- Índice
- Acerca de siic
- Expertos invitados
- Por especialidad
- de Iberoamérica
- del mundo
- Entrevistas
- Casos clínicos
-
Crónicas de Autores
- Authors’ Reports
-
Instrucciones para autores
-
Expertos Preguntan
- Novedades
- Actualización Científica sin Exclusiones
- Red Científica Iberoamericana (RedCIbe)
-
Acceso por especialidad
-
Alergia -
Anestesiología -
Bioquímica -
Cardiología -
Cirugía -
Dermatología -
Endocrinología y Metabolismo -
Enfermería -
Gastroenterología -
Hematología -
Infectología -
Inmunología -
Medicina Interna -
Nefrología -
Neumonología -
Neurología -
Nutrición -
Obstetricia y Ginecología -
Odontología -
Oncología -
Otorrinolaringología -
Pediatría -
Salud Mental -
Salud Pública -
Urología -
Más Especialidades
- Acerca de SIIC
- Expertos invitados
- Por especialidad
- de Iberoamérica
- del mundo
- Entrevistas
- Casos clínicos
- Crónicas de Autores
- Authors’ Reports
- Instrucciones para autores
-
Expertos Preguntan
- Novedades
-
Por especialidad
-
Iberomédica
- Informes comentados
- Preocupaciones Profesionales
- Actualización Científica sin Exclusiones
- Médicos Residentes de la Argentina (ACisERA)
- Recién Graduados Iberoamericanos
- Red Científica Iberoamericana
- Por materia
- Por fecha
-
Acceso por especialidad
-
Alergia
-
Anestesiología
-
Bioquímica
-
Cardiología
-
Cirugía
-
Dermatología
-
Endocrinología y Metabolismo
-
Enfermería
-
Gastroenterología
-
Hematología
-
Infectología
-
Inmunología
-
Medicina Interna
-
Nefrología
-
Neumonología
-
Neurología
-
Nutrición
-
Obstetricia y Ginecología
-
Odontología
-
Oncología
-
Otorrinolaringología
-
Pediatría
-
Salud Mental
-
Salud Pública
-
Urología
-
Más Especialidades
Authors' Reports
Sujata Jetley
describes for SIIC the most significant aspects of his articledescribe para SIIC los aspectos relevantes de su artículo
ENDOMETRIUM IN MIDDLE-AGED WOMEN WITH ATYPICAL UTERINE BLEEDING
219 perimenopausal women with abnormal uterine bleeding were studied. Endometrial tissue was evaluated. Menorrhagia was most commonly seen and functional causes accounted for majority of the histological diagnoses. Endometrial curettage is important in perimenopausal women with atypical uterine bleeding in the timely diagnosis of preneoplasia and malignancy.
The article was published by
El artículo fue publicado por
Journal of Mid-Life Health
Volume / Volumen: 4
Number / Número: 4
First and last pages / Páginas inicial-final: 216-220
Year / Año: 2013
Month / Mes: 10
This journal, which is covered by SIIC Data Bases,
is part of the bibliographic collections of the Biblioteca Biomédica (BB) SIIC.
Esta revista, clasificada por SIIC Data Bases,
integra el acervo bibliográfico de la Biblioteca Biomédica (BB) SIIC.
Volume / Volumen: 4
Number / Número: 4
First and last pages / Páginas inicial-final: 216-220
Year / Año: 2013
Month / Mes: 10
This journal, which is covered by SIIC Data Bases,
is part of the bibliographic collections of the Biblioteca Biomédica (BB) SIIC.
Esta revista, clasificada por SIIC Data Bases,
integra el acervo bibliográfico de la Biblioteca Biomédica (BB) SIIC.
Principal institution where the research took place
Institución principal de la investigación
DEPARTMENT OF PATHOLOGY, HAMDARD INSTITUTE OF MEDICAL SCIENCES AND RESEARCH, JAMIA HAMDARD, NEW DELHI, DELHI, India
Research description / Descripción de la investigación
Bibliographic references
Referencias bibliográficas
Albers JR, Hull SK, Wesley MA. Abnormal uterine bleeding. Am Fam Phys 69:1915-1926, 2004.
