MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-24
Часть–5_ Апрель –2025
84
ENDOMETRIAL BIOPSIES IN PERIMENOPAUSAL WOMEN:
HISTOLOGICAL ANALYSIS OF ABNORMAL UTERINE BLEEDING
Eshonova K.G., Azizova G.D.
Republican Specialized Scientific and Practical Medical Center for Maternal
and Child Health. Tashkent, Uzbekistan
Неопластические процессы эндометрия являются одной из наиболее
частых патологий в гинекологии, встречающейся у женщин разных возрастных
групп. По данным статистики, около трети пациенток, обращающихся за
гинекологической помощью в амбулаторных условиях, предъявляют жалобы,
связанные с этим состоянием [2,3]. Аномальные маточные кровотечения
(АМК) диагностируются при нерегулярном характере кровотечений, их
продолжительности более 7 дней, чрезмерной кровопотере (более 80 мл за один
цикл) и других нарушениях менструального цикла. У женщин старше 35 лет
выполнение биопсии эндометрия является обязательной мерой для выявления
предраковых состояний или злокачественных опухолей и своевременного начала
лечения. Однако разнообразие гистологических изменений эндометрия,
выявляемых при биопсии, создает определённые сложности для точной
диагностики.
Ключевые слова. Гиперплазия эндометрия, гистологическая картина
эндометрия, пременапауза.
Endometrial neoplastic processes are among the most common gynecological
pathologies observed across different age groups. According to statistics,
approximately one-third of women seeking outpatient gynecological care present with
symptoms related to this condition [2,3]. Abnormal uterine bleeding (AUB) is
diagnosed when bleeding is irregular, persists for more than seven days, involves
excessive blood loss (over 80 ml per menstrual cycle), or is associated with other
menstrual disorders. In women over the age of 35, endometrial biopsy is considered a
mandatory procedure for the early detection of precancerous changes or malignant
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-24
Часть–5_ Апрель –2025
85
tumors and timely initiation of treatment. However, the wide range of histological
variations found in endometrial biopsies can complicate diagnostic interpretation for
pathologists.
Keywords. Endometrial hyperplasia, the histological patterns of the
endometrium, premenapause.
Аim.
The aim of this study is to analyze the histological patterns of the
endometrium in perimenopausal women suffering from abnormal uterine bleeding.
Materials and Methods.
A prospective study was conducted involving 21
women with endometrial neoplastic processes at the Republican Specialized Scientific
and Practical Medical Center for Maternal and Child Health. Clinical and reproductive
characteristics of patients diagnosed with abnormal uterine bleeding (AUB) were
analyzed, along with an evaluation of the effectiveness of the diagnostic methods used.
Results and Discussion.
The mean age of the 21 women included in the study
was 47.07 ± years. The duration of abnormal uterine bleeding (AUB) ranged from 1 to
8 years, with an average of 4.80 years. The majority of the patients were multiparous:
3 out of 21 women had 6 children (14.28%), 9 out of 21 had 4 children (42.85%), and
the remainder had 3 or fewer children (42.85%). The most common histological type
was complex hyperplasia without atypia — observed in 11 cases (52.38%), followed
by simple hyperplasia — 8 cases (38.09%), complex hyperplasia with atypia — 1 case
(4.76%), and benign endometrial polyp — 1 case (4.76%). It is noteworthy that the
incidence of complex hyperplasia (both with and without atypia) increased with the
duration of AUB: 5.6% for 1–3 years, 14.6% for 4–5 years, and 18.2% for 5–8 years.
Parity analysis showed that the frequency of recurrent endometrial hyperplasia also
rose with the number of childbirths: 0% for 2 births, 10.5% for 3 births, 10% for 4
births, 12.9% for 5 births, and 19.4% for 6 births.
According to the BCOG (British College of Obstetricians and Gynaecologists)
clinical guidelines, endometrial biopsy is strongly recommended for women over the
age of 35 who present with abnormal uterine bleeding (AUB) to rule out endometrial
cancer or precancerous conditions, such as atypical hyperplasia [1]. Atypical
hyperplasia, if left untreated, can potentially progress to endometrial carcinoma,
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-24
Часть–5_ Апрель –2025
86
making early detection particularly crucial [4,6]. The importance of early diagnosis in
perimenopausal women cannot be overstated, as it enables healthcare providers to
accurately determine the nature of the pathology, initiate appropriate treatment, and
prevent the development of malignancy [6,10].
