scholarly journals Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 884
Author(s):  
Chiara Belcaro ◽  
Federica Scrimin ◽  
Alessandro Mangogna ◽  
Emanuele Filippo Galati ◽  
Stefania Biffi ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Low Risk ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Female Population ◽  
Diagnostic Strategies ◽  
Study Results

Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system’s resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (n = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination.

Abnormal uterine bleeding in women of reproductive age and premenopause

2020 ◽  
Vol 8_2020 ◽  
pp. 29-38
Author(s):  
Solovyeva A.V. Solovyeva ◽  
Chegus L.A. Chegus ◽  
◽  
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Reproductive Age ◽  
Women Of Reproductive Age

COMPARATIVE STUDY OF ENDOMETRIAL CYTOLOGY AND ENDOMETRIAL BIOPSY IN PERI MENOPAUSAL WOMEN

2021 ◽  
pp. 42-43
Author(s):  
Vasudha Rani ◽  
Punam Kumari ◽  
Asha Jha
Keyword(s):  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Endometrial Hyperplasia ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Reproductive Age ◽  
Treatment Modalities ◽  
Focal Lesion ◽  
Diagnostic Strategy ◽  
Rule Out

Abnormal Uterine Bleeding (AUB) is one of the most common health problems encountered by women. It affects about 20% women of reproductive age, and accounts for almost two thirds of all hysterectomies. Gynaecologists are often unable to identify the cause of abnormal bleeding even after a thorough history and physical examination. Diagnostic evaluations and treatment modalities have been evolving over time. The onus in AUB management is to exclude complex endometrial hyperplasia and endometrial cancer. From D and C + EUA under general anaesthesia the shift to more accurate procedures like hysteroscopy and vision directed biopsy was welcome. But the current minimally invasive procedures like sonohysterography, ofce vacuum aspiration (Pipette) and the use of ofce hysteroscopy have revolutionized the management of AUB. We have tried to review the current literature and guidelines for evaluation of endometrium with the twin goals of nding an accurate reason causing the AUB and to rule out endometrial cancer or a potential for the cancer in future. We have also attempted to compare the current procedures and their present perspective vis-à-vis each other. Histological assessment is the nal word, but obtaining a sample for histology makes it more accurate, and we have reviewed these techniques to enhance accuracy in diagnosis. Hysteroscopy and directed biopsy is the 'gold standard' approach for most accurate evaluation of endometrium to rule out focal endometrial Carcinoma. Blind endometrial biopsies should no longer be performed as the sole diagnostic strategy in perimenopausal as well as in postmenopausal women with AUB. Asingle-stop approach, especially in high risk women (Obesity, diabetes, family history of endometrial, ovarian or breast cancer) as well as in women with endometrial hyperplasia of combining the ofce hysteroscopy, directed biopsy in presence of a focal lesion, and vacuum sampling of endometrium in normal looking endometrium, all without anesthesia is the most minimally invasive and yet accurate approach in current practice.

scholarly journals Spectrum of endometrial lesions observed on histopathological examination of endometrial samples in women with abnormal uterine bleeding

2019 ◽  
Vol 7 (11) ◽  
pp. 4124
Author(s):  
Smriti S. Dwivedi ◽  
Malay Bajpai ◽  
Indu Bhushan ◽  
Arunima Satkirti
Keyword(s):  
Endometrial Hyperplasia ◽  
Age Groups ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Reproductive Age ◽  
Age Group ◽  
Hormonal Imbalance ◽  
Endometrial Pattern ◽  
Reproductive Age Group