Bhosle A, Fonseca M. Evaluation and histopathological correlation of abnormal uterine bleeding in perimenopausal women. Bombay Hosp J 52:69-72, 2010.
Dangal G. A study of endometrium of patients with abnormal uterine bleeding at Chitwan valley. Kathmandu Univ Med J 1:110-112, 2003.
Harmanli OH, Shunmugham S, Shen T, Houck KL, Chatwani AJ. The negative predictive value of inadequate endometrial biopsy in diagnosing endometrial neoplasia. J Gynecol Surg 20:13-16, 2004.
Johnson CA. Making sense of dysfunctional uterine bleeding. Am Fam Phys 44:149-157, 1991.
Khare A, Bansal S, Sharma P, Elhence N, et al. Morphological spectrum of Endometrium in patients presenting with dysfunctional uterine bleeding. People's J Sci Res 5:13-16, 2012.
Livingstone M, Fraser IS. Mechanisms of abnormal uterine bleeding. Hum Reprod Update 8:60-67, 2008.
ly JW, Kennedy CM, Clark EC, Bowdler NC. Abnormal Uterine Bleeding: A Management Algorithm. J Am Board Fam Med 19:590-602, 2006.
Mahajan N, Aggarwal M, Bagga A. Health issues of menopausal women in North India. J Midlife Health 3:84-87, 2012.
Michail G, Karahaliou A, Skiadopoulos S, Kalogeropoulou C, Terzis G, Boniatis I, et al. Texture analysis of perimenopausal and post-menopausal endometrial tissue in grayscale transvaginal ultrasonography. Br J Radiol 80:609-616, 2007.
Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 113:3-13, 2011.
Reys, Maheshwri HB. Tuberculosis of the endometrium. A histopathological study of 500 biopsy cases. Ind J Tub 18:27-33, 1971.
Scommenga A, Dmowski WP. Dysfunctional uterine bleeding. Clin Obstet Gynecol 16:221, 1973.
Spencer CP, Whitehead MI. Endometrial assessment revisited. Br J Obstet Gynaecol 106:623-632, 1999.
Takreem A, Danish N, Razaq S. Incidence of endometrial hyperplasia in 100 cases presenting with polymenorrhagia/ menorrhagia in perimenopausal women. J Ayub Med Coll Abbotabad 21:60-63, 2009.
Other articles written by the author Sujata Jetley
Otros artículos de Sujata Jetley
Jetley S, Rana S, Khan RN, Jairajpuri ZS. Xanthogranulomatous cholecystitis, a diagnostic challenge: An experience of 13 cases and a review of literature. J Indian Med Assoc 110(11):833-837, 2012.
Jetley S, Rana S, Khan S, Hasan MJ, Jairajpuri ZS. Incidental gall bladder carcinoma in laproscopic cholecystectomy: Report of 6 cases and a review of literature. J Clin Diag Res 7(1):85-88, 2013.
Jetley S, Rana S, Jairajpuri ZS. Low grade endometrial stromal sarcoma in a premenopausal woman: Report of a rare case. J Nat Sc Biol Med 5:214-217, 2014.
Jairajpuri ZS, Rana S, Hassan MH, Nabi F, Jetley S. An analysis of hematological parameters as indicators of Malaria in patients with acute febrile illness: An Institutional experience. Oman Med J 29(1):12-17, 2014.
Institución principal de la investigación
DEPARTMENT OF PATHOLOGY, HAMDARD INSTITUTE OF MEDICAL SCIENCES AND RESEARCH, JAMIA HAMDARD, NEW DELHI, DELHI, India
Research description / Descripción de la investigación
Delhi, India
(especial para SIIC)
Perimenopause is the period when a woman’s body makes a natural shift from regular cycles of ovulation and menstruation toward permanent infertility, or menopause, and generally occurs at 40-50 years of age. Abnormal uterine bleeding (bleeding pattern differing in frequency, duration, and amount from a pattern observed during a normal menstrual cycle; AUB) is a commonly encountered gynecological problem in this age group. It includes both dysfunctional uterine bleeding (DUB) and bleeding from structural causes like fibroids, polyps, endometrial carcinoma, and pregnancy complications. Endometrial curettage plays an important role in excluding organic uterine disorders.
