Clinical, radiological and endometrial histopathological features in perimenopausal and postmenopausal women with abnormal uterine bleeding at Moi Teaching and Referral Hospital

Abstract

Background: Abnormal Uterine Bleeding (AUB) affects 3-30% of peri- and 5-10% of postmenopausal women. While the condition is mostly due to ovulatory/endometrial dysfunction or benign pathologies, peri- and postmenopausal women with AUB are at a higher risk of being diagnosed with endometrial hyperplasia (EH) and cancer (EC). Risk factors for EH and EC include obesity, diabetes mellitus and chronic hypertension. Data on endometrial histologies and factors associated with diagnosis of EH and EC in these women is limited in Kenya. Objectives: To describe the clinical, ultrasound and endometrial histopathological features, determine the prevalence of and factors associated with diagnosis of EH and EC in peri- and postmenopausal women with AUB at Moi Teaching and Referral Hospital (MTRH). Methods: A cross-sectional study of women aged ≥40 years with AUB. All women who met the eligibility criteria and consented within a period of 12 months were enrolled (100 participants). Endometrial biopsies were done using a Pipelle. Histological evaluation of samples was done by two pathologists. Data on sociodemographic, clinical characteristics (BMI, chronic illness, bleeding patterns, parity, contraception use) and ultrasound findings were collected using a questionnaire. Associations between these factors and the diagnosis of EH/EC were tested using chi-square or fisher‟s exact test, significance was accepted at a p value ≤ 0.05. Logistic regression was modeled using factors significantly associated with EH/EC diagnosis on bivariate analysis. Results: From 64 perimenopausal women, 40 (62.5%) had cyclical or benign patterns, 23 (35.9%) had EH and 1 (1.6%) had EC. EH without atypia was the most seen individual pattern in this group (32.8%). From 36 postmenopausal women, 15 (41.7%) had cyclical or benign patterns, 14 (38.9%) had EH and 7 (19.4%) had EC. EH without atypia was the most seen individual pattern in this group too (25%). The prevalence of EH and EC in the perimenopausal group was 35.9% and 1.6% respectively, and 38.9% and 19.4% respectively in the postmenopausal. None of the clinical characteristics was significantly associated with the diagnosis of EH/EC. Thickened endometrium on ultrasound was the only feature associated with diagnosis of EH/EC (p = 0.004) on multivariate analysis. Conclusions: The histological findings in peri- and postmenopausal women with AUB at MTRH were mostly cyclical patterns/benign endometrial pathologies. However, EH without atypia was the single most commonly seen individual pathology in each group. The prevalence of both EH and EC in these women was significantly higher compared to most studies, with endometrial thickening on ultrasonography noted to significantly be associated with diagnosis of the two conditions. Recommendations: Performance of pelvic ultrasonography and endometrial biopsies in women aged ≥ 40 years who have AUB is strongly recommended to identify high risk features and rule out EH and EC in these women.