 DOI: 10.1016/j.heliyon.2020.e05372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/09/2020] [Accepted: 10/26/2020] [Indexed: 10/31/2022] Open
Abstract
Uterine cancer is the most and second most common gynecological malignancy in developed and developing countries, respectively. The majority of endometrial cancers are diagnosed early due to the presence of abnormal uterine bleeding. The existing literature however contains only little data regarding the prevalence of such symptoms compared to patients with no or benign pathology. Therefore, a systematic review was conducted in order to determine the significance of various clinical signs and symptoms predicting uterine cancer. Embase, Web of Science and Medline databases were searched from inception until 18 June 2019. Studies eligible for selection inclusion assessed the diagnostic accuracy of clinical signs and symptoms in pre- and postmenopausal women aged 18-99 years old with uterine malignancy. Case reports, case series and studies of which full text was not available, were excluded. The risk of bias was assessed using the QUADAS-2 tool by two independent reviewers. Results were visualized by forest plots using RevMan(5.3). Forty-one studies were eventually included in this systematic review. Abnormal uterine bleeding occurring in pre-, post- and perimenopausal women was proven to be the most widely investigated symptom in relation to cancer of the uterus. Thirty-two articles examined patients with postmenopausal bleeding of which sensitivity and specificity varied between 0.28 to 0.86 and 0.63 to 0.84, respectively. Abnormal bleeding in pre- and perimenopausal women on the other hand showed a sensitivity ranging from 0.63 to 0.81. Its specificity could not be calculated due to missing data. Other symptoms appeared not sufficiently examined to assess their diagnostic accuracy range. This review highlights the current lack of knowledge regarding the diagnostic accuracy of several signs and symptoms for uterine cancer. After a thorough in-depth review of the literature, meta-analysis could not be performed due to the absence of control populations in the majority of articles. Further research is needed to establish the rule-in or rule-out value of specific clinical signs to identify patients at risk for uterine malignancy prompting further clinical assessment.
Collapse
Affiliation(s)
- Shari Boeckstaens
- Department of Obstetrics and Gynaecology, KU Leuven, Belgium
- Department of Obstetric Ultrasound and Fetal Medicine, University College London Hospital, United Kingdom
| | | | - Ruben Heremans
- Department of Obstetrics and Gynaecology, KU Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Belgium
| | - Radhika Vikram
- Department of Obstetrics and Gynaecology, West Hertfordshire Hospitals, Watford, United Kingdom
| | - Dirk Timmerman
- Department of Obstetrics and Gynaecology, KU Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Belgium
| | - Thierry Van den Bosch
- Department of Obstetrics and Gynaecology, KU Leuven, Belgium
- Laboratory for Tumor Immunology and Immunotherapy, KU Leuven, Belgium
| | - Jan Y. Verbakel
- Department of Public Health and Primary Care, KU Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| |
Collapse
|
13
|
Abbas AM, Samy A, El-Naser Abd El-Gaber Ali A, Khodry MM, Ahmed MA, El-Rasheedy MI, Abdallah KM, Mohammed AE, Abdelbaky WH, Raslan OK, Badawy MA, Elktatny HH. Medications for pain relief in outpatient endometrial sampling or biopsy: a systematic review and network meta-analysis. Fertil Steril 2019; 112:140-148.e12. [DOI: 10.1016/j.fertnstert.2019.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/28/2022]
|
14
|
