جستجوی مقالات مرتبط با کلیدواژه « abnormal uterine bleeding » در نشریات گروه « پزشکی »

Distinguishing between leiomyosarcoma and benign uterine leiomyoma, as one of the common problems in reproductive age, brings a great challenge in dealing with patients. Clinical findings, imaging report, tumor markers, endometrial biopsy, and even age of the patients will not be helpful to make this distinction. So, the important question is when we should consider leiomyosarcoma probability? In this report, an unexpected case of leiomyosarcoma with a poor prognosis is presented. A 45-year-old female patient gravida 3 with complaint of hypermenorrhea from one year ago was presented to the gynecologic department. The patient did not mention anything special in her medical history. At last, a hysterectomy was planned due to her irreversible bothering symptom. The final histologic report was leiomyosarcoma in the smallest myomatous mass of the uterus, and her post-operation CT scan with contrast of abdomen-pelvic revealed several metastatic focuses. Uterine sarcomas as one of the most important causes of mortality worldwide have a low incidence and defining the standard treatment and the exact prognosis require further study. More definitive ways to differentiate benign uterine leiomyoma from leiomyosarcoma including genetic studies, specific imaging techniques, specific tumor markers, and investigating the method of intrauterine biopsy by flexible or robotic hysteroscopy are needed.

Background &  Endometrial hyperplasia is the primary precursor of endometrial cancer in the female reproductive system, with abnormal uterine bleeding (AUB) being the predominant manifestation of this condition. The purpose of this study was to determine the prevalence of endometrial hyperplasia and its correlation with various factors among patients presenting with abnormal uterine bleeding.Materials &  This cross-sectional descriptive-analytical study reviewed the hospital records of all patients with abnormal uterine bleeding admitted to Ali Ebn-e Abi Taleb Hospital in Zahedan from April 2015 to April 2018. Data were analyzed using the SPSS. The prevalence of endometrial hyperplasia was estimated to be 20.3%. The average age of the study subjects was about 45 years. The highest number of patients (37, 52.9%) belonged to the age group of 36-50 years. Among the different types of endometrial hyperplasia observed, the most common was "simple non-atypical hyperplasia" found in 45 patients (64.3%), while the least common was "simple atypical hyperplasia" observed in three patients (4.3%). Overall, "non-atypical hyperplasia" (including both simple and complex types) was present in 58 patients (82.85%). The prevalence of infertility, obesity, hypertension, diabetes, premature menarche, late menopause, family history, oligomenorrhea, and polycystic ovary syndrome (PCOS) was reported in 7.1%, 32.9%, 24.3%, 22.9%, 8.5%, 13.6%, 7.1%, 5.7%, and 3.4% of cases, respectively. Women with a history of diabetes, hypertension, and obesity are at an increased risk of developing endometrial hyperplasia. Therefore, it is crucial to evaluate these patients for the presence of endometrial hyperplasia.

 Abnormal uterine bleeding (AUB) refers to any symptomatic deviation from normal menstruation. AUB is a common gynecological disorder in non-pregnant women of reproductive age, accounting for approximately 33% of gynecological outpatient visits. The early diagnosis and management cause of AUB is important because of increased incidence of endometrial carcinoma with rapid growth. Transvaginal ultrasound is non-invasive imaging technique used to find endometrial carcinoma before referring patients for invasive techniques. Dilatation and curettage (D&C) and endometrial biopsy are surgical procedures that scrape the endometrial lining of the uterus for diagnosis and treatment. The aim of this study is to describe the clinicopathologic pattern of endometrial specimens in women with AUB and ultrasonographic correlation.

 Tissues from endometrial biopsy and curettage of 411 patients with AUB who referred to Shahid Mohammadi hospital were prospectively selected from 2021 to 2023. Patients were divided into three groups based on age and menstrual status including: premenopausal (18-39 years), perimenopausal (40-49 years) and postmenopausal (≥50 years). The results were correlated to patient’s age and other data and evaluated with statistical analysis.

 During the two-year study period, a total of 411 endometrial specimens with clinical diagnosis of AUB were submitted and the results were analyzed. The youngest patient presenting with AUB was 21 years old, while the oldest was 77 years old. The most common complaint was menorrhagia in 201 (48.0%) out of 411 patients. The most common pathology finding in three groups was polyp in 100 (24.3%) cases. Hormonal effect was the next commonly observed pattern seen in 70 (17.0%) cases. P value was calculated as 0.003 which was significant using chi-square for the trend seen in age.

