Abnormal Uterine Bleeding Patients Research Articles

A prospective observational study on thyroid dysfunction in women with abnormal uterine bleeding: In a Teritary care hospital

Background: One of the most common diseases in gynecology, abnormal uterine bleeding (AUB) has a major negative impact on women's quality of life. Unusual bleeding in women can be brought on by thyroid conditions. The purpose of the study is to determine how common thyroid abnormalities are in women who have irregular uterine bleeding. It also looks at the menstrual patterns linked to thyroid disorders. The study concluded that hypothyroidism patients have menorrhagia, hyperthyroidism patients may experience dysmenorrhea, and thyroid dysfunction may result in irregular uterine hemorrhage. Materials and procedures: Premenopausal women with abnormal uterine bleeding (AUB) participated in a prospective observational study conducted in the gynecology department of a tertiary care hospital in Trivandrum between November 2022 and April 2023 (a period of six months). Result: Of the 75 patients who were chosen, 71 (94.7%) had AUB-induced hypothyroidism and 4 (5.3%) had AUB-induced hyperthyroidism. Regarding the menstrual pattern, 83.1% of patients with hypothyroidism and 100% of patients with hyperthyroidism reported experiencing menorrhagia or dysmenorrhea. The study concludes that there is a considerable correlation between thyroid issues and abnormal uterine hemorrhage. The majority of female AUB patients exhibit both hyperthyroidism and hypothyroidism. The most common menstrual pattern linked to hypothyroidism was menorrhagia. Dysmenorrhea was thought to be the most prevalent monthly abnormality in hyperthyroidism.

FIGO PALM-COEIN Classification of Abnormal Uterine Bleeding in Saudi Women.

Abnormal uterine bleeding (AUB) is a significant concern in women's health. However, there is limited research on its prevalence and characteristics in Saudi Arabia. To determine the prevalence of AUB in a gynecology outpatient setting in Saudi Arabia and to categorize the cases of AUB according to the FIGO classification. This retrospective study included all Saudi female patients who presented to the Obstetrics and Gynecology clinic at King Khalid University Hospital, Riyadh, Saudi Arabia, over a 2-year period, except those who were pregnant. Data regarding demographics, BMI, clinical symptoms, laboratory tests, ultrasound results, and histopathology findings was collected. Cases of AUB were classified using the FIGO PALM-COEIN system. A total of 2724 patients were included, of which 44.6% had AUB. The most common presentations of AUB were irregular cycles (59.3%) and heavy bleeding (12.8%), and the most affected group was the reproductive age group (19-39 years). Obesity was identified as a significant risk factor. AUB-O (ovulatory disorder; functional cause) was the most prevalent (23%), followed by AUB-L (leiomyomas, 18%; structural cause) and AUB-P (polyps, 8.8%). Specific AUB patterns correlated with ultrasonographic findings, with heavy bleeding associated with polyps, adenomyosis, and leiomyomas. AUB patients had lower hemoglobin levels, indicating potential health impacts. The study found that nearly half of all women presenting with gynecological complaints in Riyadh, Saudi Arabia, have AUB. According to the FIGO classification, functional causes of AUB were more prevalent than structural causes. Further research is necessary to explore underlying causes of AUB and its long-term health implications.

To estimate the prevalence of anaemia in patients of Abnormal Uterine Bleeding (AUB) admitted in Tertiary Care Centre

To estimate the prevalence of anaemia in patients of Abnormal Uterine Bleeding (AUB) admitted in Tertiary Care Centre