We undertook a study to determine the types and frequencies of endometrial pathologies in perimenopausal women presenting with abnormal uterine bleeding. All the patients in this study were in the 40-50 age group. Data on the age and presenting clinical features was also retrieved and recorded wherever available.
Endometrial tissue collected by sampling procedures such as dilatation and curettage (D & C), endometrial biopsy and fractional curettage was evaluated.
A total of 219 perimenopausal women underwent endometrial sampling at the Hakeem Abdul Hameed Centenary Hospital, New Delhi over a 4-year period. Details of patterns of bleeding were available in only 155 of the total 219 cases, the most common clinical presentation being menorrhagia.
The PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic and not yet classified) classification system for AUB has been recently approved as a FIGO classification system. This classification system was developed to be used by clinicians, investigators, and even patients to facilitate communication, clinical care, and research. Functional causes accounted for majority of the diagnoses. Secretory endometrium seen in 71 cases was the most common diagnosis followed by proliferative endometrium, the second most common diagnosis seen in 67 patients. Other functional causes of atypical uterine bleeding were disordered proliferative endometrium in 15 cases, luteal phase defects in 3 cases. Endometrial hyperplasia was seen in 24 patients who presented with atypical uterine bleeding. On categorizing the types of endometrial hyperplasia, simple hyperplasia without atypia was seen in 19 cases, complex hyperplasia without atypia in 4 cases, and complex hyperplasia with atypia in 1 case. Endometritis was diagnosed in 20 patients in this study, of which tubercular etiology was demonstrated in 2 cases. Endometrial polyps were seen in 6 cases. Polyps were identified as polypoidal fragments with epithelium on three sides, fibrous stroma and thick-walled blood vessels. Irregularly shaped, crowded hyperplastic glands were seen in 4 of the cases while 2 cases showed glands with normal cycling endometrium. Spontaneous pregnancy loss was the cause of bleeding in 3 cases. Evidence of exogenous hormone therapy, which is a common line of medical management in patients of atypical uterine bleeding, and often prescribed empirically, was seen in 6 cases. Finally, in 4 cases, the endometrial curettings were scanty and inadequate for any diagnostic opinion.
Abnormal uterine bleeding that is both excessive and irregular accounts for more than 70% of all gynecological consultations in the peri- and postmenopausal years. Conventional D & C is commonly used in developing countries with limited resources as a standard and an important method of assessing abnormal uterine bleeding. We analyzed atypical uterine bleeding among women in the 40-50 age group. Atypical uterine bleeding without structural pathology is seen in women across all age groups but is more common in adolescent and perimenopausal women.
Hypothalamic-pituitary-ovarian axis derangements may result in changes in the hormonal milieu, leading to abnormal uterine bleeding. We found that the most common histopathological finding was secretory endometrium in 71 cases. Other studies in women with atypical uterine bleeding have shown similar findings. Proliferative endometrium was seen in 67 patients, disordered proliferative endometrium was present in 15 cases and endometrial hyperplasia in 24 cases. Hence 106 of the 219 perimenopausal women studied were exposed to unopposed estrogen. In the absence of ovulation and the production of progesterone, the endometrium responds to estrogen stimulation by proliferation. Painless, irregular bleeding which is characteristic in this clinical setting was seen in all these cases. In perimenopausal years, anovulatory cycles are most frequent and chronic anovulation is associated with an irregular and unpredictable pattern of bleeding. Several studies from the subcontinent have shown similar findings.
This study also detected endometrial polyps in six cases, out of which four were hyperplastic polyps characterized by simple hyperplasia without atypia, and two cases were functional polyps with a normal endometrium. Again the common implicating factor here is increased estrogen secretion, which leads to hyperplasia of the basal endometrial layer.
