Evaluation Of Abnormal Uterine Bleeding Research Articles

Rethinking the Abnormal Uterine Bleeding Consult: Creating a Patient-Centered, See-and-Treat Model of Care

Historically, the evaluation of abnormal uterine bleeding (AUB) has involved a multi-visit process that uses a multitude of care settings (eg, in-office, imaging, laboratory), with the potential for lengthy delays in care due to the now-commonplace scheduling difficulties many clinics face. Although there is strong evidence for the use of in-office uterine assessment as a best practice, uptake has been limited by the learning curve, technology acquisition costs, and other factors. However, due to the coronavirus disease 2019 (COVID-19) pandemic, clinical practice has faced rapid adaptations that have resulted in the redesigned clinical care model of evaluating this common gynecologic condition in a more patient-centered and streamlined way while maximizing the patient experience, health care efficiency, and physician engagement. This procedure would specifically involve one telehealth or initial visit to assess patient history, perform necessary laboratory testing, review results, and plan outpatient procedures to be conducted in the office or the operating room. Due to the COVID-19 pandemic, clinics have, by necessity, implemented this proposed reimagined pathway in a variety of outpatient settings nationally. We propose that, moving forward, this new procedure be permanently adopted in clinics nationwide as the patient-focused evaluation strategy for AUB.

Clinical Audit of Gynecological Cancers at National Institute of Cancer Research and Hospital, Dhaka, Bangladesh

The aim of this audit was to assess the trend of the gynecological cancers for the year of 2022. This is an observational study on retrospectively collected data of gynecological cancer patients at National Institute of Cancer Research and Hospital (NICRH), Dhaka. All cases of cancer seen at the gynecology outpatient department and cases admitted in the gynecological oncology ward at NICRH, between the months of January to December 2022 were audited. The results shown that about 5.8% of all the new cases were young women aged below 25 years. The majority of gynecological cancers were among women aged between 35 and 64 years (73.17%) and only 2.6% patients were aged above 75 years. Cervical cancer (59%) was the leading gynecological cancer among all female cancers attended at NICRH. In ovarian malignancy, most of the patients(61%) had stage lll disease and no patient in stage IV diseases. Due to improper evaluation of abnormal uterine bleeding, majority of the endometrial carcinoma patients (64%) presented with histopathology reports after hysterectomy. This study might help to get a in depth understanding of the trend of major gynecological cancers. J Bangladesh Coll Phys Surg 2024; 42: 43-48

Clinicopathological evaluation of abnormal uterine bleeding in perimenopausal female

Clinicopathological evaluation of abnormal uterine bleeding in perimenopausal female

Sonographic evaluation of abnormal uterine bleeding among non-pregnant women in Lagos, Southwest, Nigeria

Abnormal uterine bleeding (AUB) is the direct cause of a significant healthcare burden for women and society at large. Around 30% of women will experience AUB during their reproductive years, prompting them to seek medical attention. Abnormal Uterine Bleeding can significantly impact their quality of life, often causing frequent work absences and potentially requiring surgical treatment. It's crucial to accurately diagnose the underlying cause of AUB in this age group to ensure proper and effective management. This study aims to evaluate AUB among non-pregnant women in Lagos using transvaginal ultrasound. A descriptive cross-sectional study of 152 non-pregnant women of reproductive age (16 to 55 years) with abnormal uterine bleeding for a period of five months. A purposive sampling technique was used to recruit the subjects. Data was analysed using SPSS version 20.0. Sonographic evaluation reveals positive findings in 97 cases (63.8%) out of 152 cases studied. Seventy cases (46%) had structural abnormalities with the highest being Leiomyoma (41.4%), followed by Adenomyosis (3.9%), and Endometrial Polyp (0.6%). The age group 26 – 35 years presented most with abnormal uterine bleeding cases (48.6%). The major clinical history was absent menstrual bleeding with findings depicting normal endometrium. There was a positive and moderate correlation between age and parity of subjects with AUB. The study found that Transvaginal ultrasound effectively identifies AUB's structural causes. It is recommended as the initial assessment method due to its safety, affordability, and widespread availability in healthcare settings.

