CME Journal of Geriatric Medicine

ISSN (Print): 1475-1453: ISSN (Online): 3008-0398

Abbreviation: CME J Ger Med
Website: https://cmegeriatricmed.co.uk/
Original Research Article DOI: 10.61336/cmejgm

Histopathological Spectrum of Endometrial Lesions in a Tertiary

Care Hospital
Authors Information Abstract & Keywords:
Name of the Authors: Abstract
1.
Dr. Sanjay Kumar Singh, 2.Dr. Juhi Background: Excessive and abnormal menstrual bleeding is the commonest
Sisodia symptom that brings perimenopausal women to the hospital. This age group is
more amenable to serious conditions like endometrial cancers. Therefore, this
Affiliations of the Authors: bleeding should be seriously evaluated to exclude the life-threatening conditions
1. by easily available investigative modalities like biopsy before deciding the line
Assistant Professor, Department of
Pathology, Autonomous State Medical of treatment. This study aimed to examine the histopathological lesions of
College, Sultanpur, Uttar Pradesh. endometrial tissue. Methods: This cross-sectional study was conducted in the
2.
Assistant Professor, Department of Department of Pathology at a tertiary care hospital over a period of two years.
Microbiology, Autonomous State 500 endometrial samples were analyzed, including hysterectomy specimens and
Medical College, Sultanpur, Uttar endometrial biopsies. Clinical data such as age, symptoms, and provisional
diagnosis were collected from records. Specimens were processed routinely,
Pradesh.
stained with hematoxylin and eosin, and examined microscopically. Data were
statistically analyzed using the Chi-square test, with p < 0.05 considered
*Corresponding author: significant. Results: The 500-woman cohort had a mean age of 40–50 years
Dr. Juhi Sisodia (62%), but significant age-related variations in describing presenting symptoms
(χ²=214.53, p<0.001), abdominal pain (30.2%), PV bleeding (27%), and
Article History: menorrhagia (20.2%) were the most common. From an actual point,
Received: 28.03.2025 uterine/cervical fibroids (39.4%) and DUB/AUB (37.2%) prevailed. Specimens
Revision: 12.04.2025 were 79% hysterectomies and 21% biopsies, and specimen type was highly
Accepted: 28.04.2025 correlated with age (χ² = 17.02, p<0.001). Histopathology showed 98.8% non-
Published: 12.05.2025 neoplastic lesions (proliferative phase (35.8 %), atrophic (11.8 %), simple
hyperplasia (8.2 %), and 1.2% malignant neoplasms), primarily endometrioid
adenocarcinoma (0.6%). Specimen type was also closely associated with specific
histological diagnoses (χ²=68.01, p<0.001). Conclusion: The current study found
that histopathological examination plays a critical role in diagnosing endometrial
lesions, especially in perimenopausal women. Most specimens, particularly those
from women aged 41 – 50 years, presented with a proliferative phase of the
endometrium. This study found a significant association between age, clinical
presentation, specimen type, and histopathological diagnosis.

Keywords: Endometrium, Histopathology, Abnormal uterine bleeding,

Dysfunctional uterine bleeding

increase with age, and higher incidence is reported in

INTRODUCTION perimenopausal women, especially in those who
The uterus has two major components: the myometrium experience anovulatory cycles [3, 6]. The prevalence of
and the endometrium. The endometrium, which is AUB in India is around 17.9% [7]. Dysfunctional uterine
composed of glands embedded in cellular stoma is a bleeding (DUB) is an important cause of AUB, which
hormonally responsive tissue undergoing cyclic occurs without any identifiable organic pathology in
proliferation, differentiation and shedding during the perimenopausal females. Menorrhagia tends to occur in
menstrual cycle under influence of ovarian steroids [1, 2] 10–30% of menstruating women at any given time and in
This dynamic tissue plays a crucial role in etiology of up to 50% during perimenopause [6]. In postmenopausal
various gyneological conditions, which include abnormal women, the occurrence of AUB raises greater concern due
uterine bleeding (AUB) which is now becoming one the to the higher risk of malignancy. Thus, timely and accurate
major concern of women of all age groups. AUB is defined diagnosis is important to exclude serious underlying
as bleeding that deviates in frequency, duration, or amount pathology such as endometrial carcinoma. The incidence
from normal menstrual patterns. It is a distressing of which has been found in 10% of cases on
condition that is common and affects a person's physical, histopathological examination [8]. Therefore,
emotional, and social well-being. It comprises histopathological evaluation of the endometrium becomes
approximately 20–30% of outpatient gynecologic essential in identifying the cause of AUB, especially in
consultations among reproductive-age women [3-5]. The women aged 40 years and above or those who are
prevalence of AUB ranges from 9% to 30% and tends to
CME Journal of Geriatric Medicine 33
How to Cite: S K Singh, J Sisodia, “Histopathological Spectrum of Endometrial Lesions in a Tertiary Care Hospital " CME J Ger Med, Vol. 17, No.
5, 2025, pp. 33-39.