 Endometrial sampling is a useful tool for evaluation of women with AUB and referring patients for treatment. Histopathological evaluation of the endometrium is very useful in detecting the etiology of AUB. Transvaginal sonography has high sensitivity in detecting polyps.

Endometrial cancer is the most prevalent type of genital system cancers. It is needed to assess discrimination power of CEA, CA 15-3, CA 125 tumor markers in endometrial cancer patients and moreover in cases with abnormal uterine bleeding. We examined tumor markers (CA 15-3, CA 125, CEA) in differentiating endometrial cancer and unusual uterine bleeding.

The present case-control study was conducted on 60 women with endometrial cancer and evidence of abnormal uterine bleeding who referred to Ali Ibn Abitaleb Hospital in Zahedan in 2021. The sampling method was easy and accessible and was used to collect observation information, examination, and data form data. For data analysis, SPSS software version 26, statistical graphs and independent t-test were used.

The difference in serum levels of CEA marker tumor in patients of case (endometrial cancer patients) and control (abnormal uterine bleeding patients) was statistically significant. Differences in serum levels of CA 15-3 tumor marker in patients between case group (endometrial cancer patients) and control (patients with abnormal uterine bleeding) and difference in serum levels of CA 125 tumor marker in patients between case (endometrial cancer patients) and control groups (bleeding patients) uterine abnormalities were not statistically significant.

Serum level of CEA tumor marker has a statistically significant relationship with endometrial cancer patients and abnormal bleeding patients, but serum tumor marker level CA 15-3 and serum tumor marker CA 125 and with endometrial cancer patients and abnormal bleeding patients do not have.

Uterine fibroids (UFs) the most common pelvic tumors among women at reproductive age affecting women’s quality of life even their confidence with its symptoms. We designed a study to investigate the clinical, laboratory, and imaging characteristics of Iranian women with UF. This cross-sectional study was performed April 2016- September 2022 at Imam Hossein hospital (Tehran, Iran). We included all women with UF referring to the Obstetrics and Gynecology Clinic of Imam Hossein Hospital. Based on a checklist a research team interviewed the patients to investigate clinical characteristics. Also we explored laboratory and transvaginal sonography (TVS) findings of all patients. The mean age of 439 studied patients was 44.47±8.80 years (range: 23-81). The most prevalent underlying disease was hypertension (17.1%), followed by thyroid diseases (15.7%) and diabetes mellitus (13.7%). The patients mainly complained of AUB (abnormal menstrual bleeding) (60.0%), abdominal pain (23.7%). The mean NLR (neutrophil to lymphocyte ratio) and the mean PLR (platelet to lymphocyte ratio) were significantly higher than the normal upper limit (P<0.001). Largest diameter of UF was 49.89±47.92 mm. Most fibroids were located anteriorly (43.1%). The multivariate linear regression model revealed that age (β=-0.931, 95%CI= (-1.657, -0.204), P=0.012) and number of fibroid (β=22.418, 95%CI= (16.360, 28.476), P<0.001) could predict the size of fibroid. Our results showed that NLR and PLR were increased in UF patients. It seems that patient’s age and number of fibroid may be the predict factors for UF's size. Keywords: Abnormal Uterine Bleeding, hypertension, Neutrophil, Leiomyoma, Lymphocyte, Ultrasonography.

The suitable BMI cut-off point in persons with endometrial cancer or hyperplasia with abnormal uterine bleeding was investigated in this study.

This case-control research was conducted on 1470 women with abnormal uterine bleeding in Ayatollah Rouhani Hospital,Babol between 2010 and 2012, with 312 participants included in the study. In terms of uterine biopsy results, patients were split into six groups: simple hyperplasia without atypia, simple hyperplasia with atypia, complicated hyperplasia with atypia, complex hyperplasia without atypia, endometrial cancer, and normal persons.

The mean age and BMI of patients in these three groups were not significantly different (P equal to 0.081 and 0.435, respectively). The kind of disease exhibited a strong relationship with menstruation (P 0.001). The body mass index (BMI) values ​​did not have significant levels under the curve to determine the appropriate cut-off point in the diagnosis of hyperplasia plus endometrial cancer and endometrial cancer alone (P 0.380 and 0.124, respectively) and hyperplasia alone (P = 0.920). Based on logistic regression, age 50 years and older and irregular menstruation were significant with OR equal to 2.36 and 2.09 (P = 0.011) and HTN with OR equal to 0.44 (P = 0.026), respectively.

BMI has little predictive value in the detection of endometrial cancer or hyperplasia, according to the findings, and other diagnostic and screening modalities should be utilized instead. The findings backed up the theory that old age and irregular menstruation are linked to an increased risk of endometrial cancer.

