Histopathological Spectrum of Endometrial Changes in Perimenopausal Women with Abnormal Uterine Bleeding: A Cross-Sectional Study

Abstract

Background: Abnormal uterine bleeding is common during perimenopause and may reflect functional, structural, premalignant, or malignant endometrial changes. Histopathological assessment is important for identifying endometrial pathology.

Objective: To determine the histopathological spectrum of endometrial changes in perimenopausal women with abnormal uterine bleeding and assess its association with age and selected clinical and diagnostic characteristics.

Methods: This descriptive cross-sectional study included 300 consecutive women aged 40–55 years at Fatima Memorial Hospital, Lahore, from 20^thJanuary 2026 to 20^th July 2026. Clinical assessment, complete blood count, coagulation profile, pelvic ultrasonography, and endometrial sampling by dilatation and curettage, Pipelle biopsy, or hysteroscopy-guided biopsy were performed. Histopathological findings were analyzed using IBM SPSS Statistics version 26.0; p<0.05 was considered significant.

Results: Mean age was 48.31±4.89 years; 217 (72.3%) women were older than 45 years. Irregular bleeding occurred in 141 (47.0%) and heavy menstrual bleeding in 113 (37.7%). Secretory endometrium was the commonest diagnosis (99, 33.0%), followed by endometrial polyp (60, 20.0%), disordered proliferative endometrium (45, 15.0%), chronic endometritis (44, 14.7%), hyperplasia without atypia (29, 9.7%), and carcinoma (12, 4.0%). Histopathological patterns were not significantly associated with age group (p=0.539), but were associated with ultrasonographic findings and biopsy method (both p<0.001).

Conclusion: Benign and functional endometrial changes predominated, although hyperplasia and carcinoma were also identified. Histopathological evaluation remains important in perimenopausal abnormal uterine bleeding.