Background: Abnormal uterine bleeding is one of the common gynecological complaints of women of all age groups. Histopathological study of endometrial biopsy and curettage samples is an effective diagnostic modality that can be used to identify cause of AUB at its earliest. This study was done to investigate the various endometrial causes of AUB that frequently come to our hospital and their incidence in various age groups i.e. reproductive, perimenopausal and postmenopausal.Methods: This study was conducted on 108 patients who clinically presented with AUB and had their endometrial biopsy and curettage specimens sent to the histopathology department of our tertiary care hospital and teaching centre, located in Uttar Pradesh from June 2018 to May 2019. The endometrial patterns were observed, and their frequencies and percentages were computed and classified age group wise.Results: These studies included patients with age range from 19 to 77 years. The predominant age group with AUB was reproductive age group (<40 years). The most common histopathological finding in this study was normal menstrual pattern (48.15 %). The endometrial pathologies observed were hormonal imbalance and pill effect (22.22%), atrophic endometrium (10.19%), chronic endometritis (5.56%), benign endometrial polyp (4.63%), gestation products (3.70%), endometrial hyperplasia (3.70%), and endometrial carcinoma (1.85%). Conclusion: The most commonly known cause of AUB in reproductive age group is due to hormonal imbalance. Endometrial hyperplasia and carcinoma are usually more common in the perimenopausal and postmenopausal age groups. Overall, in patients with no organic cause of AUB, normal cyclical endometrial pattern is the most prevalent endometrial pattern observed.Conclusions: The most commonly known cause of AUB in reproductive age group is due to hormonal imbalance. Endometrial hyperplasia and carcinoma are usually more common in the perimenopausal and postmenopausal age groups. Overall, in patients with no organic cause of AUB, normal cyclical endometrial pattern is the most prevalent endometrial pattern observed.

Comprehensive therapy with myoinositol and D-chiroinositol in a 5:1 ratio for abnormal uterine bleeding in overweight and obese women

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (5) ◽  
pp. 402-406
Author(s):  
Alina V. Solovyeva ◽  
Ildar F. Fatkullin ◽  
Artur R. Akhmetgaliev ◽  
Elena A. Vinokurova ◽  
Ekaterina Yu. Aleynikova ◽  
...  
Keyword(s):  
Follicle Stimulating Hormone ◽  
Abnormal Uterine Bleeding ◽  
Free Testosterone ◽  
Serum Glucose ◽  
Uterine Bleeding ◽  
Reproductive Age ◽  
Obese Women ◽  
Women Of Reproductive Age ◽  
Comprehensive Therapy ◽  
Diet And Exercise

Background. Abnormal uterine bleeding (AUB) occurs in one-third of women of reproductive age and has a significant impact on women's lives, causing anemia, impaired social adaptation and professional activity. AUB-O (ovulatory dysfunction) is often caused by an excessive body mass (BM) and obesity (especially visceral). The most effective option for restoring menstrual cycle (MC) in obese women is BM reduction. There is evidence that the combination of inositols myoinositol (MI) and D-chiroinositol (DCI) has a beneficial effect on BM loss, ovulation frequency and getting pregnant in women with polycystic ovary syndrome. Aim. To study the effect of MI and DHI in a 5:1 ratio in combination with diet and exercise on the regulation of MC in overweight and obese women. Materials and methods. The study has been conducted in clinics of Moscow, Kazan and Tyumen for 20202021. It is a descriptive study assessing an efficacy of lifestyle modification (diet and exercise) plus a nutritional support with a combination of 1000 mg MI and 200 mg DCI (ratio 5:1) for 24 months in 353 women of reproductive age with AMK-O and overweight or obesity. Efficacy criteria include: MC regularity, BM index (BMI), waist circumference (WC), levels of serum glucose, free testosterone, follicle-stimulating hormone, luteinizing hormone. Results. The study showed a significant shortening of MC to its physiological duration 3112.04 days (vs 4419.51 days at the 1st visit; p=0.001), a decrease in the rate of heavy bloody vaginal discharge by 2.57 times (p=0.001), an increase in the rate of moderate bloody vaginal discharge by 1,62 times (p=0.001), an increase in the proportion of patients with regular MC by 2.69 times (p=0.001). These changes were accompanied by a decrease in BM (-3 kg; p=0.001), a decrease in WC (-2.5 cm; p=0.001). Laboratory tests revealed a decrease in serum glucose (-1.3 mmol/L; p0.05), free testosterone (-0.4 pg/L; p0.05), luteinizing hormone (-0.8 mIU/ml; p0.05), and an increase in follicle-stimulating hormone (+0.1 mIU/ml; p0.05) levels. Conclusion. The results obtained (a decrease in BM, a decrease in BMI, WC, as well as MC restoration; p0.05) make it possible to recommend Dikirogen containing MI and DCI in a 5:1 ratio as a part of comprehensive therapy for overweight and obese women with AUB-O.

scholarly journals Clinico histopathological evaluation of abnormal uterine bleeding in women of reproductive and perimenopausal age group