postmenopausal [9, 10]. Endometrial sampling remains a Sample Size: A total of approximately 500 cases were
cornerstone in the diagnostic workup, with dilatation and analyzed.
curettage (D&C) used previously as a standard technique.
However, its invasiveness, requirement for general Methodology: Endometrial specimens were received from
anesthesia, and associated risks such as uterine perforation the Department of Obstetrics and Gynecology following
and infection have led to the development of safer, procedures such as dilatation and curettage (D&C) or
minimally invasive sampling methods [11–15]. Identifying hysterectomy. All samples were transported in 10% neutral
the spectrum of endometrial lesions ranging from normal buffered formalin. Upon receipt, specimens were grossly
cyclical changes to hyperplasia, polyps, and malignancy examined, properly labeled, and fixed in formalin for 24
helps guide appropriate medical or surgical management hours. For hysterectomy specimens, sections were taken
required in these cases. Accurate diagnosis not only from the endometrium, myometrium (from the fundus,
enables timely intervention and reduces unnecessary body, and cervix), and cervix (including ectocervix,
procedures but also aids in preventing long-term endocervix, and transformation zone from both lips). A
complications. Given the wide range of histopathological minimum of three sections were taken from any grossly
findings associated with AUB, this study aims to analyze visible lesion. Endometrial biopsy specimens were
the spectrum of endometrial lesions in patients presenting weighed and fully submitted. Tissue Processing of samples
with abnormal uterine bleeding at a tertiary care hospital was performed using an automatic tissue processor as per
and correlate them with age groups, helping to optimize standard protocol.
patient care.
Sectioning and Staining: Tissue blocks were sectioned at
MATERIALS AND METHODS 3–4 µm thickness using a rotary microtome. Sections were
This was a descriptive cross-sectional study conducted in floated on a 70% alcohol bath to prevent wrinkling and
the Department of Pathology at Dr. Balasaheb Vikhe Patil transferred to a 46–50°C water bath. The sections were
Rural Medical College, Pravara Rural Hospital, a tertiary mounted on albumin-coated slides, dried in a hot air oven,
care teaching hospital located in a rural setting in Loni, deparaffinized with xylene, and stained using the standard
Maharashtra, India. Institutional Ethical approval was Hematoxylin and Eosin (H&E) protocol. Final stained
obtained for the study. The duration of the study was from slides showed nuclei in blue and cytoplasm in varying
October 2019 to November 2021. The study included shades of pink.
female patients with gynecological conditions requiring
endometrial sampling via biopsy or hysterectomy. Data Collection and Analysis: Clinical and pathological
Reporting to our hospital. data were collected from patient case records. All data
were compiled using Microsoft Excel. Statistical analyses
Inclusion Criteria were performed using IBM SPSS Statistics version 20.0
All endometrial samples (both biopsy and (SPSS Inc., Chicago, IL, USA) and OpenEpi version 2.3.1.
hysterectomy specimens) received in the Department Descriptive statistics, including mean, range, standard
of Pathology during the study period were included. deviation, and percentage, were used. The Chi-square test
was applied to categorical variables, and Student’s t-test
Exclusion Criteria was used for continuous variables. A p-value of <0.05 was
Specimens with insufficient tissue for considered statistically significant.
histopathological evaluation were excluded.

