European Journal of Cardiovascular Medicine

Bleeding patterns that deviate from those seen during a regular menstrual cycle or during menopause in terms of frequency, length, and quantity are referred to as AUBs ⁽¹⁾. About one-third of the outpatients who visit the gynaecology OPD are a result of it ^{(2, 3)}.

Physiological alterations in the endometrium (such as atrophic endometrium) and aberrant cyclical endometrium are

examples of functional reasons
(proliferative disorders) as well as organic lesions such as polyps, carcinomas, hyperplasia, and problems arising from

pregnancy. When an underlying cause cannot be identified, dysfunctional uterine bleeding is classified as a form of AUB(4). It can be identified using a variety of diagnostic approaches once structural, iatrogenic, pharmaceutical, psychological, and systemic problems have been ruled out⁽⁵⁾ . Histopathological analysis of the uterus Biopsies are the gold standard diagnostic method for evaluating AUB, and a precise diagnosis aids in the planning of the therapeutic course for

effective, creative AUB⁽⁶⁾ care.

In order to assess the aetiology of AUB histopathologically, 145 suitable endometrial biopsy samples that were obtained during an 18-month period were selected for the current investigation.

The pathology department of the MKCG MCH, Berhampur carried out this investigation. This study includes 145 biopsies taken from patients who presented with AUB between August 2017 and February 2019. After being placed in 10% formalin, endometrial samples were processed histologically and stained with hematoxylin and eosin stain. Both functional and organic reasons were identified from the histopathology results. This study covered normal cycle endometrium (proliferative and secretory phase) as well as other alterations such as disordered endometrium and atrophic endometrium as functional reasons of AUB. Retained products of conception, endometrial polyps, endometrial cancer, and endometrial hyperplasia with or without atypia were among the organic reasons.

The majority of AUB patients in our research (68.96% of all cases) had a functional aetiology, according to Table 1. In the group of women approaching menopause, organic lesions predominated (Table 2). In our research, perimenopausal women made up 44.13% of the age group with the highest frequency of AUB presentations. According to Table 3, proliferative endometrium is the most prevalent pattern at this age (32.81%).

Table 1: Functional Causes Of AUB

Table2: Organic Causes Of AUB

Table 3: Distribution Of Cases Based On Causes In Different Age Groups

Women's endometrium is a reflection of their hormonal state. The endometrium exhibits histological diversity based on the age of the woman, the period of her menstrual cycle, and any further particular pathology⁽⁷⁾.
According to S. Vaidya et al.⁽⁸⁾ and Doraiswami S et al^.(9), the age range of 41 to 50 years old was the most prevalent for AUB presentations in our research. Our study's 68.96% incidence of a functional aetiology of AUB was similar to that of Ara & Roohi (62.1%).(10), Muzaffar et al. (61%) and Abdullah LS (61.5%)^{11, 12}. Our study's 31.03% organic aetiology of AUB incidence was similar to that of SB Mune et al. (35.4%).(13) but was marginally more than S.Vaidya et al.'s (19%)⁸. Similar to the research, cyclical endometrial alteration predominated in those who were reproductive age.via Doraiswami S. et al.

Proliferative endometrium (32.81%) was the primary reason in perimenopausal age, which was similar to Bhatta et al. (29.8%) ⁽¹⁴⁾ and Damle et al. (34%)¹⁵. Among AUB cases, organic causes accounted for 28.12%, the greatest percentage when compared to other age groups. Endometrial hyperplasia was the most frequent cause among the organic reasons. Studies whereby have been reported in the literature.

One of the main causes of AUB in perimenopausal age groups was endometrial hyperplasia ^{(15, 16, 17)}.
The most prevalent cause of AUB in the postmenopausal age group was hyperplasia without atypia (33.33%), whereas in a research by Khare et al. ¹⁶, the most common cause of AUB was both complicated hyperplasia without atypia and atrophic endometrium ¹⁵ . 6.89% of all cases in our analysis were endometrial cancer, with the highest in the postmenopausal age group. This result was in line with research by Khare et al. (3.7%)¹⁶ , Bhatta et al. (5.7%)¹⁴, and Doraiswami S et al. (4.4%) ⁹ .Most research shown that post-menopausal age accounts for the bulk of cancer instances ^{(18, 19)}.

Endometrial samples' histopathological analysis is the gold standard diagnostic method for assessing AUB. In addition to offering information on the endometrium's hormonal response, it aids in the diagnosis of organic reasons, including endometrial cancer. Thus, histological investigation is essential, particularly for women in the perimenopausal and postmenopausal age groups. It can be the initial step towards diagnosing endometrial cancer, which will help the doctor decide how best to proceed with the patient's care

1. Ely JW, Kennedy CM, Clark EC, Bowdler NC. Abnormal Uterine Bleeding: A Management Algorithm. J Amer Board Fam Med 2006;19:590-602.
2. Awaad JT, Toth TL, Schiff I. Abnormal Uterine Bleeding in the Perimenopause. Int’l J Fertil Menopausal Stud 1993;38:261-269.
3. Wren BG. Dysfunctional UterineBleeding. Aus Fam Physician1998;27:371-377.
4. Brandon JB, Amy EH, Nicholas CL, Harold EF, Edward EW.The JohnHopkin’s Manual of Gynecology and Obstetrics 2002; 2nd ed. Philadelphia: Lippincott Williams & Williams;2004. p. 405-411.
5. Morano B, Zarbo R, Puglisi F et al. Dysfunctional uterine bleeding: medical therapies. Minerva Gincal 2003;55:241-
6. Parmar J, Desai D. Study of endometrial pathology in abnormal uterine bleeding.Int J ReprodContraceptObstetGynecol2013;2:182-185.
7. M.D, Subramanya. Study of Endometrial Pathology in Abnormal Uterine Bleeding. Int J Sci Research 2014;3(8):490-492.
8. Vaidya S,LakheyM,VaidyaAmatyaS.,Sharma P K, HirachandS,Lama S,KC S.Histopathological pattern of abnormal uterine bleeding in endometrial biopsies. Nepal Med Coll J .2013;15(1):74-77
9. Doraiswami S, Johnson T, Rao S, RajkumarA,Vijayaraghavan J, Panicker VK; Study of endometrial pathology in abnormal uterine bleeding. J of Obstet&Gynae of India, 2011;61(4): 426-430.
10. Ara S and Roohi M. Abnormal uterine bleeding; histopathological diagnosis by conventional dilatation and curettage. Professional Medical Journal 2011;18(4):587-591.