Histopathological Spectrum of the Endometrium in Patients with Abnormal Uterine Bleeding: A Prospective Observational Study

Background: Abnormal uterine bleeding (AUB) is a common gynaecological complaint that significantly impacts women's quality of life. It encompasses a wide spectrum of etiologies, from functional hormonal imbalances to structural lesions, including premalignant and malignant pathologies. Endometrial histopathological examination is crucial for accurate diagnosis and management. The aim is to analyse the histopathological spectrum of endometrial tissue in patients presenting with AUB and to correlate findings with clinical variables. Material and Methods: A prospective observational study was conducted over 24 months at a tertiary care hospital. A total of 228 women (≥18 years) presenting with AUB were enrolled. Endometrial sampling was performed using a Pipelle device. Tissues were processed for histopathological examination. Data on age, reproductive status, bleeding pattern, and comorbidities (diabetes, hypertension) were analysed. Results: The majority of patients were in the reproductive (43.0%) and perimenopausal (38.2%) age groups. Non-neoplastic/benign patterns predominated (81.1%), with proliferative (34.2%) and secretory (27.2%) endometrium being the most common. Hyperplasia was seen in 10.5% (atypical/EIN 3.5%), and carcinoma in 4.0%. A significant association was found between advancing age and malignancy (p<0.001). Postmenopausal bleeding was strongly correlated with hyperplasia and carcinoma (p<0.001). Diabetes (p=0.008) and hypertension (p=0.012) were significant risk correlates. Biopsy-hysterectomy concordance was 100% for carcinoma and hyperplasia without atypia. Conclusion: While benign functional endometrium is most common in AUB, a significant burden of hyperplasia and carcinoma exists, particularly in older, postmenopausal, and metabolically comorbid women. Endometrial biopsy is a reliable first-line diagnostic test, and its routine use enables early detection of serious pathology.

Keywords: Abnormal Uterine Bleeding; Endometrial Biopsy; Histopathology; Endometrial Carcinoma; Hyperplasia; Postmenopausal Bleeding.