Perimenopausal Uterine Bleeding Research Articles

Endometrial Thickness Measurement as Predictor of Endometrial Hyperplasia and Cancer in Perimenopausal Uterine Bleeding: Cross-Sectional Study.

Endometrial thickness (ET) measurement was an alternative method for predicting abnormal endometrial pathology in postmenopausal bleeding. Cut-off value of ET measurement could not be use in perimenopausal bleeding. Aim of this study was to investigate appropriate ET cut-off value for perimenopause women with abnormal uterine bleeding (PEMB) and abnormal endometrial histopathology. This was a cross-sectional study. PEMB at Bhumibol Adulyadej Hospital between July 2018 and June 2022 were recruited. Subjects who met inclusion criteria underwent ET measurement and endometrial biopsy via endometrial aspirator. Participants who had histopathology report of endometrial hyperplasia and more were classified as the study group. The Control group were subjects with no endometrial hyperplasia or cancer. Demographic and clinical character data were included. Correlation of ET and endometrial histopathology were calculated for statistical significance. A total of 304 cases were included. After exclusion, 254 subjects were recruited for this study. There were 22 and 232 cases in the study and control groups, respectively. The mean age and body mass index (BMI) of participants were 44.7 years old and 27.5 kg/m2, respectively. Prevalence of endometrial hyperplasia and cancer in perimenopausal uterine bleeding were 7.5 (19/254) and 1.2 (3/254) percent, respectively. Endometrial thickness equal to and more than 8 mm was associated with abnormal endometrial histopathology with statistical significance. Age, BMI, nulliparity, anovulatory bleeding history, hypothyroidism, diabetes mellitus and anovulation state of both groups were comparable. Endometrial thickness equal or more than 8 mm were significantly associated with endometrial hyperplasia or more among perimenopausal women with abnormal uterine bleeding.

Comparative study between tactile electrosurgical ablation guided by rectal ultrasound and versapoint hysteroscopic ablation in cases of perimenopausal uterine bleeding

Background and aim Bleeding is considered one of the most common problems in perimenopausal women. The menopausal transition is an imprecise period and can be established from the moment of appearance of menstrual disturbances and elevation of the serum follicle-stimulating hormone (FSH) level. The objective of this study was to evaluate the efficacy of tactile electrosurgical ablation of endometrium under rectal ultrasound guidance versus modified tactile versapoint hysteroscopic ablation in the management of perimenopausal abnormal uterine bleeding. Patients and methods This study was conducted in the Department of Obstetrics and Gynecology of Al-Azhar University Hospital (Assuit), Egypt on 50 perimenopausal patients with abnormal uterine bleeding. Patients were divided into two groups according to the method used. Group 1 included 25 participants, and ablation was done using tactile ablation guided by rectal ultrasound. Group 2 included 25 participants, who underwent hysteroscopic ablation using versapoint hysteroscope. Results Regarding sociodemographic study data, age in both groups ranged from 38 to 45 years, with P value of 0.903. Parity also showed no statistically significant difference between both groups. The incidence of complication was more in group 1 but less dangerous. Thermal injury of genital tract was seen in two cases in group 1 but no cases in group 2, with P value of 0.245. Cervical injury was seen in two cases in group 1 and one case in group 2, with P value of 0.500. Perforation occurred in two cases in group 1 and one case in group 2, with P value of 0.500. Regarding specific complication of endometrial ablation by versapoint hysteroscopic ablation, which occurred in group 2 only, by distension media, four cases had complications such as hyponatremia (decrease in serum sodium of 10 mmol/l). Postoperative complication such as hematometra occurred in one case only in group 1, with P value 0.500. The cost range in group 1 was from $14 to 20 and in group 2 it was from $40 to 50, with P value less than 0.001**. The time of surgery ranged from 10 to −15 min in group 1 and from 20 to 30 min in group 2, with P value less than 0.001**. After 6 months, two cases came back with recurrent Hge in group 1 and six cases in group 2, with P value 0.123. Conclusion Tactile ablation is easier, effective, and less costly.

Endometrial Volume as a Predictor of Endometrial Pathology in Perimenopausal Uterine Bleeding

Background: Transvaginal ultrasonography (TVS) imaging is aroutine, non-invasive procedure in initial evaluation of patients withabnormal uterine bleeding in perimenopausal age. However, there isno yet a cutoff value to discriminate benign form malignant cases.Aim of the Work: Is to assess the potential value of endometrialvolume measurements by 2D TVS compared with that of endometrial thickness in prediction of different endometrial pathologies inwomen with perimenopausal uterine bleeding.Patients and Methods: Ninety-two perimenopausal women presented with uterine bleeding were enrolled to the study after exclusionof general and local caused of bleeding as polyps and fibroids. TVS(2D) was done to measure endometrial thickness and volume using aspecific formula. Endometrial biopsy was taken and the pathologicalresults was correlated with the endometrial thickness and volume.Results: There was a statistically noticeable difference between benign endometrial pathology compared to endometrial hyperplasiawith atypia or endometrial carcinoma as regard age as well as bodymass index. There was a high statistically significant difference between patients with benign endometrium pathology and malignantendometrial pathology regarding endometrial thickness and volume.That endometrial volume had a high predictive value as proved byan area under the ROC curve (AUC) of 0.826. The best cut-off valuewas an endometrial volume >11.675 cm3. While (ROC) curve analysis for differentiation of patients using endometrial volume and endometrial thickness into women with benign endometrial pathologyor hyperplasia and those with endometrial carcinoma; Endometrialvolume also had a higher predictive value than endometrial thicknessas proved by an area under the ROC curve (AUC) of 0.871. Thecut-off value was an endometrial volume >13.105 cm3. While usingendometrial thickness cut-off value was an endometrial thickness >14.5mm.Conclusion: endometrial volume measured with inexpensive 2DTVS has a higher predictive value than measuring endometrial thickness in correspondence to the pathological results in patients withperimenopausal bleeding.

