Objective: To determine the histopathological diagnosis of endometrial changes in perimenopausal women with abnormal uterine bleeding (AUB) and to assess the association with age in a secondary care setting in Karachi, Pakistan.Methods: This descriptive cross-sectional study was carried out at the Department of Obstetrics and Gynecology, Kulsumbai Valika Social Security S.I.T.E Hospital, Karachi, Pakistan, between May 2025 and August 2025. A total of 250 perimenopausal women with AUB between the ages of 40 and 55 years were included in this study. A proforma was used to collect detailed information on the study population, including their sociodemographic and clinical profile, and the nature of the symptoms. Dilatation and Curettage was done under general anesthesia, and Pipelle biopsy was done on outpatient women with abnormal uterine bleeding. Hysteroscopic biopsy was done in the presence of focal lesions on ultrasound. The specimens were fixed in 10% buffered formalin and processed in the pathology department. H and E staining was done on the specimen, and histopathological classification was done using the World Health Organization criteria. All malignant and pre-malignant lesions were reported by two consultant histopathologists. All the data was entered and analyzed using IBM SPSS Statistics version 26.0.Results: The mean age of participants was 47.9 ± 4.4 years. Most women were multiparous (n=149,59.6%) and belonged to low socioeconomic strata (n=121, 48.4%). Irregular bleeding was the most common presentation (n=130, 52%), followed by heavy menstrual bleeding (n=85, 34%). Histopathology revealed secretory endometrium (n=78, 31%) as the most frequent pattern, followed by endometrial polyps (n=46, 18%), disordered proliferative endometrium (n=42, 17%), and chronic endometritis(n=41, 16%). No statistically significant association was found between histopathology and age group (p = 0.944) or bleeding pattern (p=0.198).Conclusion: Histopathological examination remains indispensable in evaluating perimenopausal AUB. While functional causes predominate, the notable frequency of premalignant and malignant lesions reinforces the need for routine endometrial assessment using targeted approaches like hysteroscopy.
Bhutto et al. (Tue,) studied this question.