Sudhamani S, Bhat R, Roplekar P. Histopathological study of endometrium in abnormal uterine bleeding in perimenopausal and postmenopausal women. JOURNAL OF THE SCIENTIFIC SOCIETY 2019. [DOI: 10.4103/jss.jss_39_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Tohma YA, Akilli H, Kirnap M, Haberal AN, Akyel D, Zengin HY, Zeyneloglu HB, Kuscu E, Ayhan A, Haberal M. Possible impact of immunosuppressive therapy regimens on histopathologic outcomes of abnormal uterine bleeding in solid-organ transplant recipients. Clin Transplant 2018; 32:e13305. [DOI: 10.1111/ctr.13305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Yusuf Aytac Tohma
- Department of Obstetrics and Gynecology; Baskent University School of Medicine; Ankara Turkey
| | - Huseyin Akilli
- Department of Obstetrics and Gynecology; Baskent University School of Medicine; Ankara Turkey
| | - Mahir Kirnap
- Department of General Surgery; Baskent University School of Medicine; Ankara Turkey
| | | | - Dilan Akyel
- Department of Family Medicine; Baskent University School of Medicine; Ankara Turkey
| | - Hatice Yagmur Zengin
- Department of Biostatistics; Baskent University School of Medicine; Ankara Turkey
| | | | - Esra Kuscu
- Department of Obstetrics and Gynecology; Baskent University School of Medicine; Ankara Turkey
| | - Ali Ayhan
- Department of Obstetrics and Gynecology; Baskent University School of Medicine; Ankara Turkey
| | - Mehmet Haberal
- Department of General Surgery; Baskent University School of Medicine; Ankara Turkey
| |
Collapse
|
16
|
Kansal Y, Bahadur A, Chaturvedi J, Rao S, Arora H, Kumari O, Pandey H, Rupendra K. Spectrum of Abnormal Uterine Bleeding: Clinical Pattern and Endometrial Pathology Aspects. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yamini Kansal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anupama Bahadur
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jaya Chaturvedi
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shalinee Rao
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Hitanshi Arora
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Om Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Harshita Pandey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - K. Rupendra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
17
|
Wijayanti D, Setiatin ET, Kurnianto E. Study on postpartum estrus of guinea pigs ( Cavia cobaya) using Anredera cordifolia leaf extract. Vet World 2017; 10:375-379. [PMID: 28507407 PMCID: PMC5422239 DOI: 10.14202/vetworld.2017.375-379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/21/2017] [Indexed: 12/02/2022] Open
Abstract
Aim: The purpose of this study was to determine the postpartum estrus cycle of guinea pigs (Cavia cobaya) using Anredera cordifolia leaf extract. Materials and Methods: Materials used were 8 males and 8 females of C. cobaya with body weight ranged 400-450 g. Mating ratio applied was 1:1. Treatments given were 0, 10, 50 and 90 mg of A. cordifolia leaf extract/head, designated as T0, T1, T2 and T3, respectively. Two females were subjected for each treatment. A. cordifolia leaf extract was administered orally from 10 days prepartum to 10 days postpartum. Observation of mating behavior, vulva morphology, and vaginal smear preparation was done in the afternoon for 10 days subsequence postpartum. Data were analyzed by univariate method and descriptively. Results: The results showed that the addition of A. cordifolia leaf extract 50 mg orally could accelerate the time of postpartum estrus based on the average frequency of mating behavior consisting of behavioral approach, allow the buck to sniffing her, mating positions, standing heat, lordosis position, and copulation. During estrus, vulva morphology was red color, had much mucus and no thin membrane covering vagina. There were a lot of superficial cells on vagina. Conclusion: The best treatment to accelerate occurring postpartum estrus was the addition of A. cordifolia leaf extract as many as 50 mg/head weight (T2) orally.
