Endometrial Patterns Among Rural Women Undergoing Gynecological Procedures in a Tertiary Care Hospital

Abstract

IntroductionWomen with endometrial diseases often present in outpatient departments, and outpatient procedures easily enable diagnosis. Histopathological patterns vary with age, menstrual cycle, drug use, and pathological state. Teaching hospitals are often located away from rural areas. Materials and methodsAn ambispective study was performed over 33 months in a rural medical college hospital by perusing the histopathological registers of the department. Details of history and endometrial samples (biopsy and hysterectomy) were obtained using biopsy numbers and requisition forms. Functional and organic histopathology findings were manually entered into a spreadsheet, and statistics were performed using Statistical Package for the Social Sciences (SPSS) for Windows version 22 (IBM SPSS Statistics, Armonk, NY, USA). ResultsThere were 226 women, with total abdominal hysterectomies (TAH) performed in a significantly higher proportion of middle-aged women (range: 41-59 years). Of the middle-aged women, 70% presented with excessive menstrual bleeding, and a similar percentage of older women presented with uterovaginal (UV) prolapse. Hysterectomy specimens constituted most samples in this study. Proliferative endometrium was observed in 40% of patients and metaplasia (papillary syncytial, tubal, and squamous) in only 1.7%. Normal proliferative and secretory endometrium were observed in 91 (40.3%) and 41 (18.1%) patients, respectively. The presence of hyperplasia, decidualization, stromal breakdown, adenocarcinoma, adenomyosis, and endometrial polyps did not vary significantly among the three age groups (elderly, middle-aged, and young). ConclusionMost women in rural areas presented to the gynecologist with uterine bleeding; middle-aged women constituted most of those with gynecological complaints. Normal endometrium was observed in nearly half of the patients. Adenomyosis was the most common cause of uterine bleeding. Uterine endometrial malignancies were rare.