Clinicopathological Correlation in Perimenopausal Women With Abnormal Uterine Bleeding Undergoing Endometrial Sampling

Abstract

Background: Abnormal uterine bleeding is a common gynecological presentation during perimenopause and may reflect benign hormonal changes, structural uterine lesions, endometrial hyperplasia, or malignancy. Because clinical symptoms and ultrasound findings may overlap across benign and high-risk pathology, histopathological assessment remains important for accurate diagnosis. Objective: To evaluate clinical presentation, transvaginal ultrasound findings, and histopathological patterns among perimenopausal women with abnormal uterine bleeding undergoing endometrial sampling. Methods: This descriptive cross-sectional study included 350 perimenopausal women aged 40–55 years presenting with abnormal uterine bleeding at tertiary-care hospitals in Lahore, Pakistan. Demographic and clinical data were recorded, transvaginal ultrasound was performed to assess endometrial thickness and focal lesions, and endometrial sampling was conducted using Pipelle biopsy or hysteroscopic-guided sampling when indicated. Data were analyzed using descriptive statistics and association testing. Results: The mean age was 47.8 ± 4.2 years and mean body mass index was 28.3 ± 5.1 kg/m². Heavy menstrual bleeding was the most common presentation (55.1%), followed by intermenstrual bleeding (25.1%). Endometrial thickening of ≥5 mm was present in 40.0%, and focal lesions were identified in 25.0%. Benign histopathological findings accounted for 79.7%, hyperplasia without atypia for 6.0%, atypical hyperplasia for 9.1%, and carcinoma for 5.1%. High-risk pathology was present in 14.3%. Conclusion: Most perimenopausal women with abnormal uterine bleeding had benign pathology, but a clinically important minority had atypical hyperplasia or carcinoma. Integrated clinical, ultrasound, and histopathological assessment is essential for timely diagnosis and risk stratification.