Endometritis was seen in 20 cases in this study. Nonspecific chronic endometritis as an etiology of atypical uterine bleeding in perimenopausal women has been reported by other workers also.
Out of 20 endometritis cases, tubercular etiology was established in 2 cases. A large Indian study of 500 biopsy proven cases of tuberculosis of the endometrium reported that while sterility was the most common presentation, atypical uterine bleeding was also seen in 22.2% cases.
Scanty endometrium, inadequate for opinion, was seen in 4 cases in this study. A study, which evaluated the negative predictive value of endometrial samples reported as inadequate in diagnosing endometrial hyperplasia and malignancy, was carried out in 2004 at the School of Medicine, Philadelphia. They concluded that an inadequate endometrial sample may be sufficient to rule out endometrial neoplasia because of its high negative predictive value.
Atypical uterine bleeding in perimenopausal women is commonly dysfunctional in origin. A significant number also show underlying organic pathological lesions thus highlighting the importance of histopathological examination of the endometrium. Accurate analysis of endometrial samplings is therefore, critical to effective therapy and optimal outcome.
Perimenopause is the period when a woman’s body makes a natural shift from regular cycles of ovulation and menstruation toward permanent infertility, or menopause, and generally occurs at 40-50 years of age. Abnormal uterine bleeding (bleeding pattern differing in frequency, duration, and amount from a pattern observed during a normal menstrual cycle; AUB) is a commonly encountered gynecological problem in this age group. It includes both dysfunctional uterine bleeding (DUB) and bleeding from structural causes like fibroids, polyps, endometrial carcinoma, and pregnancy complications. Endometrial curettage plays an important role in excluding organic uterine disorders.
We undertook a study to determine the types and frequencies of endometrial pathologies in perimenopausal women presenting with abnormal uterine bleeding. All the patients in this study were in the 40-50 age group. Data on the age and presenting clinical features was also retrieved and recorded wherever available.
Endometrial tissue collected by sampling procedures such as dilatation and curettage (D & C), endometrial biopsy and fractional curettage was evaluated.
A total of 219 perimenopausal women underwent endometrial sampling at the Hakeem Abdul Hameed Centenary Hospital, New Delhi over a 4-year period. Details of patterns of bleeding were available in only 155 of the total 219 cases, the most common clinical presentation being menorrhagia.
The PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic and not yet classified) classification system for AUB has been recently approved as a FIGO classification system. This classification system was developed to be used by clinicians, investigators, and even patients to facilitate communication, clinical care, and research. Functional causes accounted for majority of the diagnoses. Secretory endometrium seen in 71 cases was the most common diagnosis followed by proliferative endometrium, the second most common diagnosis seen in 67 patients. Other functional causes of atypical uterine bleeding were disordered proliferative endometrium in 15 cases, luteal phase defects in 3 cases. Endometrial hyperplasia was seen in 24 patients who presented with atypical uterine bleeding. On categorizing the types of endometrial hyperplasia, simple hyperplasia without atypia was seen in 19 cases, complex hyperplasia without atypia in 4 cases, and complex hyperplasia with atypia in 1 case. Endometritis was diagnosed in 20 patients in this study, of which tubercular etiology was demonstrated in 2 cases. Endometrial polyps were seen in 6 cases. Polyps were identified as polypoidal fragments with epithelium on three sides, fibrous stroma and thick-walled blood vessels. Irregularly shaped, crowded hyperplastic glands were seen in 4 of the cases while 2 cases showed glands with normal cycling endometrium. Spontaneous pregnancy loss was the cause of bleeding in 3 cases. Evidence of exogenous hormone therapy, which is a common line of medical management in patients of atypical uterine bleeding, and often prescribed empirically, was seen in 6 cases. Finally, in 4 cases, the endometrial curettings were scanty and inadequate for any diagnostic opinion.
