Abstract:Background: Abnormal uterine bleeding (AUB) is the most common reason for gynecological visits for perimenopausal bleeding and may account for more than 25% of all hysterectomies. Objective: This study was aimed to review the causes of abnormal uterine bleeding in perimenopausal women establishing the correlation with ultrasonographic and histopathological examinations. Study Method: This descriptive study was conducted in the department of gynecology and obstetrics, Ibn Sina Medical College, Dhaka during Janu… Show more
“…The second most described symptom was abnormal uterine bleeding in pre- and perimenopausal women. A majority of fourteen studies used the term as a general description whilst not specifying in detail what types of abnormal bleeding were explored [ 16 , 17 , 19 , 24 , 25 , 26 , 30 , 32 , 37 , 40 , 46 , 48 , 49 , 53 ]. Moreover, due to insufficient data, 2 × 2 tables could not be extracted from these articles.…”
Section: Resultsmentioning
confidence: 99%
“…Only three publications clarified which specific subtypes of abnormal uterine bleeding were investigated, while a remaining group of fourteen studies used only a general description [ 1 , 16 , 17 , 19 , 20 , 24 , 25 , 26 , 30 , 32 , 37 , 40 , 46 , 47 , 48 , 49 , 53 ]. Furthermore, a complete 2 × 2 table could be extracted from of one study only, which did not show a significant link with endometrial cancer [ 47 ].…”
Section: Discussionmentioning
confidence: 99%
“…The detailed characteristics of all included studies are presented in Tables 1 and 2 [1,2,3,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54]. These studies were performed in several continents including America, Europe, Asia and Australia.…”
Uterine cancer is the most and second most common gynecological malignancy in developed and developing countries, respectively. The majority of endometrial cancers are diagnosed early due to the presence of abnormal uterine bleeding. The existing literature however contains only little data regarding the prevalence of such symptoms compared to patients with no or benign pathology. Therefore, a systematic review was conducted in order to determine the significance of various clinical signs and symptoms predicting uterine cancer.
Embase, Web of Science and Medline databases were searched from inception until 18 June 2019. Studies eligible for selection inclusion assessed the diagnostic accuracy of clinical signs and symptoms in pre- and postmenopausal women aged 18–99 years old with uterine malignancy. Case reports, case series and studies of which full text was not available, were excluded. The risk of bias was assessed using the QUADAS-2 tool by two independent reviewers. Results were visualized by forest plots using RevMan(5.3).
Forty-one studies were eventually included in this systematic review. Abnormal uterine bleeding occurring in pre-, post- and perimenopausal women was proven to be the most widely investigated symptom in relation to cancer of the uterus. Thirty-two articles examined patients with postmenopausal bleeding of which sensitivity and specificity varied between 0.28 to 0.86 and 0.63 to 0.84, respectively. Abnormal bleeding in pre- and perimenopausal women on the other hand showed a sensitivity ranging from 0.63 to 0.81. Its specificity could not be calculated due to missing data. Other symptoms appeared not sufficiently examined to assess their diagnostic accuracy range.
This review highlights the current lack of knowledge regarding the diagnostic accuracy of several signs and symptoms for uterine cancer. After a thorough in-depth review of the literature, meta-analysis could not be performed due to the absence of control populations in the majority of articles. Further research is needed to establish the rule-in or rule-out value of specific clinical signs to identify patients at risk for uterine malignancy prompting further clinical assessment.
“…The second most described symptom was abnormal uterine bleeding in pre- and perimenopausal women. A majority of fourteen studies used the term as a general description whilst not specifying in detail what types of abnormal bleeding were explored [ 16 , 17 , 19 , 24 , 25 , 26 , 30 , 32 , 37 , 40 , 46 , 48 , 49 , 53 ]. Moreover, due to insufficient data, 2 × 2 tables could not be extracted from these articles.…”
Section: Resultsmentioning
confidence: 99%
“…Only three publications clarified which specific subtypes of abnormal uterine bleeding were investigated, while a remaining group of fourteen studies used only a general description [ 1 , 16 , 17 , 19 , 20 , 24 , 25 , 26 , 30 , 32 , 37 , 40 , 46 , 47 , 48 , 49 , 53 ]. Furthermore, a complete 2 × 2 table could be extracted from of one study only, which did not show a significant link with endometrial cancer [ 47 ].…”
Section: Discussionmentioning
confidence: 99%
“…The detailed characteristics of all included studies are presented in Tables 1 and 2 [1,2,3,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54]. These studies were performed in several continents including America, Europe, Asia and Australia.…”
Uterine cancer is the most and second most common gynecological malignancy in developed and developing countries, respectively. The majority of endometrial cancers are diagnosed early due to the presence of abnormal uterine bleeding. The existing literature however contains only little data regarding the prevalence of such symptoms compared to patients with no or benign pathology. Therefore, a systematic review was conducted in order to determine the significance of various clinical signs and symptoms predicting uterine cancer.
Embase, Web of Science and Medline databases were searched from inception until 18 June 2019. Studies eligible for selection inclusion assessed the diagnostic accuracy of clinical signs and symptoms in pre- and postmenopausal women aged 18–99 years old with uterine malignancy. Case reports, case series and studies of which full text was not available, were excluded. The risk of bias was assessed using the QUADAS-2 tool by two independent reviewers. Results were visualized by forest plots using RevMan(5.3).
Forty-one studies were eventually included in this systematic review. Abnormal uterine bleeding occurring in pre-, post- and perimenopausal women was proven to be the most widely investigated symptom in relation to cancer of the uterus. Thirty-two articles examined patients with postmenopausal bleeding of which sensitivity and specificity varied between 0.28 to 0.86 and 0.63 to 0.84, respectively. Abnormal bleeding in pre- and perimenopausal women on the other hand showed a sensitivity ranging from 0.63 to 0.81. Its specificity could not be calculated due to missing data. Other symptoms appeared not sufficiently examined to assess their diagnostic accuracy range.
This review highlights the current lack of knowledge regarding the diagnostic accuracy of several signs and symptoms for uterine cancer. After a thorough in-depth review of the literature, meta-analysis could not be performed due to the absence of control populations in the majority of articles. Further research is needed to establish the rule-in or rule-out value of specific clinical signs to identify patients at risk for uterine malignancy prompting further clinical assessment.
“…13 Menorrhagia was also found to be a common clinical presentation in most of the previous studies by Nargis et al (52%), Pillai (46.4%) and Jetley et al, (46.4%). 10,14,15…”
Background: AUB is a common condition affecting 14-25% of women of reproductive age and may have a significant impact on their physical, social, emotional and material quality of life. AUB can occur at any age in various forms and has different modes of presentation. The key to successful clinical management is to recognize or identify the causative factors responsible.Methods: This study was conducted over 100 patients. Patients with complaints of menstrual irregularity between menarche to premenopausal age group were considered. Data about age, parity, menstrual history, obstetric history, medical history, physical examination, thyroid function test, radiological findings and histopathology were collected and studied.Results: Incidence of AUB is more common in 5th decade of life. Menorrhagia is the most common bleeding pattern. It is concluded that DUB is the most common cause of AUB. Among the other organic pathological causes, fibroid is the commonest. Maximum number of apparently normal patients with abnormal uterine bleeding belong to category of sub clinical hypothyroid.Conclusions: Accurate analysis of endometrial sample is the key to effective therapy and rational approach to treatment of women with abnormal uterine bleeding.
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
conrmed 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.
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