RESULTS
A total of n=500 samples of endometrial biopsy and hysterectomy coming to the department of pathology, Dr. Balasaheb Vikhe
Patil Rural Medical College, Loni, were included in the study. Table 1 shows the age-wise distribution of the cases included
in the study. The majority of the study population (62%) belonged to the 40–50 years age group, indicating a predominance of
perimenopausal women. This was followed by women under 40 years, comprising 19% of the total, and those aged between
50–60 years, making up 11%. The least represented group was women aged 60 years and above, accounting for only 8% of
the cases. The mean age of the cohort in years was 44.9+11.2 years.

Table 1: Age Distribution among the study population

Age Group (years) Frequency (%)
<40 95 (19%)
40-50 310 (62%)
50-60 56 (11%)
≥60 39 (08%)
Total 500 (100%)
Figure 2 depicts the various clinical presentations observed in the study population. The most frequent symptom reported was
pain in the abdomen, seen in 30.2% of the cases, followed closely by per vaginal bleeding (27%) and menorrhagia (20.2%).

CME Journal of Geriatric Medicine 34

How to Cite: S K Singh, J Sisodia, “Histopathological Spectrum of Endometrial Lesions in a Tertiary Care Hospital " CME J Ger Med, Vol. 17, No.
5, 2025, pp. 33-39.

These results are indicative of common gynecological complaints, resulting in additional assessment of endometrial pathology.
Less common presentations included abnormal uterine bleeding (8.4%), dysmenorrhea (6.4%), and mass per vagina (1.6%).
Rare symptoms such as excessive weight loss (0.6%), menopause-related complaints (0.8%), and postpartum hemorrhage
(0.4%) were also noted. The 'others' category (4.4%) encompassed various non-specific or less frequently reported complaints.
This data shows that an abnormal bleeding pattern is commonly prevalent. Atypical clinical presentation, including a number
of other indicators, requires endometrial examination, thereby implying a broader assessment of symptoms.

Percentage
Others
Post Partum Haemmorhage
Menopause
Excessive Weight Loss
Mass per Vagina
Dysmennorhoea
Abnormal Uterine Bleeding
Menorrhagia
Per Vaginal Bleeding
Pain in abdomen

0 5 10 15 20 25 30 35

Figure 1: History of Symptoms among the Study Population

Table 2 presents the distribution of clinical symptoms across different age groups in the cohort. A critical analysis of the table
shows that the clinical presentation varies depending on age. The age group 40–50 years had the highest frequency of most
symptoms, especially pain in abdomen (81 cases), per vaginal bleeding (84 cases), and menorrhagia (80 cases). These
symptoms are frequently reported in perimenopausal women because of hormonal fluctuations or structural anomalies. In the
age group <40 years, there were striking symptoms including pain in the abdomen (31 cases) and menorrhagia (19 cases),
usually associated with anovulatory cycle or hormonal imbalance. The ≥60 years group had higher frequencies of more serious
or less common symptoms such as mass per vagina (5 cases) and others (8 cases), which may suggest neoplastic or
postmenopausal causes that warrant detailed investigation. More importantly, menorrhagia and dysmenorrhoea were rarely
reported in women ≥60 years, consistent with the postmenopausal state. Rare symptoms like excessive weight loss and
postpartum hemorrhage were observed only in a few cases. Overall, the results show that statistically significant association.
This reveals that age is an important factor influencing the type of gynecological symptoms, and it can guide clinicians in
tailoring diagnostic approaches across age groups.

Table 2: Association of Age group and History of symptoms

History of Symptoms Age group Total χ2 P-value
<40 40-50 50-60 ≥60
Pain in abdomen 31 81 23 16 151
Per Vaginal Bleeding 26 84 16 09 135
Menorrhagia 19 80 02 00 101
Abnormal Uterine Bleeding 07 31 04 00 42
Dysmennorhoea 10 16 06 00 32 214.53 <0.001**
Mass per Vagina 00 00 03 05 08
Excessive Weight Loss 00 00 02 01 03
Menopause 00 04 00 00 04
Postpartum Hemorrhage 02 00 00 00 02
Others 01 13 00 08 22
Total 95 310 56 39 500
*Significant

Table 3 shows the clinical diagnosis of the 500 women studied. The most common diagnosis in the cases was uterine/cervical
fibroid, 39.4% (197 cases). Fibroids are common benign tumors of reproductive age women and the primary cause of abnormal