An endometrial biopsy primarily aims to determine endometrial cancer and hyperplasia with atypia at an early stage.

This study aims to evaluate the indications, histopathological diagnoses, and the number of endometrial biopsies performed in our clinic, according to the age groups of patients, in light of the literature.

A retrospective review was conducted on the file data of 4,965 patients who underwent endometrial biopsy for non-obstetric reasons between 2014-2021. The patients were divided into five groups, according to their age. Pathology diagnoses were classified as benign endometrial pathology, premalignant-malignant pathology, and insufficient for diagnosis.

The most common biopsy indication was abnormal uterine bleeding (61.9%), while the most common histopathological result was benign endometrial pathologies (75.3%). Endometrial cancer was also detected in 3% of the patients. The highest diagnosis of benign endometrial pathology among age groups was 96.6% in those below 35. The comparison of age groups in the diagnosis of premalignant-malignant pathology revealed that the highest diagnosis rate was 32.1% in those 65 years and over. Furthermore, the evaluation of the relationship between indications and material adequacy showed that the highest rate of insufficient for diagnosis pathology was in the postmenopausal patient group (34.0%). Moreover, insufficient for diagnosis and endometrial surface epithelium results were highest in patients over 65 (46.7%).

Patients aged 55-64 and those over 65 had the highest rate of endometrial cancer and insufficient for diagnosis biopsy results. Therefore, dilation and curettage may be recommended while taking a biopsy from patients in this age group.

 Abnormal uterine bleeding (AUB) occurs in up to 30% of the women and is a major cause of hysterectomies. It can result from a broad spectrum of conditions ranging from physiological process to malignant lesions involving organic, systemic, and hormonal responses. The PALM component of the FIGO classification system (PALM-COEIN) deals with the structural causes, while the COEIN component deals with the non-structural causes. AUB is diagnosed by clinical examination and ultrasonography. Final diagnosis is always correlated with histopathological study. The objective of this study was clinico-histopathological evaluation of the cases of AUB, with respect to FIGO classification system in the women of reproductive and perimenopausal age group.

 Present study was a hospital-based prospective observational study conducted in the Department of Obstetrics and Gynecology of Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. It included 100 women, with complains of abnormal uterine bleeding, in the age group of 30 to 50 years and above, who were evaluated in over a period of one year, from January 2021 to December 2021. Age, parity, menstrual cycles, duration of symptoms and recurrence (if any), contraception, obstetric history, and history suggestive of Pelvic inflammatory disease (PID) were noted. General physical, systemic, and gynecological examinations of the patients were done. The findings of blood investigations, sonography, histopathology of endometrial biopsy specimens, and hysterectomised specimens were analysed.

 In our study, the maximum incidence of AUB was seen in reproductive and perimenopausal age groups between 35-40 years (38%) and 40-45 years (35%). The highest incidence of AUB was in multiparous women (44%). The most common pattern of AUB was heavy menstrual bleeding (menorrhagia) (69%). The most common type of AUB was chronic type of heavy menstrual bleeding (65%). In our study, the most common organic causes of AUB were fibroids (34%) and adenomyosis (18%). On histopathology, secretory endometrium was found in 52% cases and proliferative type in 21% of cases.

 Ultrasonography combined with endometrial biopsy proves to be the gold standard for diagnosis of AUB. The present study highlights the importance of endometrial biopsy and its interpretation which plays a pivotal role in the management of AUB.

Uterine adenosarcoma (UA) is an infrequent malignancy which contains the epithelium of benign glands and malignant mesenchymal elements. Low-grade adenosarcoma has a sarcomatous part that is uniformly low grade. Uterine adenosarcoma includes 8% of all uterine sarcomas and less than 0.2% of uterine neoplasms. It is more common in perimenopausal or postmenopausal women. Due to the rarity of uterine adenosarcoma, limited information is available to help guide treatment. A 33-year-old woman, who had one child referred to ????  with a complaint of abnormal uterine bleeding for one year; the sonography reported a polyp in fundal cavity of uterus. The patient underwent hysteroscopy and curettage. The pathology examination revealed uterine adenosarcoma which led to a total hysterectomy and bilateral salpingo-oophorectomy. Abnormal uterine bleeding is the most common symptom of UA. At a young age there is a possibility of misdiagnosis. Hysteroscopy should also be performed if symptomatic or enlarge polypoid lesions are diagnosed preoperatively.