Histopathological spectrum of uterine lesions in hysterectomy specimens of patients with abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is an overarching term that reflects any departure from normal menstruation or regular menstrual cycle patterns. Treatment depends upon the cause. Hysterectomy being a definite treatment for structural uterine pathology. Methods: This cross-sectional observational study was conducted in department of pathology, Netaji Subhash Chandra Bose medical college Jabalpur (M.P.). The study comprised of 140 hysterectomy specimens with or without salpingo-oophorectomy obtained from AUB patients and submitted for histopathological examination in our department during study period of 18 months. The relevant data of the patients was collected and analyzed as per designed proforma. Results: Out of 140 cases, majority of the patients were in 41-50 years age group 63 cases (45%), followed by 31-40 years age group 59 cases (42.14%). Most common clinical presentation was heavy menstrual bleeding in 83 cases (59.28%), followed by intermenstrual bleeding and pain in abdomen in 66 cases (47.14%) each. Commonest lesion found was leiomyoma, 83 cases (59.28%), second being dual pathology of adenomyosis with leiomyoma 23 cases (16.42%) followed by adenomyosis, 19 cases (13.57%). Four cases (2.85%) of benign endometrial polyp and endometrial carcinoma each and 1 case of adenomyoma, simple endometrial hyperplasia and endometrial stromal sarcoma, each, were reported. Conclusions: A wide spectrum of histopathological findings, ranging from normal cyclic endometrium to benign pathology and malignancy were seen. In some patients, dual pathologies, incidental findings and occult malignant lesions, which were missed clinically or radiologically, was diagnosed on histopathological examination, thus making it a gold standard for definite diagnosis.

Endometrial Hormonal Receptor Expression and Blood Vessel Density in Abnormal Uterine Bleeding: A Cross-sectional Descriptive Study

Introduction: Abnormal uterine bleeding (AUB) is bleeding which is abnormal in amount, duration, frequency, and cyclicity and differs from the normal pattern. The aim of the study is to evaluate the expression of endometrial estrogen (ER) and progesterone receptor (PR) immunohistochemically and blood vessel density in AUB patients. Furthermore, we will correlate hormonal receptor expression and blood vessel density with various endometrial pathologies presenting with AUB. Materials and Methods: A cross-sectional study of 60 cases with clinical diagnosis of AUB, (30 cases of cyclical endometrium and 30 cases of hyperplasia/carcinoma) was done. Histological typing of endometrial lesions was done. Microvessel density (MVD) was calculated by counting the average number of blood vessels/10 HPFs. Evaluation of MVD was done on hematoxylin and eosin (H and E) stain and also reticulin stain which highlighted the basement membrane. Immunohistochemistry for steroid hormone receptors, ER and PR was done as per avidin-biotin technique with Diaminobenzidine as the chromogen. Carcangiu scoring system for semiquantitative analysis of ER/PR expression in endometrial samples was adopted. Results: There was a significant difference in microvessel density between different histopathology microscopic diagnoses (P < 0.05). The mean value of microvessel density on reticulin stain was significantly higher as compared to the mean value of MVD on H and E. A decrease of the hormonal receptor expression, ER and PR was observed in parallel with the decreased histological degree of differentiation, the lowest values occurring in the case of endometrioid Grade 3 carcinomas. Conclusion: Angiogenesis is significantly correlated with increasing severity of the lesion. The correlation of immunohistochemical findings with histologic grade can be useful in predicting biological behavior in patients.

Levonorgestrel-releasing intrauterine device to treat abnormal uterine bleeding; not one treatment option fits all.

Initially, medical treatment options are preferred in patients with abnormal uterine bleeding (AUB) who are hemodynamically stable. The aim of the present study was to investigate the effectiveness of a levonorgestrel-releasing intrauterine device (LNG-IUD) in reducing bleeding symptoms in patients with AUB stratified by underlying pathology. In line with the polyp, adenomyosis, leiomyoma, malignancy (and hyperplasia), coagulopathy, ovulatory disorders, endometrial, iatrogenic and not otherwise classified classification system, patients who were administered LNG-IUD due to adenomyosis, endometrial hyperplasia, leiomyoma and AUB due to not otherwise classified causes were included in the study. A total of 172 otherwise patients with a mean age of 42.58±5.00 years were included. The distributions in the adenomyosis, endometrial hyperplasia, leiomyoma and otherwise unclassified groups were 30.8%, 12.8%, 26.2%, and 30.2%, respectively. Overall effectiveness of LNG-IUD in reducing menstrual bleeding was 82%. The proportion whose bleeding decreased was 95.50% in the endometrial hyperplasia group, 88.70% in the adenomyosis group, 55.60% in the leiomyoma group and 92.30% in the not otherwise classified group. The power of the current study was 99%. The efficacy of LNG-IUD was significantly less in the leiomyoma group (p<0.05) and thus this group were more likely to require surgical intervention. The overall incidence of spotting was 50%. Amenorrhea developed in 14% of patients. While LNG-IUD was more effective in reducing symptoms of AUB in patients with adenomyosis, endometrial hyperplasia and not otherwise classified causes, LNG-IUD was less effective in cases of leiomyoma.

