# Spectrum of Abnormal Uterine Bleeding in the Women of Sub-Himalayan Hilly Region of North India: Clinicodemographic Profile and Management Options

## TL;DR

This study examines the types and management of abnormal uterine bleeding in women from a region in North India, highlighting the importance of histopathological evaluation.

## Contribution

The study provides a clinicodemographic profile and management options for AUB in a specific geographic and cultural population.

## Key findings

- Heavy menstrual bleeding was the most common type of AUB reported.
- Histopathological analysis revealed proliferative endometrium as the most frequent diagnosis.
- Medical management was the primary treatment approach, with surgical interventions used in a smaller proportion.

## Abstract

Introduction

Abnormal uterine bleeding (AUB) is one of the common complaints affecting women across different stages of life.

Aim

The aim of this study was to determine the AUB spectrum in our population and correlate it with the histopathological spectrum.

Material and methods

This is a hospital-based prospective cross-sectional study of women presenting with AUB. The baseline demographic data and clinical details of menstrual complaints were collected through a pre-validated, semi-structured proforma after taking informed consent. Endometrial biopsy was offered to all eligible women for histopathological confirmation of diagnosis and ruling out malignancy.

Results

A total of 260 women were enrolled. Heavy menstrual bleeding was the most common complaint (56.2%), followed by prolonged bleeding (16.9%), and irregular bleeding (18.4%). The histopathological results confirmed the diagnosis of secretory endometrium in 17.3%, proliferative endometrium in 49.2%, disordered proliferative endometrium in 25.4%, simple hyperplasia in 3.5%, endometrial polyp in 3.5%, and endometrial carcinoma in 1.2%. Majority of the women were classified as AUB-N (36.2%) according to the PALM-COEIN classification. Majority received medical management, either antifibrinolytic (98.5%), non-hormonal therapy (0.8%), or hormonal therapy in the form of oral progesterone (16.9%), combined oral contraceptive pills (1.9%), and levonorgestrel-releasing intrauterine contraceptive device (0.8%). Surgical management in the form of hysterectomy (20.8%) and hysteroscopy-guided endometrial polypectomy (1.9%) was also offered.

Conclusion

AUB affects women across all age groups, significantly affecting their quality of life. AUB-N, AUB-O and AUB-L contribute to a major proportion of AUB. A detailed evaluation, including histopathology, is required to rule out the associated cause and malignant/pre- malignant lesions of the endometrium.