RET/PTC rearrangement in papillary thyroid carcinoma arising in malignant struma ovarii with abdominal wall metastasis and cervical thyroid gland: a case report and review of the literature

BackgroundStruma ovarii refers to rare mature cystic teratomas containing at least 50% of thyroid tissue, and malignant transformation is known to be even rarer. The synchronous development of malignant struma ovarii and cervical thyroid carcinoma are also scarce and poorly understood due to limited data about molecular features. Here, we present the first report of RET/PTC 1 rearrangement in synchronous metastatic malignant struma ovarii to the abdominal wall and cervical thyroid cancer.Case presentationWe described a 47-year-old multigravida woman with bilateral adnexal and lower abdominal wall masses detected during the evaluation of abnormal uterine bleeding. The patient underwent a hysterectomy, bilateral salpingo-oophorectomy, and surgical removal of abdominal wall mass. Then, the pathological evaluation revealed papillary thyroid carcinoma (PTC) within struma ovarii and metastatic PTC in the abdominal wall fibro adipose tissue. Further, cervical thyroid gland physical examination and ultrasound illustrated a nodule within the left lobe. Subsequently, a total thyroidectomy was performed, and a histological examination revealed PTC. Furthermore, all affected tissue, i.e., struma ovarii, abdominal wall metastasis, and cervical thyroid gland tested for BRAF and RAS mutations and RET/PTC 1 rearrangement. RET/PTC 1 rearrangement was identified among all three different sites. Finally, after six years of follow-up, the patient had no evidence of recurrence or distant metastasis.ConclusionsIn light of these findings, malignant struma ovarii might yield a clue to cervical thyroid carcinoma, and the molecular analysis could provide valuable information for understanding the underlying mechanism, tumor clinicopathological behaviors, and prognosis.

Evaluation of Abnormal Uterine Bleeding in Adolescents: Single Center Experience.

Abnormal uterine bleeding (AUB) is adolescent girls' most common gynecologic complaint. This study aimed to determine the diagnostic and management differences between those with/without heavy menstrual bleeding. We collected retrospective data such as follow-up, final control, and treatment regimen of adolescents aged 10-19 with the diagnosis of AUB. We excluded adolescents with known bleeding disorders at admission. We classified all subjects according to the level of anemia. Group 1 consisted of subjects with heavy bleeding (Hb<10 g/dl), and the rest with moderate and mild bleeding (Hb>10 g/dl) presented in Group 2. Admission and follow-up characteristics between the two groups were compared. In this study, we included 79 adolescent girls with a mean age was 14.3±1.8 years. 85% of all had a menstrual irregularity in the first two years after menarche. Anovulation was observed in 80%. 95% of group 1 had irregular bleeding in the two years (p<0.01). In all subjects, while 13 girls (16%) were diagnosed with PCOS, two adolescents (2%) had structural anomalies. No adolescents had hypothyroidism or hyperprolactinemia. Three (10.7%) were diagnosed with Factor 7 deficiency. Nineteen girls had MTHFR mutation. None had venous thromboembolism during at least six month-follow-up-period. This study showed that 85% of AUB had occurred in the first two years. We found the frequency of hematological disease (Factor 7 deficiency) 10.7%. The frequency of MTHFR mutation was 50%. We thought this did not increase the risk of bleeding/thrombosis. Its routine evaluation was not necessarily due to the similarity in population frequency.