Effect of Ayurvedic Formulations on Abnormal Uterine Bleeding (Asrigdara): A Prospective Uncontrolled Multicenter Clinical Study

IntroductionAsrigdara in Ayurveda simulates the dysfunctional type of abnormal uterine bleeding (AUB) and is a common gynaecological complaint. It negatively affects the quality of life and is associated with the poor health of women. This study aimed to evaluate the effect of Ayurvedic formulations, Pushyanuga churna (PC) and Usheerasava (UA) in managing AUB. MethodsA multicenter, single-arm clinical study was conducted on 80 diagnosed patients of AUB. PC 3 g and UA 20 ml were given twice daily for 90 days. Clinical assessment was done at baseline, every 15th day for the initial 3 months, and on 120th day. Pictorial blood loss assessment chart score, visual analogue scale, and Psychological General Well-being Index were utilised to measure the outcome parameters. The safety of formulations was evaluated by reporting adverse drug reactions and changes in liver function tests and renal function tests at baseline and on 90th day. ResultsSixty-eight participants completed the trial. Data were analysed using SPSS version 28.0. The mean age of the participants was 31.7 ± 6.3 years and majority (73.5%) were multiparous. The most typical presentation was heavy menstrual bleeding in 92.6%, followed by frequent bleeding (52.9%). At baseline, 94.2% participants had a pictorial blood loss assessment chart score >100, which decreased to 30.7% at the end of the study. Highly significant changes (P < 0.001) were observed in frequent, prolonged bleeding and psychological general well-being index score. No adverse drug reactions and significant changes in safety parameters were found. ConclusionsPC and UA are effective, well-tolerable, and safe in managing AUB.

Histopathological Diagnosis of Hysterectomy Specimens in Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is a common and distressing condition effecting predominantly perimenopausal women. Heavy menstrual bleeding (HMB) is the most common presentation of AUB. There are many structural and non structural causes of AUB. Histopathology of endometrial curettings is well studies before but the histopathological patterns of hysterectomy specimens are not well studied. Objective: The objective of this study is to: Find out histopathological diagnosis of hysterectomy specimens in patients of AUB. Study Design: Retrospective Cohort study. Place and Duration of Study: Gynecology and Pathology departments of Azra Naheed and Rashid Latif medical colleges from January 2022 to January 2023. Methods: Histopathology reports of all hysterectomies done for AUB in both medical colleges allied hospitals were retrieved retrospectively and evaluated in detail. Four age groups were defined 30-40 years, 41-50, 51-60 and 61-70 years. Various patterns were recorded overall and separately for each group and results established. Results: A total of 221 abdominal hysterectomy histopathology reports were retrieved and evaluated. All hysterectomies were performed for AUB during one year period between January 2022 to January 2023. 40(18.09%) women were between 30-40 years of age, 134(60.6%) were between 41-50 years of age, 39(17.6%) were between 51-60 years of age and 08(3.61%) patients were between 61-70 years of age. Distorted proliferative phase endometrium was seen in 28(12.6%) of cases, Adenomyosis was seen in 76(34.38%), endometrial polyps in 19(8.55%), fibroids in 92(41.6%), metaplasia 07(3.1%), hyperplasia 10(4.5%), and endometrial carcinoma was seen 09 (4.07%) of cases. Conclusion: AUB is most common in perimenopausal women. Fibroids, Adenomyosis, and disordered proliferative endometrium were most common in perimenopausal women while carcinoma endometrium was most common cause of AUB in postmenopausal women. This study will help Gynecologists to better find out the cause of AUB and treat accordingly. Keywords: Abnormal uterine bleeding (AUB), Heavy menstrual bleeding (HMB), Perimenopausal, Hysterectomy. Histopathology, Endometrium

Modern options for the treatment of iron defciency anemia in patients with abnormal uterine bleeding

The article presents a modern, comprehensive approach to the treatment of anemia in abnormal uterine bleeding in patients with endometrial hyperplastic processes. The effectiveness of therapy with the iron-containing drug Sorbifer Durules was evaluated.