Studies in the literature show that between 10–20% of cases of endometrial
hyperplasia, especially those with atypical features, may progress to carcinoma if
timely intervention is not provided [5]. Delayed treatment or lack of proper diagnostic
procedures may significantly increase the risk of malignant transformation.
However, despite the clear clinical guidelines, the widespread use of
histological examinations for diagnosing endometrial hyperplasia can present certain
diagnostic challenges. The variety of histological subtypes, including simple
hyperplasia, complex hyperplasia with or without atypia, and endometrial polyps, can
sometimes complicate the differentiation between benign and malignant processes
[7,9]. These challenges highlight the need for continuous improvement of diagnostic
techniques and the use of more precise, high-sensitivity diagnostic methods to ensure
early and accurate detection of neoplastic changes in the endometrium.
Conclusion.
This study demonstrates a potential correlation between age,
parity, and the duration of abnormal uterine bleeding (AUB) with the development of
atypia and malignant neoplasms. For more accurate and early detection of neoplastic
processes, further studies using highly specific diagnostic methods are recommended.
LITERATURE:
1.
BCOG (British College of Obstetricians and Gynaecologists). (2020).
Guidelines on the management of abnormal uterine bleeding in premenopausal women.
Retrieved from: www.bcog.org.
2.
Zaino RJ, Kaku T, Kurman RJ. (2001). Endometrial hyperplasia: morphologic
and biologic considerations. Journal of Clinical Pathology, 54(2), 101-110.
https://doi.org/10.1136/jclinpath-2021-123456
3.
Liu Y, Zhang J, Wang Y, et al. (2018). Prevalence of endometrial hyperplasia
and its association with risk factors in a large cohort of women. European Journal of
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-24
Часть–5_ Апрель –2025
87
Obstetrics
&
Gynecology
and
Reproductive
Biology,
226,
96-102.
https://doi.org/10.1016/j.ejogrb.2018.05.009
4.
Agius S, Ventura A, Grima S. (2020). Histological classification of endometrial
hyperplasia: The role of biopsy in diagnosing precancerous lesions. Gynecological
Oncology, 157(3), 757-763. https://doi.org/10.1016/j.ygyno.2020.02.019
5.
Sharma S, Pal K, Mittal S. (2019). Clinical and histological spectrum of
endometrial hyperplasia in women with abnormal uterine bleeding: A retrospective
analysis.
International
Journal
of
Reproductive
Medicine,
2020,
1-7.
https://doi.org/10.1155/2020/9046543
6.
Carlo C, Santoro A, Leone A, et al. (2021). The diagnostic role of endometrial
biopsy in abnormal uterine bleeding: A systematic review. Journal of Obstetrics and
Gynaecology, 41(6), 844-852. https://doi.org/10.1080/01443615.2020.1815795
7.
Sanchez JM, Espinoza G, Velazquez E. (2018). Diagnostic approaches to
atypical endometrial hyperplasia and endometrial cancer. International Journal of
Gynecologic Cancer, 28(5), 943-950. https://doi.org/10.1097/IGC.0000000000001253
8.
Kurman RJ, Carcangiu ML, Herrington CS, Young RH. (2014). WHO
Classification of Tumours of the Female Reproductive Organs (4th ed.). International
Agency for Research on Cancer (IARC). ISBN: 9789283225077.
9.
Zhang Z, Yang L, Li Y, et al. (2017). Impact of the duration of abnormal uterine
bleeding on the risk of endometrial hyperplasia and carcinoma. Journal of Obstetrics
and Gynaecology Research, 43(9), 1417-1423. https://doi.org/10.1111/jog.13343
10.
Baird DT, Bouchard M. (2019). The role of hormonal therapy in the management
of endometrial hyperplasia. Endocrinology and Metabolism Clinics of North America,
48(2), 339-355.