The Utility of Pelvic Ultrasounds in Adolescents Presenting to the Emergency Department with Abnormal Uterine Bleeding

To analyze what factors influence a provider's decision to order a pelvic ultrasound (PUS) in the emergency department (ED) for adolescents with abnormal uterine bleeding (AUB), to determine if endometrial stripe (EMS) measurements are used in treatment decisions, and to evaluate if treatment outcomes differ based on EMS thicknesses. Retrospective chart review of patients aged 11-19 presenting to the ED with AUB from 2006 to 2018. Those receiving a PUS were divided into three EMS groups: ≤5 mm, 6-9 mm, and ≥10 mm. Outcomes were evaluated in admitted patients by progress notes indicating resolution of bleeding. Cross-tab, χ2, and logistic and linear regression analysis were performed. Of 258 adolescents meeting study criteria, 113 (43.8%) had a PUS. None had an abnormality. A PUS was more likely to be performed in patients with lower hemoglobin values (P < .003). Provider decision to order a PUS did not differ by age or bleeding duration (P > .1). Among those with a PUS, 67 (59%) received hormonal therapy (pill, progestin-only, IV estrogen). There were no significant differences in treatment choices based on EMS (P < .061) or, among the 44 admitted patients (17%), in the time it took bleeding to stop after initiating treatment (pill: P=.227, progestin-only: P=.211, IV estrogen: P=.229). In adolescents with AUB in the ED, performing a PUS was more common in those with low hemoglobin. EMS thickness did not appear to affect treatment decisions or inpatient outcomes. Larger studies are needed to confirm the current findings and determine if PUS is needed in the evaluation of AUB.

Efficacy of MRI Over Ultrasound in Evaluation of Abnormal Uterine Bleeding With Histopathological Correlation.

Introduction Abnormal uterine bleeding (AUB) is one of the most common problems in gynecologic practice. In the peri- and postmenopausal age group, it accounts for more than 70% of all gynecological complaints. The current study's objective was to compare the effectiveness of MRI and ultrasonography (USG) in detecting the cause of abnormal uterine bleeding with pathological correlation. Material and methods We conducted an observational study involving subjects with abnormal uterine bleeding. Patients who presented with abnormal uterine bleeding were referred to the department of radiodiagnosis and underwent USG of the abdomen and pelvis, followed by an MRI of the pelvis. Findings were analyzed and compared with the histopathological examination (HPE) of the samples of hysterectomized uterus, polypectomy, myomectomy, and dilation and curettage (D&C) of the endometrium. Results Among the study population, USG reports showed two patients (4.10%) with polyps, seven patients (14.58%) with adenomyosis, 25 patients (52.08%) with leiomyomas, and 14 patients (29.16%) with malignancies. On MRI examination, three patients (6.25%) were diagnosed with polyps, nine patients (18.7%) with adenomyosis, 22 patients (45.8%) with leiomyomas, and 14 patients (29.16%) were reported to have malignancies. The measure of agreement with the kappa value for MRI and HPE in evaluating the causes of abnormal uterine bleeding is 1.0 (very good). Whereasthe kappa agreement value of USG and HPE in evaluating the causes of abnormal uterine bleeding is 0.903 (acceptable). The sensitivity of USG in diagnosing polyps, adenomyosis, leiomyoma, and malignancy was observed at 66%, 77.78%, 100%, and 100%, respectively. The sensitivity of MRI in diagnosing polyps, adenomyosis, leiomyoma, and malignancy was 100% for each. Conclusion MRI is the most effective method for accurate identification of the location, number, and characterization of lesions, extensions, and staging of carcinomas.

Histopathological Evaluation of Abnormal Uterine Bleeding in Women of Reproductive and Perimenopausal Age Groups

Histopathological Evaluation of Abnormal Uterine Bleeding in Women of Reproductive and Perimenopausal Age Groups

Cine magnetic resonance imaging of the uterus for evaluation of abnormal uterine bleeding