Value and influencing factors of preoperative MRI evaluation for previous cesarean scar defect associated abnormal uterine bleeding in patients undergoing laparoscopic surgery.

As the cesarean section rate increases year by year, the treatment of previous cesarean scar defects (PCSD) poses a significant challenge. This study aims to evaluate the clinical value of preoperative magnetic resonance imaging (MRI) technology and analyze relevant influencing factors for patients with abnormal uterine bleeding (AUB) associated with cesarean scar defects who underwent laparoscopic surgery. A retrospective cohort analysis was performed on women who underwent laparoscopic surgery for PCSD-related AUB at the Department of Gynecology, the Third Xiangya Hospital of Central South University from 2018 to 2022. A total of 57 patients who underwent laparoscopic surgery for the treatment of AUB associated with PCSD were divided into 2 groups based on their postoperative clinical cure status: The clinically-cured group (n=28, 49.1%) and the non-clinically-cured group (n=29, 50.9%). After a postoperative follow-up period of 3 months for all participants, logistic regression analysis was conducted to explore the correlation between the clinical cure rate of AUB associated with cesarean scar defects treated by laparoscopic surgery and various factors. These factors included patient age, clinical symptoms, obstetric history, history of cesarean section, basic clinical information, preoperative MRI parameters, and postoperative menstrual conditions. There were no significant differences in many aspects, including the patient's age at the time of previous cesarean section, number of pregnancy, time since the previous cesarean section, the uterus position assessed by preoperative T2 signal MRI, defect length, defect width, residual muscle layer thickness, adjacent uterine muscle layer thickness, and distance from the defect to the external cervical os between the 2 groups (all P>0.05). However, the time of onset of AUB symptoms (P=0.036, OR=1.019, 95% CI 1.002 to 1.038) and the depth of the defect on the preoperative MRI (P=0.010, OR=5.793, 95% CI 1.635 to 25.210) were identified as risk factors affecting the clinical cure rate. The time of onset of AUB symptoms and the depth of the defect on preoperative MRI are risk factors that influence the clinical cure rate of laparoscopic surgery for the treatment of AUB associated with PCSD, which could be helpful for evaluating the prognosis of disease.

Prognosis of abnormal uterine bleeding in women of reproductive age with extragenital disorders

The purpose of the study was to elaborate on a prognostic model for predicting the development of abnormal uterine bleeding in women of reproductive age with accompanying extragenital disorders based on mathematical methods.&#x0D; Materials and methods. The study, which was in 2019-2022, involved 100 women of reproductive age with AUB and accompanying extragenital disorders under observation, who made up the main group. The control group comprised 50 women of reproductive age undergoing medical checkups. On the basis of 23 diagnostic indicators, the most informative ones were mathematically selected for the prognosis of AUB in women with extragenital abnormalities.&#x0D; Results and their discussion. The prognosis of the risk of developing AUB in women of reproductive age with extragenital disorders was carried out on a double scale (0 – low probability, 1 – high probability). The search for diagnostically informative factors involved a set of 23 working indicators that were investigated in the examined patients using four levels of the risk scale. In order to solve this issue, the factors that have the greatest importance in the formation of the prognosis were selected using discriminant analysis methods, and a corresponding mathematical model was created. The classification functions made it possible to enter the practical plane and form rules for assessing the presence/absence of the risk of developing AUB in patients of reproductive age with extragenital disorders. The corresponding expressions are the following equations:&#x0D; NP = BAS ART*75.57+FSH*2.96+prolac*0.02+estrad*0.02-40.78&#x0D; PP = BAS ART*105.35+FSH*0.79+prolac*0.1+estrad*0.08-114.49,&#x0D; where NP is a negative prognosis, PP is a positive prognosis.&#x0D; If NP &gt; PP, then the most likely prognosis is the absence of AUB in the patient; otherwise, if PP &gt; NP – there is an increased risk of AUB.&#x0D; Conclusion. Pulsation index in the basal arteries of the uterus, FSH, prolactin and estrogens are prognostically significant indicators for predicting the risk of abnormal uterine bleeding in patients of reproductive age with extragenital disorders. The above formula, obtained from the conducted discriminant analysis, makes it possible to predict bleeding in a specific patient