Collapse
Affiliation(s)
- D Wijayanti
- Department of Animal Science, Faculty of Animal and Agricultural Sciences, Diponegoro University, Tembalang Campus, Semarang 50275, Central Java, Indonesia
| | - E T Setiatin
- Department of Animal Science, Faculty of Animal and Agricultural Sciences, Diponegoro University, Tembalang Campus, Semarang 50275, Central Java, Indonesia
| | - E Kurnianto
- Department of Animal Science, Faculty of Animal and Agricultural Sciences, Diponegoro University, Tembalang Campus, Semarang 50275, Central Java, Indonesia
| |
Collapse
|
18
|
Singh P, Singh P, Chaurasia A, Dhingra V, Misra V. Expression of ERα and PR in Various Morphological Patterns of Abnormal Uterine Bleeding-Endometrial causes in Reproductive Age Group. J Clin Diagn Res 2016; 10:EC06-9. [PMID: 27656443 PMCID: PMC5028559 DOI: 10.7860/jcdr/2016/19565.8290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/03/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Abnormal Uterine Bleeding (AUB) is most common gynaecological problem but its management is not well defined. So FIGO/PALMCOEIN classification was developed to provide clear management options as treatment is different in PALM and AUB-E group. FIGO/PALM-COEIN classification and immunohistochemistry with ERα and PR expression in AUB-E group will be helpful in management of these patients, thus preventing surgical interventions. AIM To study histomorphological classification according to FIGO/PALM-COEIN classification in patients presenting with AUB into PALM and AUB-E group. To study the receptor expression of ERα and PR in AUB-E group. MATERIALS AND METHODS This cross sectional study was performed in patients presenting with AUB in reproductive age group (15-45 years). Six hundred endometrial specimens were stained with H&E for histolomorphological examination and classified as per FIGO/PALM-COEIN classification of AUB in non-gravid women in reproductive age group. Fifty endometrial biopsies were of pregnancy and pregnancy related complications and were excluded from study. A total of 550 samples were evaluated in present study. IHC for quantification of ERα and PR expression was carried out in AUB-E (100) cases and control group endometrium (20) cases due to technical constraints. STATISTICAL ANALYSIS Unpaired student t-test was performed. p-value ≤ 0.05 was taken as critical level of significance. RESULTS Endometrial (58.19%) (AUB-E) causes were most common cause of AUB. Most common morphology was AUB-E (Proliferative endometrium), AUB-L (Leiomyoma) and AUB-E (Secretory endometrium) respectively. Statistically significant expression of ERα and PR was found in AUB-E endometrium as compared to control group endometrium. In Non secretory/Proliferative endometrium AUB-E group. Proliferative endometrium and hyperplasia without atypia had significant expression of ERα and PR in glands and stroma when compared with proliferative phase control group endometrium. But disordered proliferative endometrium had only significant PR expression in stroma. When secretory phase endometrium was compared with control group secretory phase significant expression for PR was noted only in stroma. CONCLUSION FIGO/PALM-COEIN classification will be helpful in deciding treatment of AUB cases. Study of receptor expression in AUB-E group will help in providing evidence based treatment and prevent from surgical procedures like hysterectomy and endometrial ablation.
Collapse
Affiliation(s)
- Priya Singh
- Junior Resident, Department of Pathology, Moti Lal Nehru Medical College, Allahabad, U.P., India
| | - Pallavi Singh
- Assistant Professor, Department of Pathology, Moti Lal Nehru Medical College, Allahabad, U.P., India
| | - Amrita Chaurasia
- Associate Professor, Department of Obstetrics and Gynaecology, Moti Lal Nehru Medical College, Allahabad, U.P., India
| | - Vishal Dhingra
- Assistant Professor, Department of Pathology, Moti Lal Nehru Medical College, Allahabad, U.P., India
| | - Vatsala Misra
- HOD, Department of Pathology, Moti Lal Nehru Medical College, Allahabad, U.P., India
| |
Collapse
|
19
|
Abstract
Approximately 30% of women will experience abnormal uterine bleeding (AUB) during their life time. Previous terms defining AUB have been confusing and imprecisely applied. As a consequence, both clinical management and research on this common problem have been negatively impacted. In 2011, the International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Group (FMDG) published PALM-COEIN, a new classification system for abnormal bleeding in the reproductive years. Terms such as menorrhagia, menometrorrhagia, metrorrhagia, dysfunctional uterine bleeding, polymenorrhea, oligomenorrhea, and uterine hemorrhage are no longer recommended. The PALM-COEIN system was developed to standardize nomenclature to describe the etiology and severity of AUB. A brief description of the PALM-COEIN nomenclature is presented as well as treatment options for each etiology. Clinicians will frequently encounter women with AUB and should report findings utilizing the PALM-COEIN system.
