Abnormal Uterine Bleeding in Perimenopausal Women: Relevance of Transvaginal Ultrasound, Office Endometrial Biopsy, Dilatation and Curettage—An Observational Study

Introduction: Abnormal uterine bleeding (AUB) in perimenopausal women requires careful evaluation due to the risk of endometrial malignancy. Symptomatic women with thick endometrium by transvaginal ultrasound (TVS) warrant endometrial sampling. D&C has been the mainstay over decades whereas pipelle has gained popularity due to good tissue yield and easy technique with no admission or anesthesia. This study aims to determine the use of office endometrial biopsy in perimenopausal women with AUB and the endometrial pathology detected by TVS. Materials and methods: In this observational study over five years, 159 women with AUB who underwent endometrial sampling were included. The patients were randomly assigned D&C or pipelle depending on symptoms and endometrial thickness after clinical examination and laboratory investigations. 79.2% of women underwent office endometrial sampling, and 20.8% underwent D&C. samples were sent for histopathology. Statistical analysis was done with respect to the type of sampling and endometrial thickness by TVS. Results: Mean age of the study group was 44 years. About 60.3% of these women had ET of 10–20 mm. It was noted that women with thinner endometrium had more benign lesions and no atypia or malignancy. Sampling was 100% adequate in D&C cases compared to 97.8% of office biopsy group, though statistically not significant. Office endometrial biopsy and D&C yielded adequate sample and a reliable histopathological report and were comparable with respect to sampling, reports and endometrial thickness. Endometrial malignancy was diagnosed in 1.3% of the study group. 56.6% of women had simple hyperplasia without atypia, and 27% had a normal endometrium. Conclusion: Office endometrial biopsy is a sensitive method to detect abnormal endometrium in women with AUB. Diagnostic Office endometrial sampling is comparable to D&C with lesser complications. TVS prior to endometrial sampling improves the sensitivity to diagnose endometrial pathology.