Ovarian Strumal Carcinoid Tumour: Case Report

BACKGROUND:Ovarian strumal carcinoid is a germ cell tumour characterised by a mixture of thyroid tissue and carcinoid. Ovarian struma is a very rare occurrence with 0.3-1% incidence of all ovarian tumours and 3% of mature teratomas. Primary carcinoid ovarian tumours are still uncommon as a part of mature teratoma or mucinous cystadenoma. There are four major variants of a carcinoid tumour: insular, trabecular, strumal and mucinous. A strumal carcinoid is an unusual form of ovarian teratoma composed of an intimate admixture of thyroid/carcinoid tissues.CASE REPORT:This is a case report of a 59-year old woman with a 5-year clinical history of perimenopausal uterine bleeding and three explorative curettages. Gynaecological and ultrasound examinations revealed ovarian enlargement with a diameter of 50 mm with hypoechoic zones suspected of benign teratoma. The diagnostic test such as Ca-125, AFP, free-T4 and TSH was in normal range. A smooth, solid right ovarian 50 an mm-size tumour, as well as small amount of fluid in the Douglas pouch, was found during the total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging biopsy. The histopathology revealed teratoma with strumal carcinoid tumour IA stage according to AJCC 2010 of the right ovary and negative cytopathology of the fluid from the Douglas pouch. On the postoperative 2-year control, the patient was tumour free, and Ca-125, free-T4 and TSH were in normal range.CONCLUSION:We would like to point out those specific diagnostic tools, such as ultrasound and Ca-125 have low specificity and sensitivity in detection of this rare ovarian malignancy.

Unicornuate Uterus with NonCommunicating Non-Cavitated Rudimentary Uterine Horn: An Unusual Case with Adenomyosis Managed with Total Hysterectomy

A 45-year-old woman admitted to our hospital complaining of perimenopausal uterine bleeding not responding to medical treatment. Ultrasound evaluation revealed unicornuate uterus with adenomyosis and it was so difficult to see the distant small left rudimentary horn on ultrasound. The patient underwent laparotomy with total hysterectomy for both horns and was sent to pathologist that indicated adenomyosis and non-communicating non-cavitated left rudimentary horn.

TERAPIA DE REEMPLAZO HORMONAL EN LA PERIMENOPAUSIA. UNA ALTERNATIVA PARA LA MUJER QUE NO DESEE MENSTRUAR. ESTUDIO PRELIMINAR

OBJETIVO: Evaluar los resultados de la administración de tibolona como terapia de reemplazo hormonal en perimenopáusicas que aún presentan sangrado uterino. Diseño: Estudio observacional clínico. MATERIAL Y MÉTODOS: Cincuenta mujeres perimenopáusicas con FSH sérico mayor de 40 UI/mL y ausencia de patología ginecológica, a quienes se administró tratamiento combinado de tibolona y píldoras anticonceptivas, con el fin de abatir el endometrio, para luego prescribir tibolona sola. RESULTADOS: El 50% de las pacientes estudiadas respondió satisfactoriamente a este esquema terapéutico. CONCLUSIÓN: El esquema terapéutico combinado de tibolona y píldoras anticonceptivas puede lograr la amenorrea en un grupo de mujeres perimenopáusicas.

Efficacy observation on mifepristone in the treatment of perimenopausal dysfunctional uterine bleeding

Objective To find out the clinical effects of mifepristone in the treatment of perimenopausal dysfunctional uterine bleeding.Methods 87 patients with perimenopausal dysfunctional uterine bleeding were received mifepristone treatment.The thickness of the endometrium and sex hormones indicators,including progesterone(P),estrogen (E2),the corpus luteum generated hormone (LH),follicle hormone (FSH),prolactin (PRL) and testosterone (T),were checked before and after treatment.Results The treatment efficiency was 90.8％.Endometrial thickness before treatment (10.9 ± 1.9) mm,endometrial thickness after treatment (5.4 ± 1.1) mm,with significant differences between them(t =0.684,P ＜ 0.01).After treatment,patients with hemoglobin (102.5 ± 7.1) g/L,significantly increased compared with before treatment (t =0.539,P ＜ 0.01).After treatment,the P,E2,LH,FSH levels were significantly lower than those of before treatment (t =0.690,0.552,0.513,0.376,all P ＜ 0.05) ; PRL,T levels after treatment compared with before treatment,there were no significant differences (all P ＞ 0.05).Conclusion The mifepristone treatment for perimenopausal uterine bleeding has high effective rate,less adverse reactions,and high clinical value. Key words: Mifepristone; Uterine hemorrhage; Perimenopause

Aspiration cytology from the pouch of Douglas at hysteroscopy.

Eighty-seven fine needle aspiration cytological samples from 29 patients suffering from irregular perimenopausal uterine bleeding were evaluated. Aspiration cytology was performed prior to hysteroscopy, after distension of the uterine cavity and finally after uterine curettage. In this paper, cytological examination of fluid from the pelvic content in women with benign endometrial findings is compared with that of patients with adenocarcinoma. Endometrial curettage influenced the cell content of the cytologica specimens.