Collapse
|
20
|
Khan R, Sherwani RK, Rana S, Hakim S, S Jairajpuri Z. Clinco-Pathological Patterns in Women with Dysfunctional Uterine Bleeding. IRANIAN JOURNAL OF PATHOLOGY 2016; 11:20-6. [PMID: 26870139 PMCID: PMC4749191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/08/2015] [Indexed: 10/27/2022]
Abstract
BACKGROUND The term dysfunctional uterine bleeding (DUB) refers to any abnormal bleeding from the uterus, unassociated with tumour, inflammation and pregnancy. The histological diagnosis of DUB is very essential for adequate management especially in perimenopausal and postmenopausal females. The present study was undertaken with the aim of evaluating DUB in various age groups, carry out histopathological study of the endometrium and analyze its clinic-pathological patterns. METHODS The study included 500 cases of atypical uterine bleeding, out of which 120 cases of DUB were included based on clinical features and detailed investigations. Study was conducted in Jawaharlal Nehru Medical College, Aligarh Muslim University, between March 2003 to December 2004 Endometrial tissue was collected by D&C procedure and the samples were sent for histopathological evaluation by pathologist. RESULT Hyperplasia was the commonest endometrial pathology (20.5%) followed by luteal phase insufficiency (15.6%) and secretory endometrium (13.7%). Endometritis including tubercular endometritis (12.7%), post abortal (5.8%), proliferative (6.8%), polyp (3.9%), atrophic (3.9%), exogenous hormone changes (2.9%) and anovulatory cycles (6.8%) made up for the remaining lesions. CONCLUSION DUB occurs secondary to a wide variety of functional and structural abnormalities, warranting a thorough evaluation especially in perimenoupausal females. Menorrhagia is a common symptom and the most likely etiology relates to the patient's age. Significant number of endometrial samples revealed pathology rendering endometrial curetting and biopsy an important procedure. Cervical cytology is a valuable adjunct however histopathology remains the gold standard in diagnosis.
Collapse
Affiliation(s)
- Rehana Khan
- Dept. of Obstetrics and Gynaecology, JN Medical College, AMU, Aligarh, India
| | - Rana K Sherwani
- Dept. of Pathology, JN Medical College, AMU, Aligarh, , India
| | - Safia Rana
- Dept. of Pathology,Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - Seema Hakim
- Dept. of Obstetrics and Gynaecology, JN Medical College, AMU, Aligarh, India
| | - Zeeba S Jairajpuri
- Dept. of Pathology,Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, India
| |
Collapse
|
21
|
Mittal P, Goyal M. Pain relief during minor procedures: a challenge for gynaecologists. Indian J Med Res 2015; 142:366-8. [PMID: 26609027 PMCID: PMC4683820 DOI: 10.4103/0971-5916.169192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Pratima Mittal
- Department of Obstetrics & Gynaecology, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi 110 029, India
| | | |
Collapse
|
22
|
Acmaz G, Bayraktar E, Aksoy H, Başer M, Yilmaz MO, Müderris İİ. Effect of paracetamol, dexketoprofen trometamol, lidocaine spray, pethidine & diclofenac sodium application for pain relief during fractional curettage: A randomized controlled trial. Indian J Med Res 2015; 142:399-404. [PMID: 26609031 PMCID: PMC4683824 DOI: 10.4103/0971-5916.169197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background & objectives: Patients frequently experience pain of moderate to severe degree during gynaecologic procedures. This prospective, randomized, placebo-controlled trial was aimed to investigate the analgesic efficacy of preoperative oral dexketoprofen trometamol, intravenous paracetamol, lidocaine spray, pethidine and diclofenac sodium on fractional curettage procedure. Methods: A total of 144 mutiparous women were randomly allocated to one of the six groups. The first group (control group) consisted of 22 participants and they did not receive any treatment. The second group had 26 participants receiving oral 25 mg dexketoprofen trometamol. The 23 participants of the third group received two puff lidocaine sprays on cervical mucosa. The forth group consisted of 25 participants receiving 100 mg pethidine. In the fifth group, the 23 participants received 1000 mg intravenous paracetamol and the sixth group consisted of 25 participants receiving diclofenac sodium. Results: Pethidine was the best choice for reducing pain score during curettage procedure (t2:intra-operative). All analgesic procedures were significantly effective in reducing pain during postoperative period (t3). Significant pain reduction was achieved for both intra- and postoperative period by using analgesics. Interpretation & conclusions: The results of our study showed that lidocaine puffs provided the best pain relief than the other analgesics used. Therefore, lidocaine may be considered as the first choice analgesic in fractional curettage (NCT ID: 01993589).