To assess the potential role of cine magnetic resonance imaging (MRI) in the evaluation of uterine peristalsis in women classified with abnormal uterine bleeding - endometrial (AUB-E) by measuring frequency and directionality of waveforms. This was a prospective pilot study of seven women with normal menses and eight women with AUB-E, defined as regular but excessive flow causing anemia or interfering with daily activities. Exclusion criteria included other causes of AUB in the PALM-COEIN system. Subjects were evaluated using a modified Menstrual Impact Questionnaire (MIQ). MRI studies were performed within days 1-5 of the subject's menstrual cycle using a 3.0T MRI and 8-channel cardiac phased array coil. Axial and sagittal T2-weighted fast spin echo was obtained to evaluate uterine morphology. Cine MRI imaging was performed using a single shot fast spin echo with a temporal resolution of 2 to 3 seconds over a 2 minutes sequence to evaluate frequency and directionality of uterine waveforms, repeated 2-3 times, and maximum number of waveforms per two minutes reported. Images were reviewed independently by two expert radiologists blinded to patients’ histories. Primary outcome was peristaltic frequency of the subendometrium measured as number of waveforms per two minutes. Secondary outcome was directionality. Primary outcome and MRI morphology were compared by Mann-Whitney U test. MIQ responses were compared by Fischer’s exact test and Mann-Whitney U test. Normal subjects bled an average of 3.9 days and those with AUB-E bled an average of 6.4 days (p= 0.016). Normal subjects defined their flow as light or moderate. Six of seven normal subjects reported no impact on their work, physical or social activity. In comparison, all but one subject with AUB-E defined their flow as heavy or very heavy with passage of clots or flooding (p = 0.001). All subjects with AUB-E reported effect on their daily activities (p < 0.001) and were more likely to report effect on their social activity (p < 0.001) and physical activity (p < 0.001). Subjects with AUB-E were more likely to report dysmenorrhea (p=0.041). Thirteen of fifteen women demonstrated motility of the subendometrium during cine display. Two women with AUB-E did not demonstrate waveforms. There was complete agreement between readers with regard to maximum number of waveforms per two minute cycle and directionality. Median number of waveforms in subjects with normal menses was 3 per two minutes. In patients with AUB-E, the median number of waveforms was 1 per two minutes (p=0.009). All subjects with waveforms exhibited cervico-fundal directionality during menses. Cine MRI is a feasible modality for measuring differences in the frequency of uterine peristalsis in women with AUB-E. This pilot study supports further investigation into the endometrial and myometrial contributions to abnormal bleeding in women with AUB-E.

Understanding Patient Evaluation of Abnormal Uterine Bleeding (AUB): A Standardized Patient Case on AUB for OB/GYN Clerkship Students

IntroductionThe differential diagnosis for abnormal uterine bleeding (AUB) among reproductive-age women is broad and includes common and life-threatening conditions. Recognition and accurate diagnosis of AUB are important but can be challenging for medical students. We developed a standardized patient (SP) encounter for medical students during their OB/GYN clerkship.MethodsWe implemented two SP encounters, on AUB and dyspareunia, that included a postencounter note and SP evaluations. Here, we describe the implementation of the SP encounter on AUB. Students received formative feedback on their interpersonal and history-taking skills, differential diagnosis, and management plan from the SP as well as OB/GYN residents and faculty. Student cumulative feedback was obtained mid-clerkship and following the clerkship. Summary statistics and qualitative data for students’ experiences are reported.ResultsSP cases were implemented at the Duke University School of Medicine with 101 second-year medical students who completed the encounter from September 2018 to July 2019. Regarding the AUB case, SPs identified students as adequate history takers, with a mean evaluation score of 3.45 (SD = 0.15) out of 5. Most students (94%) correctly identified at least one diagnosis and provided evidence. Endometrial cancer/hyperplasia (63%) and uterine leiomyoma (60%) were most likely to be identified. Regarding both SP encounters, of the 82 students (81%) completing the end-of-clerkship survey, 57% indicated that the experience enhanced their overall learning at least adequately well or better.DiscussionThe AUB case provided students with the opportunity to exercise their diagnostic and management skills.