Abnormal uterine bleeding that is both excessive and irregular accounts for more than 70% of all gynecological consultations in the peri- and postmenopausal years. Conventional D & C is commonly used in developing countries with limited resources as a standard and an important method of assessing abnormal uterine bleeding. We analyzed atypical uterine bleeding among women in the 40-50 age group. Atypical uterine bleeding without structural pathology is seen in women across all age groups but is more common in adolescent and perimenopausal women.
Hypothalamic-pituitary-ovarian axis derangements may result in changes in the hormonal milieu, leading to abnormal uterine bleeding. We found that the most common histopathological finding was secretory endometrium in 71 cases. Other studies in women with atypical uterine bleeding have shown similar findings. Proliferative endometrium was seen in 67 patients, disordered proliferative endometrium was present in 15 cases and endometrial hyperplasia in 24 cases. Hence 106 of the 219 perimenopausal women studied were exposed to unopposed estrogen. In the absence of ovulation and the production of progesterone, the endometrium responds to estrogen stimulation by proliferation. Painless, irregular bleeding which is characteristic in this clinical setting was seen in all these cases. In perimenopausal years, anovulatory cycles are most frequent and chronic anovulation is associated with an irregular and unpredictable pattern of bleeding. Several studies from the subcontinent have shown similar findings.
This study also detected endometrial polyps in six cases, out of which four were hyperplastic polyps characterized by simple hyperplasia without atypia, and two cases were functional polyps with a normal endometrium. Again the common implicating factor here is increased estrogen secretion, which leads to hyperplasia of the basal endometrial layer.
Endometritis was seen in 20 cases in this study. Nonspecific chronic endometritis as an etiology of atypical uterine bleeding in perimenopausal women has been reported by other workers also.
Out of 20 endometritis cases, tubercular etiology was established in 2 cases. A large Indian study of 500 biopsy proven cases of tuberculosis of the endometrium reported that while sterility was the most common presentation, atypical uterine bleeding was also seen in 22.2% cases.
Scanty endometrium, inadequate for opinion, was seen in 4 cases in this study. A study, which evaluated the negative predictive value of endometrial samples reported as inadequate in diagnosing endometrial hyperplasia and malignancy, was carried out in 2004 at the School of Medicine, Philadelphia. They concluded that an inadequate endometrial sample may be sufficient to rule out endometrial neoplasia because of its high negative predictive value.
Atypical uterine bleeding in perimenopausal women is commonly dysfunctional in origin. A significant number also show underlying organic pathological lesions thus highlighting the importance of histopathological examination of the endometrium. Accurate analysis of endometrial samplings is therefore, critical to effective therapy and optimal outcome.
Bibliographic references
Referencias bibliográficas
Albers JR, Hull SK, Wesley MA. Abnormal uterine bleeding. Am Fam Phys 69:1915-1926, 2004.
Bhosle A, Fonseca M. Evaluation and histopathological correlation of abnormal uterine bleeding in perimenopausal women. Bombay Hosp J 52:69-72, 2010.
Dangal G. A study of endometrium of patients with abnormal uterine bleeding at Chitwan valley. Kathmandu Univ Med J 1:110-112, 2003.
Harmanli OH, Shunmugham S, Shen T, Houck KL, Chatwani AJ. The negative predictive value of inadequate endometrial biopsy in diagnosing endometrial neoplasia. J Gynecol Surg 20:13-16, 2004.
Johnson CA. Making sense of dysfunctional uterine bleeding. Am Fam Phys 44:149-157, 1991.
Khare A, Bansal S, Sharma P, Elhence N, et al. Morphological spectrum of Endometrium in patients presenting with dysfunctional uterine bleeding. People's J Sci Res 5:13-16, 2012.
Livingstone M, Fraser IS. Mechanisms of abnormal uterine bleeding. Hum Reprod Update 8:60-67, 2008.
ly JW, Kennedy CM, Clark EC, Bowdler NC. Abnormal Uterine Bleeding: A Management Algorithm. J Am Board Fam Med 19:590-602, 2006.
Mahajan N, Aggarwal M, Bagga A. Health issues of menopausal women in North India. J Midlife Health 3:84-87, 2012.