Abnormal Uterine Bleeding (AUB) is the most common reason for women’s medical referral in the reproductive age. In Persian Medicine, one of the major causes of this disorder is known as uterine dystemperament (Su-e Mizaj). AUB is known as “Kesrat-e Tams” in this medical school. We aimed to investigate the frequency of positive symptoms of uterine dystemperament in patients with AUB from the perspective of Persian Medicine. This cross-sectional study was conducted from October 2009 to September 2010 in Tehran, Iran. It comprised 70 patients with abnormal uterine bleeding who were 15-45 years old. Data were collected by a questionnaire prepared based on the textbooks of Persian Medicine. The frequency of each symptom of uterine dystemperament was obtained. Among the four uterine dystemperaments, the “dry” and “warm” uterine types had the highest rankings. In patients with excess uterine hemorrhage, the symptoms of warm uterine is more frequent than cold uterine. Meanwhile, the warm uterine dystemperament interference was also observed in excess uterine hemorrhage.

Cyclic mastalgia is clinically related to alterations in sex hormone levels during the menstrual cycle. A derangement in normal menstrual cycle leads to exacerbated mastalgia; which can also cause menstrual irregularities and abnormal uterine bleeding (AUB). A decrease in severity of mastalgia is observed in patients with simultaneous cyclic mastalgia and menstrual irregularities/AUB, following correction of menstrual irregularity. This study was designed and conducted to investigate the possibility of whether correction of menstrual irregularities can diminish cyclic mastalgia.

This case-control study was carried out on women suffering from simultaneous mastalgia and menstrual irregularity. One-hundred and fifty patients were randomly distributed between case and control groups, each including 75 patients. Patients in both groups took 100 mg vitamin E oral tablet daily for 3 months. Patients in case group also received low-dose oral contraceptive pills (OCP-LD) to correct menstrual irregularity. Patients recorded the severity of mastalgia in Cardiff breast pain chart using Visual Analogue Scale (VAS).

At the beginning of study, there was no significant difference in the number of days suffering from mild and severe mastalgia between two groups. However, at the end of the study, mild and severe mastalgia reduced significantly in the case group compared to the control group (P=0.003 and P=0.045, respectively).

In women with cyclic mastalgia, correction of menstrual irregularity leads to significant pain relief. Correcting menstrual irregularity is suggested as a first-line treatment in women with mastalgia.

Selective estrogen receptor modulators (SERMs) have been shown to reduce the risk of developing estrogen-positive breast cancer. Tamoxifen, a potent SERM, has been successfully administered as adjuvant therapy for breast cancer. However, uterine pathologic changes may develop due to the effect of tamoxifen as both an agonist and antagonist of estrogen on the uterus. Here, we discuss a case of breast cancer treated with tamoxifen to clarify one of the most important complications, namely, endometrial hyperplasia. A 51-year-old woman presented with left breast mass and axillary lymphadenopathy. Mammography showed a 26-mm spiculated mass consistent with invasive ductal carcinoma in core needle biopsy. Immunohistochemical analysis revealed that the tumor was ER- and PR-positive, HER2-negative, and P53-negative. Adjuvant chemotherapy was completed, and the patient was referred to undergo adjuvant radiotherapy (RT). After the completion of RT, treatment with tamoxifen was initiated at the recommended dose of 20 mg/day. The questions are when to use tamoxifen as adjuvant therapy for breast cancer, How to follow the patient treated with tamoxifen, and when to discontinue tamoxifen therapy. Use of tamoxifen for at least 5 years after diagnosis is a reasonable option for the prevention of breast cancer or its recurrence in high-risk patients. Premenopausal women on tamoxifen presenting with abnormal uterine bleeding must undergo transvaginal ultrasonography. For premenopausal women taking tamoxifen, irregular vaginal bleeding should be evaluated by hysteroscopy or uterine ultrasonography, and, if the etiology remains unclear, a biopsy should be done. There are no evidence-based recommendations for uterine malignancy screening in patients who take tamoxifen. Current recommendations are annual gynecologic examination and evaluation of any abnormal vaginal bleeding.

This study intended to explore whether letrozole and metformin can change endometrial histology in the patients diagnosed with disordered proliferative endometrium.
In a pre- and post-interventional study, 31 patients with abnormal uterine bleeding (AUB) were participated to receive 5 mg letrozole and 500 mg metformin daily for 3 months after pathology report of disordered proliferative endometrium. The effect of this combination therapy on endometrial histology was evaluated through comparing the endometrial histology results before and after the intervention.
After treatment with letrozole and metformin, 77.4% of patients showed significant response to therapy in the form of inactive and atrophic endometrium (P Based on the results of this study, letrozole and metformin can be successfully used for treatment of disordered proliferative endometrium. Hence, the effects of these medications deserve to be noticed for careful treatment of the patients with AUB.