Comparative Study of Abnormal Uterine Bleeding with History of Cesarean Section and Vaginal Delivery in Women Referring to Gynecology Clinic of Ali-Ebn-Abitaleb Hospital in Zahedan

Background: The aim of this study was to compare the abnormal uterine bleeding with a history of cesarean section and normal delivery in women referred to the gynecology and obstetrics clinic of Ali Ibn Abitaleb Hospital in Zahedan, Iran in 2020-21.&#x0D; Methods: Patients were divided into two groups of 100 patients. For each patient, information including demographic characteristics and evaluation of the causes of abnormal uterine bleeding in patients based on paraclinical procedures, BMI calculation, vaginitis and Pelvic inflammatory disorder (PID) were obtained.&#x0D; Results: The mean age of patients in the normal delivery group was 30.14 ± 6.26 years and in the cesarean section patients was 29.13 ± 6.70 years. There was no statistically significant difference between the two groups in terms of age. There was a statistically significant difference between the two groups in terms of type between menorrhagia (p value = 0.047) and in comparison between the two groups in terms of bleeding causes, anatomical cause (p value = 0.02) and neoplasia (p value = 0.04).&#x0D; Conclusion: The present findings showed that the incidence of menorrhagia was higher in cesarean delivery and the incidence of abnormal uterine bleeding (AUB) in cesarean delivery may occur after delivery with a shorter time interval than the delivery time. The most important cause of abnormal bleeding in both groups was infection, but with regards to anatomical causes, the most important cause was fibroids in both groups.

To Study the Efficacy and Safety of Diosmin with Tranexamic Acid and Mefenamic Acid Versus only Tranexamic Acid and Mefenamic Acid in Medical Management of Abnormal Uterine Bleeding: A Randomized Controlled Trial.

Abnormal uterine bleeding (AUB) is a common problem in reproductive age group and perimenopausal age group being responsible for many outpatient visits. Traditional management of AUB consists of giving mefenamic acid, tranexamic acid, or their combination with progestogens or hormonal intrauterine deviced levonorgestrel intrauterine system (LNG-IUS) for severe or nonresponsive cases. The objective of the current study was to study the efficacy and safety of adding diosmin along with tranexamic acid and mefenamic acid in reducing menstrual blood loss in AUB patients. It was a prospective double-blind randomized controlled trial in which 900 mg of diosmin was given once daily along with 500 mg tranexamic acid and 250 mg mefenamic acid during menstruation (Group I-92 patients), or only tranexamic acid and mefenamic acid during menstruation (Group II-92 patients). Mean age, parity, body mass index, and socioeconomic status were similar in the two groups. It was 35.68 years versus 36.78 years, 2.2 versus 2.3, 23.68 kg/m2 versus 24.62 kg/m2 respectively. Mean days of bleeding before this treatment were 6.8 versus 6.6 (P = 0.33) and were 3.5 versus 5.2 (P = 0.02) after treatment. There was a significant reduction in both groups as compared to before treatment (P = 0.021 in Group I, 0.027 in Group II) but the reduction was greater in Group I (P = 0.02). The amount of blood loss was 385 ml versus 390 ml (P = 0.7) before treatment which was significantly reduced in both groups to 68 ml versus 112 ml (P = 0.02 in Group I, 0.03 in Group II) with more decrease in Group I than in Group II (P = 0.01). Mean hemoglobin at beginning of the study was 8.4 versus 8.5 g/dl in Group I and Group II (P = 0.02) and significantly increased in both groups posttreatment to 10.9 and 9.8 g/dl in Group I and Group II (P = 0.012 in Group I, 0.011 in Group II) with increase being more in Group I than Group II (P = 0.03). Pictorial blood assessment chart score was 398 versus 406 (P = 0.35) before treatment and decreased significantly to 86.5 and 110.5 (P = 0.001 in Group I, 0.001 in Group II) with more decrease being in Group I than II (P = 0.01). There was significant decrease in dysmenorrhea with both treatments with no difference in the two groups. Various adverse effects such as nausea, vomiting, abdominal pain, diarrhea, constipation, and headache were equal in the two groups. Both the group's diosmin with tranexamic acid and mefenamic acid (Group I) and tranexamic acid and mefenamic acid (Group II) were efficacious in reducing menstrual blood loss, number of menstrual days and dysmenorrhea with effect being more by addition of diosmin. Adverse effects were equal in both the two groups.

