Abnormal Uterine Bleeding: Clinical and Histopathological Correlation in a Tertiary-Care Cohort from Rajshahi

Abstract

Background: Abnormal uterine bleeding affects women across reproductive and postmenopausal life stages and may signal a spectrum extending from benign endometrial change to malignancy. Objective: This study evaluated the correlation between clinical presentation and histopathological findings in women with abnormal uterine bleeding. Methods: A cross-sectional analytical study was conducted in the Department of Gynecology and Obstetrics, Rajshahi Medical College Hospital, from July 2025 to June 2026, enrolling 156 women aged 18–65 years with abnormal uterine bleeding. Clinical variables, endometrial thickness, and histopathological diagnoses were extracted from case records and analysed using SPSS v26.0, with p<0.05 taken as significant. Results: Mean age was 40.6 ± 14.6 years and mean haemoglobin was 11.1 ± 2.1 g/dL, with anaemia (haemoglobin <12 g/dL) in 93/156 participants (59.6%). Polymenorrhoea (21.8%) and intermenstrual bleeding (21.2%) were the leading presentations. Histopathology showed endometrial hyperplasia without atypia in 39/156 (25.0%) and endometrial carcinoma in 33/156 (21.2%) specimens, with 84/156 (53.8%) classified as benign. Age group was strongly associated with histopathological category (χ²=94.08, df=18, p<0.001), and carcinoma cases were significantly older than non-malignant cases (47.3 ± 16.9 versus 38.8 ± 13.4 years; t=3.06, p=0.0026). Endometrial thickness, haemoglobin, and body mass index did not differ significantly across histopathological categories (all p>0.05). Hysteroscopy (26.9%) was the commonest management modality, and procedure-related complications occurred in 7/156 participants (4.5%). Conclusion: Age-stratified clinicohistopathological correlation reveals a substantial premalignant and malignant burden among women with abnormal uterine bleeding, supporting routine, age-directed endometrial sampling in this population.