Abstract

Objectives: To determine the etiologies, patterns of bleeding and the associated factors of endometrial hyperplasia and cancer in perimenopausal women.

Methods: A cross-sectional research approach was used in this study. Women (n = 346) with perimenopausal abnormal uterine bleeding (AUB) visited the Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Thailand, a tertiary medical school were enrolled in this study. Ethical clearance was obtained from the University’s human ethics committee. Data collection included history taking, pelvic examination, transvaginal sonography, and endometrial pathology. Data analysis was through descriptive and inferential statistics the factors which had statistically significant (p-value < 0.10) were included in multiple logistic regression analysis to evaluate the significant factors related to endometrial hyperplasia and cancer.

Results: Among all the participants (n = 346) 164 were indicated for gynecologic surgery (47.4%). Causes of bleeding included fibroids (31.21%) and adenomyosis (24.28%), whereas the prevalence of endometrial hyperplasia and cancer was 12.5%. The common perimenopausal bleeding patterns were intermenstrual bleeding (IMB) (47.69%) and heavy menstrual bleeding (HMB) (47.11%). After the univariate and multiple logistic regression analyses, the significant risk factors of endometrial hyperplasia and cancer were endometrial thickness > 10 mm (OR 7.61, 95%CI 3.52 - 16.45) and IMB (OR 4.66, 95%CI 2.05 - 10.57), respectively.

Conclusion: The uterine fibroids and adenomyosis took a majority of perimenopausal AUB causes, which mostly presenting with IMB or HMB patterns. However, endometrial hyperplasia and cancer should be concerned, especially in present AUB, with evidence of thick endometrium or IMB.

Keywords: Perimenopausal Bleeding; Abnormal Uterine Bleeding; Endometrial Hyperplasia; Endometrial Cancer; Perimenopausal Woman

References

1. Singh Sukhbir., et al. “Abnormal uterine bleeding in pre-menopausal women”. Journal of Obstetrics and Gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC5 (2013): 473-475.
2. Fraser Ian S., et al. “The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding”. Seminars in Reproductive Medicine5 (2011): 383-390.
3. Munro Malcolm G., et al. “FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age”. International Federation of Gynaecology and Obstetrics1 (2011): 3-13.
4. Harlow Siobán D., et al. “Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging”. The Journal of Clinical Endocrinology and Metabolism 4 (2012): 1159-1168.
5. Van den Bosch, T., et al. “Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women”. Facts, Views and Vision in ObGyn1 (2015): 17-24.
6. American College of Obstetricians and Gynecologists. “ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women”. Obstetrics and Gynecology 4 (2013): 891-896.
7. Ferlay Jacques., et al. “Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012”. International Journal of Cancer5 (2015): E359-386.
8. Reed Susan D., et al. “Incidence of endometrial hyperplasia”. American Journal of Obstetrics and Gynecology 6 (2009): 678.e1-e6.
9. Constantine Ginger D., et al. “Increased Incidence of Endometrial Cancer Following the Women's Health Initiative: An Assessment of Risk Factors”. Journal of Women's Health (2002) 28.2 (2019): 237-243.
10. Ali Aus Tariq. “Risk factors for endometrial cancer”. Ceska Gynekologie5 (2013): 448-459.
11. Munro Malcolm G., et al. “The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions”. International Federation of Gynaecology and Obstetrics3 (2018): 393-408.
12. Foth Dolores., et al. “Symptoms of uterine myomas: data of an epidemiological study in Germany”. Archives of Gynecology and Obstetrics 2 (2017): 415-426.
13. Puri Kanchan., et al. “Submucosal fibroids and the relation to heavy menstrual bleeding and anemia”. American Journal of Obstetrics and Gynecology 1 (2014): 38.e1-7.
14. Struble Jennifer., et al. “Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition”. Journal of Minimally Invasive Gynecology2 (2016): 164-185.
15. Singh Kanika., et al. “A Clinicopathological Correlation of International Federation of Gynecology and Obstetrics's PALM-COEIN Classification of Abnormal Uterine Bleeding: Indian Scenario”. Journal of Mid-Life Health 3 (2019): 147-152.
16. Sun Yu., et al. “Prevalence of abnormal uterine bleeding according to new International Federation of Gynecology and Obstetrics classification in Chinese women of reproductive age: A cross-sectional study”. Medicine 31 (2018): e11457.
17. Damle Rajshri P., et al. “Clinicopathological Spectrum of Endometrial Changes in Peri-menopausal and Post-menopausal Abnormal Uterine Bleeding: A 2 Years Study”. Journal of Clinical and Diagnostic Research: JCDR12 (2013): 2774-2776.
18. Abid Mariam., et al. “Clinical pattern and spectrum of endometrial pathologies in patients with abnormal uterine bleeding in Pakistan: need to adopt a more conservative approach to treatment”. BMC Women's Health132 (2014).
19. Doraiswami Saraswathi., et al. “Study of endometrial pathology in abnormal uterine bleeding”. Journal of Obstetrics and Gynaecology of India4 (2011): 426-430.
20. Kazemijaliseh Hadigheh., et al. “A Population-Based Study of the Prevalence of Abnormal Uterine Bleeding and its Related Factors among Iranian Reproductive-Age Women: An Updated Data”. Archives of Iranian Medicine 9 (2017): 558-563.
21. Rezk M., et al. “Perimenopausal bleeding: Patterns, pathology, response to progestins and clinical outcome”. Institute of Obstetrics and Gynaecology5 (2015): 517-521.
22. “Practice Bulletin No. 149: Endometrial cancer”. Obstetrics and Gynecology4 (2015): 1006-1026.
23. Braun Michael M., et al. “Diagnosis and Management of Endometrial Cancer”. American Family Physician6 (2016): 468-474.
24. Pennant ME., et al. “Premenopausal abnormal uterine bleeding and risk of endometrial cancer”. BJOG: An International Journal of Obstetrics and Gynaecology 3 (2017): 404-411.
25. “ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding”. Obstetrics and Gynecology5 (2018): e124-e129.
26. Tsuda, Hiroshi., et al. “Measurement of endometrial thickness in premenopausal women in office gynecology”. Reproductive Medicine and Biology 1 (2017): 29-35.
27. Nicula Renata., et al. “Accuracy of transvaginal ultrasonography compared to endometrial biopsy for the etiological diagnosis of abnormal perimenopausal bleeding”. Clujul Medical (1957) 90.1 (2017): 33-39.
28. Getpook Chatpavit and Saranya Wattanakumtornkul. “Endometrial thickness screening in premenopausal women with abnormal uterine bleeding”. The Journal of Obstetrics and Gynaecology Research6 (2006): 588-592.

Citation

Citation: Orawin Vallibhakara., et al. “Perimenopausal Bleeding a Risk Factor for Endometrial Hyperplasia and Endometrial Cancer”. Acta Scientific Women's Health 2.8 (2020): 43-49.

Copyright

Copyright: © 2020 Orawin Vallibhakara., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.