An Observational Study On Etiological Distribution of Abnormal Uterine Bleeding Among the Perimenopausal Women at A Tertiary Care Centre

Background: Abnormal uterine bleeding (AUB) is a frequent gynecologic issue in the perimenopause period, and is linked to substantial physical, psychological and social morbidity. The etiology of AUB is very complex and can be broadly divided into structural causes and non-structural causes according to the classification system presented by FIGO PALM – COEIN. Knowing the distribution of these is important for proper diagnosis and management. The objective of the present study was to identify distribution of etiological factors and to assess their association with demographic, clinical and histopathological findings in women who presented with abnormal uterine bleeding during perimenopause in a tertiary care centre. Material and Methods: The study was an observational study done at Government RDBP Jaipuria Hospital, Jaipur, Rajasthan, in the Department of Obstetrics and Gynaecology, MTNL from January 2025 toJanuary 2026. 110 women who were between the ages of 40 and 55, and had been presenting with AUB, were entered. Laboratory tests, clinical examination, ultrasound and histopathological examination were performed. The classification of etiologies was conducted by the FIGO PALM–COEIN system. The data were analysed in SPSS version 26.0. Results: The majority of participants were aged 40–45 years [68 (61.8%)] and multiparous [77 (70.0%)]. Heavy menstrual bleeding was the most common presentation [47 (42.7%)]. Moderate anemia was observed in 43 (39.1%) women, while hypothyroidism was the most frequent comorbidity [17 (15.5%)]. Histopathological examination revealed proliferative endometrium in 48 (43.6%) cases. According to the PALM–COEIN classification, leiomyoma was the predominant etiology [63 (57.3%)], followed by ovulatory dysfunction [14 (12.7%)], endometrial causes [11 (10.0%)], adenomyosis [10 (9.1%)], and polyps [8 (7.3%)]. Conclusion: AUB in perimenopausal women is predominantly caused by leiomyoma and commonly presents as heavy menstrual bleeding with associated anemia. Proliferative endometrium is the most frequent histopathological finding. Comprehensive evaluation using the PALM–COEIN classification facilitates accurate etiological diagnosis and guides appropriate management strategies in this population. Keywords: Abnormal uterine bleeding; Perimenopause; PALM–COEIN classification; Leiomyoma; Endometrial histopathology.