2019 ◽  
Vol 8 (12) ◽  
pp. 4736
Author(s):  
Ela Jha ◽  
Arun Kumar Jha ◽  
Annie Samuel
Keyword(s):  
Significant Proportion ◽  
Abnormal Uterine Bleeding ◽  
Signs And Symptoms ◽  
Well Being ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Reproductive Age ◽  
Common Symptom ◽  
Age Group ◽  
Disease Etiology

Background: Abnormal uterine bleeding constitutes a significant proportion of cases attending gynaecology outpatient department. It affects woman’s physical, emotional, social and maternal well-being, and hence it demands adequate management. It is a multifactorial entity; presented in various patterns, signs and symptoms. The PALM COEIN classification is the most recent method of categorizing AUB (abnormal uterine bleeding) based on structural and non-structural causes. The treatment of AUB depends on age, parity, symptom severity, investigation findings and cause. Various invasive and non-invasive investigations including USG, endometrial biopsy and hysteroscopy helps find different causes. Whatever be the etiology endometrium gets affected; hence AUB is likely managed through hormonal preparations, LNG-IUS, endometrium ablation/resection and ultimately hysterectomy as the last resort.Methods: A retrospective study comprising 216 patients in the age group of 30-50 years with complaints of AUB were recorded as per a structured proforma at department of obstetrics and gynaecology, MGM MCH over a period of one year (January 2018-19). The results of investigations, ultrasound scans, endometrial biopsy and histopathology of hysterectomised specimens were correlated. The endometrial biopsy and histopathology of the specimens was done at department of pathology, MGM MCH.Results: The most common age group showing AUB lies under 35-40 years (40.2%) and 40-45 years (33.7%). Menorrhagia was found to be the most common symptom (66.2%). As per PALM COEIN classification, the most common type in our study was of AUB-L (33.7%) and the associated histopathological pattern was of secretory type (50.4%).Conclusions: The features and patterns of AUB differ according to the age of patient, affecting mostly women in perimenopausal and late reproductive age group. There are various modalities for its diagnosis and management and PALM COEIN classification helps better understand the disease etiology.

scholarly journals The Anemia Syndrome in Contemporary Women: an Unsolved Worldwide Problem. A Therapeutic Approach

Doctor Ru ◽  
2020 ◽  
Vol 19 (8) ◽  
pp. 20-24
Author(s):  
V.E. Radzinsky ◽  
◽  
A.V. Solovyeva ◽  
N.G. Fedotov ◽  
◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anemia ◽  
Ferric Hydroxide ◽  
Abnormal Uterine Bleeding ◽  
First Trimester ◽  
Uterine Bleeding ◽  
Reproductive Age ◽  
Deficiency Anemia ◽  
Women Of Reproductive Age

Objective of the Review: To set forth the frequency and prevalence of the anemia syndrome in non-pregnant and pregnant women and approaches to treating this disorder. Key Points: Anemia syndrome is the most common health problem in contemporary women. The leading cause of iron deficiency in women of reproductive age is abnormal uterine bleeding (AUB). Anemia in women significantly reduces their ability to work and quality of life, and increases the rates and severity of complications in pregnant women and parturients. It is also a significant contributor to maternal mortality and fetal and neonatal morbidity. Treating anemia in pregnant women presents certain challenges. In the period between the first trimester and delivery, there is an 8-fold increase in the requirement for iron; therefore, hemoglobin levels return to normal slowly. The active ingredient of Ferrum Lek is a ferric hydroxide polymaltose complex, which is as effective as medications containing ferrous sulfate, but is significantly better tolerated by patients and easier to use. The active transport of iron allows its controlled absorption from the polymaltose complex, minimizing the risk of an increase in serum levels of iron not bound to transferrin. This ensures that this medication is very safe and eliminates the risk of overdose or poisoning. Conclusion: Anemia syndrome is the most common type of homeostatic imbalance in women of reproductive age. It most often results from frequent and abundant uterine bleeding (AUB). Therefore, an obstetrician-gynecologist plays the leading role in identifying menstrual disorders and choosing therapies to reduce blood loss. A gynecologist will also work with an internist (hematologist) in treating iron deficiency anemia. Keywords: anemia syndrome, iron deficiency anemia, abnormal uterine bleeding, ferric hydroxide polymaltose complex.

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