Emergency Department Evaluation of Abnormal Uterine Bleeding in US Children's Hospitals

To assess initial evaluation patterns of patients presenting to the Emergency Department (ED) with abnormal uterine bleeding (AUB) including differences by race DESIGN: Retrospective multicenter cohort study from October 2015 through September 2020 SETTING: Forty-seven children's hospitals submitting data to the Pediatric Health Information System PARTICIPANTS: Female patients aged 8-21 with an ED encounter with AUB as the primary diagnosis code INTERVENTIONS AND MAIN OUTCOME MEASURES: Proportion of visits with at least 1 laboratory assessment for the evaluation of anemia, iron deficiency, and/or hemostatic disorders RESULTS: We identified 17,759 unique patients with AUB seen in the ED who met inclusion criteria. Median age was 16.3 years (IQR, 14.1-17.8 years). Most encounters (n=11,576, 65.2%) included evaluation for anemia, but only 6.8% (n=1,215) included assessment for iron deficiency and 26.2% (n=4,654) for hemostatic disorders. Black patients accounted for 34.7% (n=6,155) of AUB encounters yet constituted only 25% of all ED encounters (n=198,192). Black patients with AUB were less likely to undergo bleeding disorder evaluation (OR=0.76; 95% CI, 0.69-0.83) but more likely to receive evaluation for sexually transmitted infections (OR=1.63; 95% CI, 1.48-1.80) compared with White patients, despite controlling for age and concomitant pain. In a national cohort of adolescents presenting to the ED with AUB, evaluations for anemia and hemostatic disorders were infrequently performed, and racial differences existed regarding initial assessment. Further studies are needed to understand the factors underlying racial differences in hematologic testing and the impact of this disparity on health outcomes for females with AUB.

Doppler Study of Uterine Artery and Ultrasonography of Endometrial Thickness in Perimenopausal and Postmenopausal Bleeding

Background: Transvaginal color Doppler sonography of the uterine artery has been reported useful for evaluation of abnormal uterine bleeding in peri-/post-menopausal women. It may differentiate physiological from malignant endometrial changes. Objective: Evaluating the endometrial thickness and uterine artery Doppler as an initial diagnostic tool to identify patients with abnormal endometrial pathology. Methods: This is a prospective case control study consisted of total 50 women with peri-(n = 35) and post-(n = 15) menopausal bleeding, with 20 women consisting control group (no bleeding) (peri-(n = 10) and post-menopausal (n = 10)). Double layer endometrial thickness and uterine-artery-Doppler waveforms were measured, with the latter being S/D ratio, RI and PI. These were related to histological findings (endometrial biopsy). Result: Patients with abnormal uterine bleeding (both peri- and postmenopausal) had a significantly higher mean endometrial thickness than the control women. Study group showed a significantly lower value of all Doppler indices (S/D ratio, RI and PI). In study group, patients with malignant endometrial pathology showed significantly thicker endometrium and significantly lower Doppler indices than those with benign pathology. Conclusion: The combination of endometrial thickness and uterine artery color Doppler pattern might predict uterine endometrial malignancy, although whether it can discriminate (screen) patients requiring endometrial biopsy is not evident. Further study is needed.

A Randomized Comparative Study to Compare Karman's Cannula and Pipelle Biopsy for Evaluation of Abnormal Uterine Bleeding.

Objectives:This study aimed to compare the diagnostic accuracy, inadequate sampling, pain during the procedure (Visual Analog Scale [VAS] score), and ease of insertion of the Karman's cannula and Pipelle biopsy for patients with abnormal uterine bleeding (AUB).Methods:This prospective observational randomized comparative study included women of age more than 40 years with complaints of AUB. Two hundred and fifty women were randomly divided into two groups: (1) Group A (n = 125) who underwent endometrial aspiration using Karman's cannula and (2) Group B (n = 125) who underwent Pipelle endometrial sampling. Both the groups were followed by conventional dilation and curettage (D and C) which was considered the gold standard. Sensitivity, specificity, positive predictive value, and negative predictive value for differentiating benign and malignant conditions of endometrium were calculated.Results:Group B had a sensitivity of 89.29% followed by Group A (86.36%); on the other hand, Group A had a specificity of 96.08% followed by Group B (95.74%) (P > 0.05). Inadequacy was comparable among the two groups with 1 inadequate in Group A and 3 inadequate in Group B. Mean VAS score was significantly lesser in Group A than Group B (4.5 ± 2 vs. 5.8 ± 2.1, P < 0.0001). Ease of insertion was similar in Groups A and B (P = 0.345).Conclusion:Both procedures were equivalent in diagnostic accuracy, inadequacy, and ease of insertion. However, the use of Karman cannula resulted in less pain and is a much cheaper option in comparison to Pipelle. Overall, either procedure can be performed on an outpatient basis without cervical dilation and anesthesia and thus may be routinely used for women presenting with AUB.