Clinic pathological study on AUB patients undergoing hysterectomy in a tertiary care hospital, Bengaluru: A cross sectional study

Background: Abnormal uterine bleeding (AUB) is one of the most common debilitating menstrual problems and has remained one of the most frequent indications for hysterectomy in developing countries. AUB requires careful evaluation due to the risk of endometrial malignancy [1]. Approximately in 40% of hysterectomy specimens, no definite organic pathology could be established [2]. The objective of present study is to find out the distribution of various uterine pathology in hysterectomy specimens among women with AUB.Methods: In the present study, thirty patients with AUB undergoing hysterectomy were included and evaluated for various uterine pathology.Results: Majority of the study participants belonged to the age group between 35-40 years (57%) of age. The mean age of the study participants was found to be 40.90+3.24 years. Majority of the study participants had Menorrhagia (83%). 14% of the study participants had postmenopausal bleeding. 70% of the study participants had proliferative endometrium findings on histopathology. 30% of the study participants had secretory endometrium. 64% of the study participants were diagnosed as AUB (L) based on histopathology with 25% of the study participants diagnosed as AUB (A) based on PALM-COEIN system of classification of AUB.Conclusions: Hysterectomy is a very commonly performed major surgical procedure in gynaecological practice. This study confirms that benign diseases are more common than their malignant counterparts and the most common pathology identified is leiomyoma. To identify the exact cause is essential to successfully treat patients with AUB.

A histopathological and immunohistochemistry analysis of endometrial lesions among women presenting with abnormal uterine bleeding.

We aimed to histopathologically evaluate the morphological spectrum, apoptotic index (AI), and mitotic index (MI) of endometrial lesions in patients presenting with abnormal uterine bleeding (AUB). A cross-sectional study was done over a period of 18 months where a total of 60 newly diagnosed cases of perimenopausal women presenting with AUB were included. All H and E stained pathology slides from the specimens were reviewed for initial histopathological evaluation and diagnosis. Immunohistochemistry for Bcl-2 and Bax was done. The study subjects were divided into two groups: Group 1 included 30 cases of histologically proven proliferative endometrium (PE) and endometrial polyps and Group 2 included 30 cases of hyperplasia, endometrial epithelial neoplasia (EIN)/or carcinoma. For all cases, AI and MI were calculated and compared among the two groups. Quantitative variables were compared using the Independent t-test/Mann-Whitney test between the two groups and Kruskal-Wallis test for comparison between more than two groups. Qualitative variables were correlated using the Chi-square test. P < 0.05 was considered statistically significant. In our study of 60 patients of AUB, the mean age was 45.87 years with a parity of 2 or more in most of the patients. Most of the patients in our study had heavy menstrual bleeding (66.67%) with associated complaints of weakness, pallor, and low backache. Out of 60 patients of AUB, Endometrial carcinoma was diagnosed in 13 (21.67%) patients, with the most common histopathological type being Endometrioid carcinoma. There was a significant difference in the AI, MI, and the ratio of AI/MI among various histopathological diagnoses. AI was highest for Endometrial carcinoma and lowest for hyperplasia and polyps. MI was also highest for Endometrial carcinoma and lowest for hyperplasia and polyps. However, the ratio was incongruent as it was highest for hyperplasia without atypia and lowest for PE with endometrial carcinoma being midway. The Bcl-2 expression of relatively benign conditions (Group 1) was significantly higher than Group 2 (Endometrial epithelial neoplasia/carcinoma). Bax intensity showed an almost inverse pattern, being highest in endometrial carcinoma and lower in hyperplasia and polyps with the lowest expression in PE. Even the Bcl-2:Bax ratio was also highest for PE and lowest for endometrial carcinoma with others falling in between them. It can be concluded that the combination of the proliferative and apoptotic markers and the ratio will help as a tool in aiding the diagnosis of endometrial lesions for patients presenting with AUB.

