Clinical and Pathologic Study of Abnormal Uterine Bleeding in Premenopausal Women-To Evaluate the Prognostic Variables of Endometrial Hyperplasia

Ko, Ji Kyung; Choi, Hoon; Kang, Woong Sun; Kim, Myung Hwan; Park, Kee Hyun; Lee, Chul Min; Cho, Yong Kyoon; Kim, Bok Lin; Lee, Hong Kyoon

Abstract

OBJECTIVE
We performed this study to understand correlation between clinical aspects and pathological findings of abnormal uterine bleeding (AUB) and to evaluate the prognostic variables of endometrial hyperplasia.
METHODS
We reviewed 500 premenopausal women with abnormal uterine bleeding who underwent endometrial biopsy from January 1996 to February 2003, retrospectively. Pregnant women, or women who had hematologic disease, or who used iatrogenic hormones were excluded. The age of women with AUB was mostly in the 5th decade (41.3 +/- 6.8). Body mass index (BMI) in most of women (69.6%) was between 18.6 and 24.9 (22.7 +/- 3.5).
RESULTS
Among AUB menorrhagea (51.0%) was the most common bleeding pattern, and the next one was intermenstrual bleeding (38.0%). Histologic findings of endometrium were proliferative phase (34.0%), hyperplasia (26.4%), and seceretory phase (22.6%), in order of frequency. 79.0% (104 cases) of endometrial hyperplasia were simple hyperplasia, 16.0% (21 case) were complex hyperplasia, and 5.0% (7 case) were atypical hyperplasia. The associated diseases were myoma uteri, hypertension, and diabetes mellitus, in order of frequency. The endometrial hyperplasia was diagnosed in 46.4% of patients whose BMI was between 27.0-29.9, in 40% of patients between 30.0-34.9 and in 100% of patients whose BMI was 35.0 or more. The endometrial hyperplasia was diagnosed in 40.6% of patients with an endometrial thickness measured 15.1 mm to 20.0 mm, in 57.1% of patients with 20.1 mm to 25.0 mm, and in 100% of patients with 25.1 mm or higher.
CONCLUSION
In premenopausal woman with AUB, the endometrial hyperplasia was highly associated with women whose BMI was 27.0 or higher, or with endometrial thickness measured more than 15.0 mm. Therefore endometrial biopsy should be taken in women with AUB whose BMI is high, or endometrial thickness is thick to exclude the endometrial hyperplasia.