CME Journal of Geriatric Medicine 35

How to Cite: S K Singh, J Sisodia, “Histopathological Spectrum of Endometrial Lesions in a Tertiary Care Hospital " CME J Ger Med, Vol. 17, No.
5, 2025, pp. 33-39.

uterine bleeding and pelvic discomfort. Dysfunctional uterine bleeding / abnormal uterine bleeding was the second most
frequently diagnosed condition. It was observed in 37.2% (186 cases). This reflects a high trend of bleeding disorders among
women, especially at the perimenopausal age. Uterovaginal prolapse was noted in 8% (25 cases) and is commonly associated
with multiparity and muscle weakness of the pelvic floor in aged women. Ovarian tumors/masses/cysts were seen in 3.2% (16
cases) and adenomyosis in 3.6% (18 cases). All are associated with pain and menstrual irregularities. Other rare but important
conditions included endometrial carcinoma (0.6%), carcinoma cervix (1.4%), and hydatidiform mole (0.6%), thus underscoring
the need to carry out histopathological analysis in detecting potentially malignant or premalignant lesions.

Table 3: Clinical Diagnosis in the cases of the study

Clinical diagnosis Frequency Percentage
UV prolapse 25 8
DUB/AUB 186 37.2
Adenomyosis 18 3.6
Adherent / abruption Placenta 2 0.4
Atrophic uterus 1 0.2
Carcinoma cervix 7 1.4
Cervical polyp 1 0.2
Chronic pelvic disease 1 0.2
Ectopic rupture with tubal ligation failure 2 0.4
Endometrial carcinoma 3 0.6
Endometrial polyp 4 0.8
Endometriosis 10 2
Gestational endometrium 1 0.2
Hyadatiform mole 3 0.6
Ovarian tumor/mass/cyst 16 3.2
Post menopausal bleeding 4 0.8
Postpartum hemorrhage 3 0.6
Tuberculosis endometrium 1 0.2
Uterine/Cervix Fibroid 197 39.4
In the present study, out of 500 cases, hysterectomy specimens had a maximum of n=397(79%), while the remaining 103
(21%) were endometrial biopsies. The maximum number of cases of hysterectomy specimens, it is worth noting that vast
numbers of gynecological conditions were detected among women that were severe and required surgical management of the
uterus, such as fibroids, prolapse, or persistent abnormal uterine bleeding unresponsive to conservative measures. In contrast,
endometrial biopsies are mainly used for diagnostic assessment, especially in patients with abnormal uterine bleeding or
suspected endometrial pathology, especially in perimenopausal or postmenopausal women.

The description of the association between age group and type of specimen is given in Table 4. A critical analysis of the table
shows that the majority of hysterectomy specimens were observed in the 40–50 years age group (261 cases, 65.7% of
hysterectomies), followed by the <40 and 50–60 years age groups. Endometrial biopsies were more frequently performed in
the 40–50 years group (49 cases) and the <40 years group (32 cases), although the decision was solely based on the clinical
symptoms and need for conservative diagnostic methods before a surgical approach. A statistically significant association was
found between the age group and type of specimen (p < 0.001), implying that the type of specimen collected varies significantly
with age.

Table 4: Association between age group and types of specimens

Types of specimens Total χ2-value P-value
Age in years Endometrial Biopsy Hysterectomy specimen
<40 32 63 95
40-50 49 261 310
50-60 10 46 56 17.02 <0.001*
≥60 12 27 39
Total 103 397 500
*Significant

Table 5 projects the association between the type of specimen and histopathological diagnosis for endometrial biopsy and
hysterectomy. The table showed that the proliferative phase of the endometrium was found in both biopsies as well as
hysterectomy specimens. The secretory phase was distributed in 29 hysterectomy specimens and 30 biopsies. Atrophic
CME Journal of Geriatric Medicine 36
How to Cite: S K Singh, J Sisodia, “Histopathological Spectrum of Endometrial Lesions in a Tertiary Care Hospital " CME J Ger Med, Vol. 17, No.
5, 2025, pp. 33-39.

endometrium and cystic atrophy were also common in hysterectomy samples, while cystic hyperplasia and endometrial
hyperplasia, both types, were observed. Endometrial carcinoma was very rare (one biopsy specimen and five hysterectomy
specimens).