Correlation of Abnormal Uterine Bleeding (AUB) with Thyroid Profile and Endometrial Biopsy

Abnormal uterine bleeding (AUB) is defined as any change in the frequency of menstruation, duration of flow or amount of loss. Menstrual disturbances and different endometrial pattern may accompany and precede thyroid dysfunction. The objective of the study was to correlate thyroid profile with endometrial biopsy in cases of AUB. This study was conducted on 74 patients who presented with AUB, had undergone TFT and endometrial biopsy/hysterectomy. Among 74 patients, thyroid disorders were identified in 26 patients. Maximum number of patients with AUB belonged to the category of hypothyroidism (27%) and 8.1% of cases had hyperthyroidism. In the present study 29 (39.1%) had proliferative endometrium, followed by secretory pattern in 21 (28.4%) patients. Hormone induced changes was seen in 3 (4.1%) patients. Disordered proliferative endometrium and endometrial hyperplasia was observed in 6 patients (8.1%) each. Malignant lesion was not common and it comprised of only 1.4% cases. AUB is frequently seen in patients with thyroid dysfunction. Thyroid function test is a cost effective, easily available test and can detect a possibly curable cause of AUB and avoid unnecessary intervention like hormonal treatment and hysterectomy. AUB due to endometrial cause is an age related pathology. Histopathological examination of endometrial biopsy is a major diagnostic tool in evaluation of AUB. It helps the physician to plan therapy for successful management of AUB.

Costs for diagnostic evaluation of abnormal uterine bleeding are high, vary greatly in the USA

Costs for diagnostic evaluation of abnormal uterine bleeding are high, vary greatly in the USA