Collapse
Affiliation(s)
- Gökhan Acmaz
- Department of Obstetrics & Gynecology, Kayseri Education & Research Hospital, Kayseri, Turkey
| | | | | | | | | | | |
Collapse
|
23
|
LIU HAIYANG, MA WEI, LIU QI, WANG FASHAN, CAO LING, LI TIENAN, ZHANG NING, GENG FANG. Effect of Wujia Shenghua capsule on uterine bleeding following medically-induced incomplete abortion in rats during early pregnancy. Exp Ther Med 2015; 10:635-640. [PMID: 26622367 PMCID: PMC4509024 DOI: 10.3892/etm.2015.2548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/20/2015] [Indexed: 12/14/2022] Open
Abstract
The Wujia Shenghua capsule (WSC) is derived from Sheng-Hua-Tang, a well-known traditional Chinese medicine compound prescription that has been widely applied during the postpartum period in Chinese communities for a number of years. The aim of the present study was to investigate the effect of WSC on uterine bleeding following medically-induced incomplete abortion in rats during early pregnancy. Incomplete abortions were induced in Wistar rats during early pregnancy using mifepristone combined with misoprostol. The effects of WSC treatment were investigated in terms of the duration and volume of uterine bleeding, the uterine index and shape, and various hemodynamic indexes. In addition, blood samples were collected to measure the levels of estradiol (E2), fibronectin (FN) and laminin (LM) via a radioimmunoassay or enzyme-linked immunosorbent assay, while the expression levels of FN, estrogen receptor (ER) and progesterone receptor (PR) in the uterine tissues were determined by immunohistochemistry. The in vivo results demonstrated that WSC treatment markedly shortened the duration and reduced the volume of uterine bleeding when compared with the model group. Furthermore, WSC treatment significantly elevated the E2 level in the serum and the expression of the ER and PR in the uterine tissues, while notably decreasing the FN and LM levels in the serum and uterine tissues. In addition, the hemodynamic indexes were shown to improve with WSC treatment. These results demonstrated that WSC exerted an inhibitory effect on the bleeding caused by medical abortion, possibly through modulating the E2, ER, PR, FN and LM levels.
Collapse
Affiliation(s)
- HAIYANG LIU
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - WEI MA
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - QI LIU
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - FASHAN WANG
- Duoduo Pharmaceutical Co. Ltd., Jiamusi, Heilongjiang 154002, P.R. China
| | - LING CAO
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - TIENAN LI
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - NING ZHANG
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - FANG GENG
- College of Chemistry and Chemical Engineering, Harbin Normal University, Harbin, Heilongjiang 150025, P.R. China
| |
Collapse
|
24
|
NICULA RENATA, COSTIN NICOLAE. Management of endometrial modifications in perimenopausal women. CLUJUL MEDICAL (1957) 2015; 88:101-10. [PMID: 26528056 PMCID: PMC4576794 DOI: 10.15386/cjmed-421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
Perimenopause has a variable length and time of onset and is characterized by its variability in hormonal levels. The histological changes in the perimenopausal endometrium may be represented by nonproliferative or proliferative benign or malignant lesions. A commonly encountered manifestation of endometrium lesions during menopausal transition is the abnormal uterine bleeding (AUB). The clinical management of AUB must follow a standardized classification system for optimal results. The medical and surgical treatment must be adapted according to age, risk factors, symptoms, and cycle irregularities. Use of alternative therapies and proper diet may result in improved long-term outcomes.