Table 5: Association between type of specimen and Histopathological Diagnosis

Histopathological Diagnosis Type of specimen χ2-value P-value
Endometrial Biopsy Hysterectomy specimen
Decidualized endometrium 0 3
Proliferative phase 31 179
Secretory phase 30 29
Adenomyosis 1 15
Atrophic endometrium 5 55
Cystic atrophy 1 20
Cystic Hyperplasia 15 53
Endometrial carcinoma 1 5 68.01 <0.001*
Endometrial hyperplasia 11 17
Endometrial polyp 2 8
Inadequate for opinion 5 5
Pill endometrium 1 8
Total 103 397
*Significant

Table 6 summarizes the 494 non-neoplastic endometrial lesions (98.8% of specimens). The most common were the
proliferative-phase endometrium (35.8%), atrophic endometrium (11.8%), and secretory-phase endometrium (7.8 %). Simple
hyperplasia contributed 8.2%, while complex hyperplasia with and without atypia contributed 3.2% and 4.2%, respectively.
Adenomyosis and cystic glandular hyperplasia accounted for 4.6 % of all the cases. Other rare entities were disordered phases
(5.8%), endometrial polyps (3.4%), cystic atrophy (3.8%), and endometritis (2%). Decidual, gestational, and pill endometria
accounted for <4% of all cases.

Table 6: Histopathological diagnosis of non-neoplastic lesions

Histopathological diagnosis No. of lesions Percentage (%)
Proliferative phase 179 35.8
Secretory phase 39 7.8
Atrophic phase 59 11.8
Adenomyosis 23 4.6
Complex hyperplasia without atypia 16 3.2
Complex hyperplasia with atypia 21 4.2
Cystic glandular hyperplasia 23 4.6
Cystic atrophy 19 3.8
Decidua with glandular change 6 1.2
Disordered phase endometrium 29 5.8
Endometrial polyp 17 3.4
Gestational endometrium 6 1.2
Pill endometrium 9 1.8
Endometritis 10 2
Simple hyperplasia 41 8.2
Inadequate for opinion 7 1.4
Total No of non-neoplastic lesion 494 98.8
Among 6 malignant lesions, n=3 (50%) cases are endometroid carcinoma, n=1(16.6%) case of adenosquamous carcinoma,
n=1(16.6%) case of mucinous adenocarcinoma, and 1(16.6%) case of undifferentiated adenocarcinoma is observed in this
study, as given in Table 7. These results emphasize the relative rarity of malignant endometrial neoplasms in this cohort and
the importance of careful histopathological assessment in differentiating multiple carcinoma subtypes for proper clinical
management.

CME Journal of Geriatric Medicine 37

How to Cite: S K Singh, J Sisodia, “Histopathological Spectrum of Endometrial Lesions in a Tertiary Care Hospital " CME J Ger Med, Vol. 17, No.
5, 2025, pp. 33-39.

Table 7: Histopathological diagnosis of malignant endometrial lesions

Histopathological diagnosis No. of lesions Percentage
Adenosquamous carcinoma 1 0.2
Endometrioid Adenocarcinoma 3 0.6
Undifferentiated Adenocarcinoma 1 0.2
Mucinous Adenocarcinoma 1 0.2
Number of malignant neoplastic lesions 6 1.2

