Risk Categories for Abnormal Endometrial Biopsy in Dysfunctional Uterine Bleeding

Abstract

Objective: this study was designed to examine the clinical utility of risk factors for postmenopausal endometrial adenocarcinoma in predicting abnormal endometrial biopsy in premenopausal women diagnosed with dysfunctional uterine bleeding (DUB). The second purpose was to develop risk categories for abnormal endometrial biopsy in women with DUB.Design: prospective observational study.Setting: gynaecology department of a large teaching hospital.Population: women complaining of premenopausal abnormal gynaecological bleeding.Methods: women were included in the study if they experienced abnormal gynaecological bleeding due to either DUB or small fibroids. The risk factors for endometrial cancer that were tested included menstrual cycle irregularity, diabetes, nulliparity, hypertension, obesity (weight ≥ 100 kilograms or Body Mass Index > 33) and age ≥ 40 years. Logistic regression was used to investigate the relative importance of each risk factor.Main outcome measures : the correlation of abnormal endometrial histology with risk factors for endometrial cancer.Results: six hundred women were studied. Sixty-nine patients were excluded. The results from 531 patients with either DUB alone (467) or bleeding associated with small fibroids (64) were analysed. Thirty-four (6.4%) patients had abnormal endometrial biopsies. Menstrual cycle irregularity was the only statistically significant independent risk factor for an abnormal biopsy. No specific subtype of irregular menstrual pattern predicted an increased prevalence of abnormal endometrial biopsy.Conclusions: premenopausal women diagnosed with DUB whose menstrual cycles are regular have a negligible risk of developing endometrial hyperplasia, and can safely be spared the discomfort and risk of complications associated with endometrial biopsy.