Collapse
Affiliation(s)
- RENATA NICULA
- Dominic Stanca Clinic of Obstetrics and Gynecology, Cluj-Napoca, RomaniaIuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - NICOLAE COSTIN
- Dominic Stanca Clinic of Obstetrics and Gynecology, Cluj-Napoca, RomaniaIuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
25
|
Sardo ADS, Calagna G, Di Carlo C. Tips and tricks in office hysteroscopy. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2014.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
26
|
Corbacioglu Esmer A, Akbayir O, Goksedef BPC, Gunduz N, Kisacık S, Dagdeviren H, Guraslan B, Ark C. Is there an appropriate cutoff age for sampling the endometrium in premenopausal bleeding? Gynecol Obstet Invest 2013; 77:40-4. [PMID: 24334971 DOI: 10.1159/000356959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 11/04/2013] [Indexed: 11/19/2022]
Abstract
AIM To determine a cutoff age for endometrial evaluation in premenopausal abnormal uterine bleeding (AUB). METHODS Histopathology reports of endometrial sampling performed due to AUB in women aged 50 years or less were reviewed retrospectively. Histopathological findings were categorized into three groups as follows: group 1: hyperplasia without atypia + hyperplasia with atypia + malignancy, group 2: hyperplasia with atypia + malignancy, and group 3: malignancy. RESULTS Data from 2,516 patients were analyzed for this study. Overall, 13.5% of patients had endometrial hyperplasia without atypia, 1% of patients had hyperplasia with atypia and 0.6% of patients had malignant disease. Logistic regression revealed a significant difference in the odds ratios of group 1 in the age ranges of 40-45 and 45-50 years compared with <40 years (p = 0.001 and p = 0.01, respectively). There were no significant differences between the age groups for the odds ratio of group 2 and group 3. CONCLUSION There is no cutoff age for sampling the endometrium in order to detect hyperplasia with atypia and cancer in premenopausal women with AUB. Therefore, the management of AUB should be tailored to each patient regardless of age, incorporating all risk factors for malignant disease.
Collapse
Affiliation(s)
- Aytul Corbacioglu Esmer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Soleymani E, Ziari K, Rahmani O, Dadpay M, Taheri-Dolatabadi M, Alizadeh K, Ghanbarzadeh N. Histopathological findings of endometrial specimens in abnormal uterine bleeding. Arch Gynecol Obstet 2013; 289:845-9. [PMID: 24121689 DOI: 10.1007/s00404-013-3043-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 09/19/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to assess the frequency of different histopathological findings obtained from dilatation and curettage (D&C) specimens in patients with abnormal uterine bleeding (AUB). METHODS In a retrospective review of 591 specimens, the included subjects were all women with AUB who underwent D&C between 2002 and 2006 in Be'sat Hospital, Tehran, Iran. The pathological diagnoses were analyzed in four groups from normal to malignant endometrium. The pathological groups were evaluated for patients' characteristics including demographic data and medical history. RESULTS The majority of patients (61.6%) were in the 41-50 year age group. Totally, 81.4% of patients had normal pathology. The disordered proliferative endometrium/polyps, hyperplasia, and malignant pathology were found in 15.4, 2.5, and 0.7% of specimens, respectively. The abnormal pathologies were seen more among patients with postmenopausal status, nulli-/primigravid women, and those with hypertension, diabetes, hypothyroidism, and polycystic ovary syndrome. CONCLUSIONS The proliferative endometrium and secretory endometrium were the most common histopathological observations in AUB patients in our region, and except normal endometrium, disordered proliferative endometrium was the most common cause of AUB.
Collapse
Affiliation(s)
- Ebrahim Soleymani
- Department of Pathology, Be'sat Hospital, AJA University of Medical Sciences, Basij Highway, Tehran, Iran
| | | | | | | | | | | | | |
Collapse
|