Abstract
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.
Highlights
Abnormal uterine bleeding (AUB), known as dysfunctional uterine bleeding, is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to90% in perimenopausal women [1,2,3]
The Federation of Gynecology and Obstetrics (FIGO) systems have given an acronym for common etiologies, which apply to chronic AUB
It can be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can affect women in their reproductive age, with an incidence that the National Cancer Institute estimated in 16.7% in the 45–54 age group, and 34.5% in the 55–64 age group [10]
Summary
Abnormal uterine bleeding (AUB), known as dysfunctional uterine bleeding, is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to. It can be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can affect women in their reproductive age, with an incidence that the National Cancer Institute estimated in 16.7% in the 45–54 age group, and 34.5% in the 55–64 age group [10]. Since the most frequent indication for endometrial evaluation in reproductive and perimenopausal age is the AUB, it is advisable to establish the optimal management of this symptom in order to decrease the number of inappropriate examinations and to reduce the incidence of complications related to the procedure, such as infection, perforations, visceral injuries vasovagal attack, adverse reaction to anesthetics, and excessive pain [20,21,22,23]. The present study aims to compare different diagnostic strategies recommended by the leading scientific societies to manage AUB in patients of reproductive age without risk of endometrial cancer [26,27]
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