Michail G, Karahaliou A, Skiadopoulos S, Kalogeropoulou C, Terzis G, Boniatis I, et al. Texture analysis of perimenopausal and post-menopausal endometrial tissue in grayscale transvaginal ultrasonography. Br J Radiol 80:609-616, 2007.
Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 113:3-13, 2011.
Reys, Maheshwri HB. Tuberculosis of the endometrium. A histopathological study of 500 biopsy cases. Ind J Tub 18:27-33, 1971.
Scommenga A, Dmowski WP. Dysfunctional uterine bleeding. Clin Obstet Gynecol 16:221, 1973.
Spencer CP, Whitehead MI. Endometrial assessment revisited. Br J Obstet Gynaecol 106:623-632, 1999.
Takreem A, Danish N, Razaq S. Incidence of endometrial hyperplasia in 100 cases presenting with polymenorrhagia/ menorrhagia in perimenopausal women. J Ayub Med Coll Abbotabad 21:60-63, 2009.
Other articles written by the author Sujata Jetley
Otros artículos de Sujata Jetley
Jetley S, Rana S, Khan RN, Jairajpuri ZS. Xanthogranulomatous cholecystitis, a diagnostic challenge: An experience of 13 cases and a review of literature. J Indian Med Assoc 110(11):833-837, 2012.
Jetley S, Rana S, Khan S, Hasan MJ, Jairajpuri ZS. Incidental gall bladder carcinoma in laproscopic cholecystectomy: Report of 6 cases and a review of literature. J Clin Diag Res 7(1):85-88, 2013.
Jetley S, Rana S, Jairajpuri ZS. Low grade endometrial stromal sarcoma in a premenopausal woman: Report of a rare case. J Nat Sc Biol Med 5:214-217, 2014.
Jairajpuri ZS, Rana S, Hassan MH, Nabi F, Jetley S. An analysis of hematological parameters as indicators of Malaria in patients with acute febrile illness: An Institutional experience. Oman Med J 29(1):12-17, 2014.
SIIC System of Assisted Editing (SSEA)
/ Sistema SIIC de Edición Asistida (SSEA)
The article is strictly related to the following sections of siicsalud
El artículo se relaciona estrictamente con las siguientes secciones de siicsalud
Information about the full text
Acerca del trabajo completo
ENDOMETRIUM IN MIDDLE-AGED WOMEN WITH ATYPICAL UTERINE BLEEDING
Author / Autor
Zeeba Jairajpuri1, Safia Rana2, Sujata Jetley3, Sujata Jetley4
4, Department of Pathology, Hamdard Institute of Medical Sciences & Research (HIMSR), Jamia Handard, India
Access to the original source
Journal of Mid-Life Health
Article URL: / URL del artículo:
http://www.jmidlifehealth.org
siic DB: / siic DB:
www.siicsalud.com/main/distriprinrel.php
/ Sistema SIIC de Edición Asistida (SSEA)
|
The author's report was accepted on La crónica del autor fue aprobada el 2024, January 24 |
Published in siicsalud Publicado en siicsalud 2024, April 23 |
|
The article is strictly related to the following sections of siicsalud
El artículo se relaciona estrictamente con las siguientes secciones de siicsalud
 Anatomo-Pathology / Anatomía Patológica |
Gynaecology and Obstetrics / Obstetricia y Ginecología |
||||||
|
and secondarily related to the following sections y secundariamente con las siguientes secciones
|
|||||||
Information about the full text
Acerca del trabajo completo
ENDOMETRIUM IN MIDDLE-AGED WOMEN WITH ATYPICAL UTERINE BLEEDING
Author / Autor
Zeeba Jairajpuri1, Safia Rana2, Sujata Jetley3, Sujata Jetley4
4, Department of Pathology, Hamdard Institute of Medical Sciences & Research (HIMSR), Jamia Handard, India
Access to the original source
Journal of Mid-Life Health
Article URL: / URL del artículo:
http://www.jmidlifehealth.org
siic DB: / siic DB:
www.siicsalud.com/main/distriprinrel.php
ua40317