PULMONARY ROCKS! A CASE OF PULMONARY ALVEOLAR MICROLITHIASIS

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Pulmonary alveolar microlithiasis (PAM) is an extremely rare lung disease characterized by the development of calcium phosphate deposits (microliths) within the alveolar spaces. Genetic mutations in the SLC34A2 gene (solute carrier family 34 member 2 gene), which encodes for a sodium-phosphate co-transporter, have been described as the cause of the disease. This co-transporter is located on type II alveolar pneumocytes and is responsible for removing phosphate ions from the alveolar space. Without effective transport, phosphate ions bind to calcium ions leading to calcium phosphate deposits within the alveoli. Over time this often leads to pulmonary fibrosis and progressive respiratory failure. Here, we present a case of pulmonary alveolar microlithiasis that was initially suspected to be metastatic endometrial carcinoma. CASE PRESENTATION: A 37-year-old female presented to gynecology clinic for evaluation of abnormal uterine bleeding. Endometrial biopsy showed endometrioid adenocarcinoma of the uterus. Staging CT scans revealed bilateral adnexal masses, metastatic disease in the liver, peritoneal carcinomatosis, and concern for lymphangitic carcinomatosis in the lungs due to calcification of the pleura and diaphragm. Liver biopsy confirmed metastatic disease of ovarian primary consistent with synchronous stage IV ovarian cancer. She underwent chemotherapy with carboplatin and paclitaxel as well as abdominal hysterectomy and debulking surgery with good response; however, repeat CT chest showed persistent pulmonary disease with innumerable calcified micronodules and extensive pleural, fissural, and interlobular calcifications. Transbronchial biopsies were obtained and revealed diffuse intra-alveolar laminated concentric deposits consistent with microliths and diagnostic of pulmonary alveolar microlithiasis. At the time of diagnosis her pulmonary function testing showed mild restriction. She has no family history of pulmonary disease and had no pulmonary symptoms. Calcium supplements were discontinued, and she was treated with a low phosphorus diet. She continues to undergo monitoring for the development of symptoms as well as monitoring of her pulmonary function. DISCUSSION: PAM is an extremely rare genetic disease caused by a defective sodium-phosphate co-transporter that leads to the accumulation of microliths within the alveolar spaces. Pulmonary fibrosis and progressive respiratory failure is the typical cause of death, although the rate of progression is variable. There is no known effective treatment except for lung transplant. A low phosphorus diet, bisphosphonates, and repeated bronchoalveolar lavage have been studied without clear clinical benefit. CONCLUSIONS: (See Discussion) REFERENCE #1: Castellana G, Castellana G, Gentile M, Castellana R, Resta O. Pulmonary alveolar microlithiasis: review of the 1022 cases reported worldwide. Eur Respir Rev. 2015 Dec;24(138):607-20. REFERENCE #2: Saito A, McCormack FX. Pulmonary Alveolar Microlithiasis. Clin Chest Med. 2016;37(3):441-448. doi:10.1016/j.ccm.2016.04.007. DISCLOSURES: No relevant relationships by Carlos Cardenas, source=Web Response No relevant relationships by Sakda Sathirareuangchai, source=Web Response No relevant relationships by Andrew Tomlinson, source=Web Response

Endometrial biopsy is an important diagnostic tool for the evaluation of abnormal uterine bleeding

In this study 100 biopsies were taken from the endometrium of childbearing women (18-50 yrs. of age) suffering from abnormal vaginal bleeding from Jan 2019-Dec 2019. Endometrial Biopsy (EB) is safe, an outpatient procedure, low cost, carries out without general anesthesia &amp; the incidence of hemorrhage, infection &amp; uterine perforation are less common than with D&amp;C. EB is an alternative to dilatation &amp; curette (D&amp;C) for the evaluation of infertile &amp; abnormal vaginal bleeding or dysmenorrheic patients. There are two main groups of causes to irregular vaginal bleeding. 1. Organic disease (74% of the cases), in this group there are obvious lesion such as, endometrial polyp, endometrial hyperplasia &amp; chronic endometritis. The most common cause was endometrial hyperplasia 48%, it is commonly seen during the perimenopausal period (40-50yr). Less common causes include chronic endometritis 8%, hydatidiform mole 7%, and endometrial polyp 7%. 2. non-organic disease comprises 19% of all cases, anovulatory period 13% or Luteal phase insufficiency 6%. They are commonly seen from age of 18-40yrs. 6% of the cases found to have normal endometrium. 5 endometrial biopsies were inadequate &amp; unsatisfactory for histopathological interpretation. The aim of this study is to evaluate the usefulness &amp; disadvantages of EB &amp; to compare it with the traditional method of endometrial curette.

13. Contraceptive Implant-associated Abnormal Uterine Bleeding in Adolescents and Young Adults: Predictors, Management, and Rates of Continuation