DISCUSSION
The current study was done in 500 women for Vaidya et al. [22], who found maximum symptomatic cases
histopathological analysis of endometrial specimens (both in the perimenopausal age. Among malignant endometrial
neoplastic and non-neoplastic), conducted over two years at lesions, 1.2% of cases were neoplastic, including
the Department of Pathology in a tertiary care hospital. The endometrioid adenocarcinoma (0.6%), adenosquamous
results of this study showed a statistically significant carcinoma (0.2%), mucinous carcinoma (0.2%), and
association (χ² = 17.02, p < 0.001) between the age group undifferentiated carcinoma (0.2%). These results are in
and type of specimen. The most frequently received agreement with the studies by Bhatta S et al. [23] and Shah
specimens were hysterectomy samples in 79% of cases, S et al. [24], which observed a low incidence of malignancy
which were predominantly from the age group 41 – 50 years, in their endometrial cohorts. Endometrial sampling remains
n=261 (81.8%), followed by the age group 31 – 40, n=131 a procedure that yields valuable diagnostic information,
(80.5%). In our study, the mean age was 44.9 ± 11.2 years, especially on abnormal uterine bleeding and malignancies.
and the age group with the highest incidence of patients was Our study shows that proliferative and hyperplastic
the 41–50 years group, ranging from 19–85 years. Studies endometria prevail in perimenopausal women, whereas
show that the average age can differ, where: The mean age atrophic and neoplastic patterns are more common after
reported by A Sobande et al. [16] was 51.29 ± 12.86 years, menopause. Overall, histopathological examination of
Günakan et al. [17] 70.53 years, and Deeba et al. [18] endometrial tissue is essential for the evaluation of uterine
calculated the mean age as 61.6 ± 6.17 years. The difference pathology. Our findings support the clinical importance of
in the mean age among studies may be attributed to routine histopathological evaluation, particularly in women
variations in population makeup, the number of participants, presenting with abnormal bleeding patterns, as it helps in the
or the availability of healthcare services. Similar findings early detection of pre-malignant and malignant lesions.
were reported by Tiwana et al. [19], who frequently received
samples from perimenopausal women. In their study, they Conclusion
found endometrium was in the proliferative phase in 35.22% Within the limitations of the current study, we found that
of cases and atrophic endometrium in 25.8% of cases. The histopathological examination plays a critical role in
findings of this study also align with several other Indian diagnosing endometrial lesions, especially in
and international studies, which include the study by Singh perimenopausal women. Most specimens, particularly those
et al. [20], who found that proliferative endometrium was from women aged 41 – 50 years, presented with a
the most common histological pattern. Naeem et al. [21] in proliferative phase of the endometrium. This study found a
a similar study found proliferative endometrium in 29%, significant association between age, clinical presentation,
endometrial hyperplasia in 24.8%, chronic endometritis in specimen type, and histopathological diagnosis. The
16.8%, and atrophic endometrium in 12.6% of cases. diagnosis of malignant lesions is rare compared to that of
In the current study, from the non-neoplastic lesions, we non-malignant lesions. Therefore, this study highlights the
found proliferative endometrium was the most frequent importance of routine histopathological analysis of
histopathological finding (35.8%), followed by atrophic endometrial samples for early diagnosis and management of
endometrium (11.8%), and simple hyperplasia (8.2%). In symptomatic women across different age groups.
7.8% of cases secretory phase endometrium was diagnosed.
179 cases of hysterectomy specimens sent showed signs of REFERENCES
the proliferative phase, and 31 cases of biopsies also showed 1. Mutter G.L, Ferenczy A, Blaustein’s Pathology of
this stage. The high correlation between specimen type and Female Genital Tract: Anatomy and Histology of the
histological findings (χ² = 68.01, p < 0.001) emphasizes the Uterine Corpus, Fifth Edition; Springer-verlag; 2002:
value of both hysterectomy and endometrial biopsy for the 383-419.
assessment of uterine pathology. Clinical presentation in our
2. Awwad JT, Toth TL, Schiff I: Abnormal Uterine
study revealed that pain in abdomen (30.2%) as the most
frequently reported symptom, followed by per vaginal Bleeding in the Perimenopause. International Journal
bleeding (27%), menorrhagia (20.2%), and abnormal of Fertility & Menopausal Studies. 1993;38(5):261-69.
uterine bleeding (8.4%). A significant association was found 3. Mencoglia L, Perino A, Hamou J. Hysteroscopy in
between age group and clinical symptoms (χ² = 214.53, p < perimenopausal and post-menopausal women with
0.001), and the majority of symptomatic patients were in the abnormal uterine bleeding. J Reprod Med. 1987; 32:
40–50-year age group. This is in agreement with findings by 577- 582.
CME Journal of Geriatric Medicine 38
How to Cite: S K Singh, J Sisodia, “Histopathological Spectrum of Endometrial Lesions in a Tertiary Care Hospital " CME J Ger Med, Vol. 17, No. 5,
2025, pp. 33-39.