Correction of iron deficiency in patients with abnormal uterine bleeding

INTRODUCTION: Iron deficiency (ID) occurring latently or as iron deficiency anemia (IDA) is common in gynecology, particularly in patients with abnormal uterine bleeding (AUB).&#x0D; AIM: We aimed at exploring the efficiency of a medication containing ferrous sulfate and multivitamins for the correction of latent ID and treatment of mild IDA in AUB patients.&#x0D; MATERIALS AND METHODS: We performed a comprehensive clinical, laboratory, and instrumental examination of 60 women aged 35 to 50 years with AUB, revealing many gynecological pathologies (endometrial polyps or hyperplasia, ade nomyosis, and uterine myoma). The examined patients with AUB were divided into two groups: women with latent ID (group 1, n=38) and women with IDA (group 2, n=22). Moreover, all the patients had extragenital pathology in addition to gynecological diseases. As a treatment, ferrous sulfate with multivitamins was prescribed for 13 months.&#x0D; RESULTS: Before treatment, the hemoglobin level in the examined patients ranged from 95 to 130 g/L, with an average of 127.11.8 g/L in group 1 and 100.32.1 g/L in group 2. Serum iron concentrations in the examined groups were 9.80.2 and 6.91.3 mol/L, respectively. After treatment, the average levels of hemoglobin and serum iron increased significantly and reached normal levels in all those examined. Hemoglobin was 143.31.8 g/L in group 1 and 122.51.5 g/L in group 2, whereas serum iron was 14.90.2 mol/L in group 1 and 13.51.0 mol/L in group 2. Furthermore, a significant increase to normal values was observed in other indicators of complete blood count and biochemical analysis.&#x0D; CONCLUSIONS: The results of the study reveal a high clinical efficiency of ferrous sulfate and multivitamins in the treatment of ID in patients with AUB.

Quality of life in Thai women with various types of abnormal uterine bleeding

To determine the quality of life (QoL) in Thai women with various types of abnormal uterine bleeding (AUB). A cross-sectional study was conducted on 353 AUB patients between November 2010 and January 2012. They were grouped according to the duration of symptom: <6months (acute AUB, n= 122), ≥6months (chronic AUB, n= 138), and postmenopausal bleeding (PMB, n= 93); and the bleeding pattern: hypermenorrhea (n= 24) and irregular bleeding (n= 236). QoL was determined using the 36-Item Short-Form Health Survey (SF-36) Thai version. The acute AUB and chronic AUB groups had a mean age of 43.84 ± 4.87 and 43.81 ± 6.55 years; they were younger than the PMB group (55.62 ± 7.55 years) (P< 0.001). Medical diseases were more prevalent in the PMB than in the acute and chronic groups (66.7% vs. 27.9% and 35.5%, respectively, P< 0.001). Some subscales of the SF-36 were significantly lower in the women with AUB than in those with normative values, in those with chronic AUB or PMB than in those with acute AUB, and in those with hypermenorrhea rather than in those with irregular bleeding. Thai women with any AUB types have a poorer QoL than general Thai women. QoL tends to be poorer in women with symptoms longer than 6months or with hypermenorrhea.

Diagnostic Value of Vaginal Ultrasound under Improved Clustering Algorithm Combined with Hysteroscopy in Abnormal Uterine Bleeding.

In order to explore the diagnostic value of the improved clustering algorithm of vaginal ultrasound combined with hysteroscopy in abnormal uterine bleeding (AUB), 128 patients diagnosed with AUB in the hospital were selected as the research objects. A K-means improved clustering color image segmentation algorithm was designed and applied to AUB vaginal ultrasound image processing. The running time, mean square error (MSE), and peak to signal noise ratio (PSNR) were calculated to evaluate the algorithm, and the sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio were used to evaluate the diagnostic accuracy of the detection method. In addition, combined with hysteroscopy, a comprehensive evaluation of the diagnostic value of abnormal uterine bleeding diseases was implemented. The results showed that compared with the traditional K-means clustering algorithm, the running time of the improved K-means clustering color image segmentation algorithm in the training set was significantly shortened, the MSE was significantly decreased, and the PSNR was significantly increased (P < 0.05). The sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio (90.5%, 93.2%, 84.3, and 96.3%) of AUB diagnosis were significantly improved in the algorithm of vaginal ultrasound combined with hysteroscopy (P < 0.05). In summary, the combination of vaginal ultrasound and hysteroscopy based on K-means improved clustering color image segmentation algorithm can significantly improve the clinical diagnostic accuracy of AUB patients.

