Frequency of Structural and Hormonal Causes of Abnormal Uterine Bleeding (AUB) in Perimenopausal Women

Abstract

Background: Abnormal uterine bleeding (AUB) is one of the most frequent gynecological complaints during the perimenopausal period. It may result from structural uterine pathology, such as leiomyoma, endometrial polyps, adenomyosis, hyperplasia and malignancy, or from hormonal disturbances including ovulatory dysfunction, thyroid disease, hyperprolactinemia and polycystic ovarian syndrome. Timely evaluation is essential because perimenopausal AUB may be the first clinical manifestation of premalignant or malignant endometrial disease.

Objective: To determine the frequency of structural and hormonal causes of abnormal uterine bleeding among perimenopausal women.

Methods: This descriptive cross-sectional study included 195 perimenopausal women aged 40-55 years presenting with AUB. Detailed menstrual history, clinical examination, pelvic ultrasonography, thyroid profile, serum prolactin and relevant hormonal evaluation were performed. Endometrial sampling was done where indicated, particularly in women aged 45 years or older, those with thickened endometrium, persistent bleeding or risk factors for endometrial pathology. Causes were classified as structural or hormonal according to clinical, sonographic, laboratory and histopathological findings. Data were analyzed as frequencies and percentages.

Results: The mean age of patients was 47.8 +/- 4.2 years. Heavy menstrual bleeding was the most common bleeding pattern, observed in 86 patients (44.1%), followed by irregular bleeding in 48 (24.6%), prolonged bleeding in 32 (16.4%), intermenstrual bleeding in 19 (9.7%) and frequent cycles in 10 (5.1%). Structural causes were identified in 128 patients (65.6%), while hormonal causes were found in 67 patients (34.4%). Among structural causes, leiomyoma was most frequent, seen in 52 patients (26.7%), followed by endometrial polyp in 30 (15.4%), adenomyosis in 22 (11.3%), endometrial hyperplasia in 18 (9.2%) and endometrial malignancy in 6 (3.1%). Among hormonal causes, perimenopausal ovulatory dysfunction was the most common, observed in 35 patients (17.9%), followed by hypothyroidism in 18 (9.2%), hyperprolactinemia in 7 (3.6%), polycystic ovarian syndrome in 5 (2.6%) and hyperthyroidism in 2 (1.0%).

Conclusion: Structural causes were more frequent than hormonal causes of AUB in perimenopausal women. Leiomyoma was the leading structural cause, while ovulatory dysfunction was the most common hormonal cause. Careful clinical assessment, pelvic ultrasonography, hormonal workup and selective endometrial sampling are essential for early diagnosis and appropriate management.