4. Sarswati D, Thanlca J, Shalinee R, Arthi R, Jaya V. 15. Brand AH. The woman with postmenopausal
Study of endometrial pathology in abnormal uterine bleeding. Aust Fam Physician2007;36(3):116–120.
bleeding. Obstet & Gynecol India. 2011; 61: 424-3. 16. Sobande A, Eskandar M, Archibong EI, Damole IO. The
5. Mary Ann Lumsden, Jay McGavigan. Menstruation histopathological pattern of endometrial disease in
and Menstrual Disorders. In: Robert W shaw, W. patients with abnormal uterine bleeding in Saudi Arabia.
Ann Saudi Med. 2001 May–Jul;21(3–4):207–210.
Patrick Soutter, Staurt L. Stauton.Gynaecology.3rd.
17. Günakan E, Oz M, Atalay CR. Histopathological
Ed. U.K., Churchill Livingston;2003: 459-473. evaluation of endometrial biopsies in geriatric women: a
6. Speroff L, Fritz MA. Menopause and the peri- single institution experience. Turk Patoloji Derg.
menopausal transition. In: Clinical gynaecologic 2015;31(2):81–87.
endocrinology and infertility. 7th edition. Jaypee 18. Deeba F, Rizvi G, Pandey H. Histopathological pattern
Brothers Med Publishers (P) Ltd. 2005: 621-88. of endometrium in abnormal uterine bleeding in peri and
7. Mary Ann Lumsden, Jay McGavigan. Menstruation post-menopausal age group: a study of 356 cases. J Ayub
Med Coll Abbottabad. 2012;24(1):54–57.
and Menstrual Disorders.In: Robert W shaw, W.
19. Tiwana K, Rani G, Gupta V, Sidhu M, Rani S, Bhatia A.
Patrick Soutter, Staurt L. Stauton. Gynaecology. Histopathological correlation of abnormal uterine
3rd.ed.U.K,Churchill Livingston;2003: 459-473. bleeding in perimenopausal and postmenopausal age
8. Khan S, Hameed S, Umber A. Histopathological group. J Clin Diagn Res. 2015 Jun;9(6): EC08–EC11.
Pattern of Endometrium on Diagnostic D&C in 20. Singh N, Negi N, Rana A. A study of histopathological
patients with Abnormal Uterine Bleeding. Annals patterns in hysterectomy specimens in a tertiary care
2011; 17(2): 166-70. center in Uttarakhand, India. J Clin Diagn Res. 2014
Jun;8(6): FC08–FC11.
9. Jairapuri ZS, Rana S, Jettey S. Atypical uterine
21. Naeem N, Malik TM, Mubarik A. Histopathological
bleeding- histopathological audit of endometrium. A pattern of endometrial biopsies in abnormal uterine
study of 638 cases. Al Ameen J Med Sci. 2013; 6(1): bleeding. J Ayub Med Coll Abbottabad. 2009;21(4):60–
21-28. 63.
10. Livingstone M, Fraser IS. Mechanisms of Abnormal 22. Vaidya S, Lakhey M, Vaidya SA, Sharma PK,
uterine bleeding. Human Reproduction Update. Hirachand S, Lama S, et al. Histopathological pattern of
abnormal uterine bleeding in endometrial biopsies.
2002;8(1):60-7.
JNMA J Nepal Med Assoc. 2006;45(162):182–186.
11. Neese RE Abnormal vaginal bleeding in 23. Bhatta S, Sinha AK. Histopathological study of
perimenopausal women. Am Fam physician1989;40: endometrium in abnormal uterine bleeding. Nepal Med
185-192. Coll J. 2013;15(2):140–143.
12. Johnson CA. Making sense of dysfunctional uterine 24. Shah S, Shrestha R, Pun M. Histopathological study of
bleeding. Am Fam Physician 1991; 14:149-157. endometrial biopsy specimens in abnormal uterine
13. Mazur MT, Kurman RJ. Normal endometrium and bleeding. Int J Reprod Contracept Obstet Gynecol.
2014;3(3):552–556.
infertility evaluation. In: Mazur MT, Kurman RJ,
editors. Diagnosis of endometrial biopsies and
curettings: A practical approach. 2nd ed. New York:
Springer Verlag; 2005: 7-33.
14. Takreem A, Danish N, Razaq S. Incidence of
endometrial hyperplasia in 100 cases presenting with
polymenorrhagia/menorrhagia in perimenupausal
women. J Ayub Med Coll Abbottabad. 2009
AprJun;21(2):60-63.

CME Journal of Geriatric Medicine 39