<h3>Background</h3> Abnormal uterine bleeding (AUB) is commonly experienced by adolescents and young adults (AYA) following contraceptive implant placement. We assessed for predictors of AUB, factors contributing to AUB management, and differences in implant continuation rates by AUB management approach. <h3>Methods</h3> We analyzed data from a long-acting reversible contraception database from 3 AYA sites in tertiary care institutions. We included patients with the contraceptive implant placed from 7/1/2014-12/31/2018 and follow-up data through 12/31/2019. We excluded patients with ≥3 years since insertion without follow-up. Variables included age at insertion, comorbid conditions, menstrual history, prior contraceptive use, patient-reported AUB after implant placement, AUB evaluation and management, and implant discontinuation. We included data from insertion, follow-up, and removal visits. We assessed AUB predictors with logistic regression. Descriptive statistics, chi-square, and t-tests compared patient demographic and clinical variables by AUB status. Survival analysis examined predictors of time to discontinuation. This study was IRB approved. <h3>Results</h3> Our sample included 609 patients, average age was 19 years (SD=2.5). Prior to implant placement 37% reported irregular menses, and after insertion 25% reported AUB. In those with AUB, 67% had evaluation and management including laboratory studies (32%), pelvic ultrasound (4%), or medication therapy (86%). Medication initiation occurred at first AUB report for the majority of patients. Of those prescribed a medication, 60% received a combined oral contraceptive or progestin-only pill. AUB was associated with polycystic ovary syndrome (PCOS) in bivariate analysis (p-value=0.006), 57% of patients with PCOS (n=14) reported AUB after implant insertion. This association persisted after adjusting for age, medical comorbidities, menstrual history, and prior contraceptive use. Bivariate analyses did not identify any predictors for AUB evaluation and management. Implant discontinuation was low: 16% at 1 year, 27% at 2 years, and 35% at 3 years. Early discontinuation was significantly different between patients with and without AUB: 21% vs. 14% at 1 year (p-value=0.047), 38% vs. 23% at 2 years (p-value=0.000), 44% vs. 31% at 3 years (p-value=0.007). Medication for AUB management did not impact rates of or time to early discontinuation. <h3>Conclusions</h3> In this large cohort of AYA, PCOS was the only significant predictor of implant-associated AUB. There were no relationships between AUB and comorbid medical conditions or prior contraceptive use. There were no significant predictors of AUB evaluation and management following implant insertion, and such evaluation and management did not impact rates of early discontinuation.

A STUDY OF CLINICAL CORRELATION WITH HISTOPATHOLOGICAL DIAGNOSIS OF ABNORMAL UTERINE BLEEDING AT JLNMCH, BHAGALPUR, BIHAR

Background: Abnormal uterine bleeding in perimenopausal women accounts for about 70% of gynaecologic Outpatient Department visits. Perimenoppause, also called the menopausal transition, is the interval in which a woman's body makes a natural shift from more or less regular cycles of ovulation and menstruation toward permanent infertility, or menopause. Polymenorrhagia, intermenstrrual bleeding and metrorrhagia are other common disorders at perimenopause. Endometrial sampling is a safe and effective diagnostic step in evaluation of abnormal uterine bleeding after ruling out medical causes. The present study was aimed to review the causes of abnormal uterine bleeding in perimenopausal women establishing the correlation with clinical diagnosis and histopathological examinations. A total of 150 perimenopausal Material and Methods: women with abnormal uterine bleeding in the age group of 37-51 years for a period of 6 months were included. These women were evaluated clinically and ultrasonographically for the cause of abnormal uterine bleeding. Clinical impression and USG reports were correlated. These women underwent dilatation and curettage for endometrial sampling and specimen sent for histopathological examination. Histopathological reports were correlated with clinical diagnosis. Most of the patients with AUB were Results: between 37-41 years of age (56%). The incidence was high in parity-3 (26%) annd grand multipara (49.33%). The majority of the women were presented with menorrhagia (54.66%). Clinically, majority of the cases were diagnosed as broids 66 (44%) followed by dysfunctional uterine bleeding (DUB) 56 (37.33%). However, histopathological reports conrmed broid in 52 cases, DUB in 49, adenomyosis in 36 and polyp in 11 cases. Fibroi Discussion: ds are common nding in women with menorrhagia. Clinical, radiological and pathological evaluation correlated very well to diagnose broids and DUB. However clinically as well USG proved of little help to diagnose adenomyosis and carcinoma of cervix and endometrium. Thus, histopathological evaluation of endometrium is recommended in perimenopausal women.