Etiology distribution of abnormal uterine bleeding according to FIGO classification system: A combined study of ultrasound and histopathology.

To classify the FIGO's PALM-COEIN etiology for abnormal uterine bleeding (AUB) patients according to the ultrasound and histopathology and to evaluate the etiology prevalence distribution for AUB patients. A total of 1065 women with AUB in the Second Hospital of Shandong University between January 2019 and March 2021. The intrauterine histopathological and ultrasound results were reviewed retrospectively.PALM-COEIN etiology classification was performed according to histopathology and ultrasound. The classification system was stratified into nine basic categories: Polyp (AUB-P), adenomyosis (AUB-A), leiomyoma (AUB-L), malignancy and hyperplasia (AUB-M), coagulopathy (AUB-C), ovulatory disorders (AUB-O), endometrium (AUB-E), Iatrogenic(AUB-I), and not classified (AUB-N). The number of cases and composition ratio were also calculated. According to the FIGO's classification system, the PALM group (656,61.60%), which were defined as structural entities that can be measured visually with ultrasound and/or histopathology. 176 (16.53%) patients were classified as AUB-P,102 (9.58%) patients were classified as AUB-A, 487(45.73%) patients were classified as AUB-L, 31 (2.91%) patients were classified as AUB-M. The COEIN group (409,38.40%), which were defined as nonstructural entities that cannot be measured by ultrasound and/or histopathology. Nobody were classified as AUB-C in our group, and 383 (35.96%) patients were classified as AUB-O, 4 (0.38%) patients were classified as AUB-E,14 (1.31%) patients were classified as AUB-I,8 (0.75%) patients were classified as AUB-N. In our study, AUB-L was the most common cause, followed by AUB-O, AUB-P, AUB-A, AUB-M, AUB-I, AUB-N, and AUB-E.PALM-COEIN etiology classification system played an important role in the epidemic and management standardization of AUB patients, provided an effective communication between physicians and researchers also. Ultrasonography was the preferred examination for AUB patients, especially with structural abnormalities.

Subclinical Hypothyroidism in Perimenopausal Abnormal Uterine Bleeding Patients.

Background Abnormal uterine bleeding (AUB) can be very troublesome and is common in women with thyroid dysfunction. The current study aimed to assess the incidence of subclinical hypothyroidism in women with perimenopausal AUB.Methodology A cross-sectional study was conducted at Hayatabad Medical Complex (HMC), Peshawar, Pakistan, between September 2020 to February 2021. All outdoor female patients with complications in the obstetrics and gynecology department, aged between 40 to 55 years of age, and no obvious cervical and genital lesions were included in the study. Patients with a history of suspected inflammatory disease, use of oral contraceptives, and malignant lesions of the cervix were excluded from the study. All cases were evaluated for AUB and their thyroid profile was evaluated. Data regarding menstrual irregularities were recorded in a pre-defined proforma and clinical examination was performed.ResultsA total of 500 women were enrolled with a mean age of 47.2 ± 7.3 years. Of these, 234 (46.8%) women were overweight and the mean levels of the thyroid-stimulating hormone were 4.4 ± 2.5 mIU/L. The mean triiodothyronine and thyroxine were 3.2 ± 1.9 and 1.5 ± 0.7 pmol/L, respectively. The rate of subclinical hypothyroidism was 33%. It was shown that the body mass index was significantly correlated with subclinical hypothyroidism (p=0.03). Furthermore, the rate of oligomenorrhea was significantly higher in patients with subclinical hypothyroidism (p=0.05).Conclusion This study highlights the association between thyroid dysfunction in women with menstrual disorders. Screening and surveillance of thyroid-related abnormalities are warranted in patients with menstrual irregularities to avoid complications of the disease.