{"paper_id":"653d857f-6c48-480c-abf1-c3fbd48ab058","body_text":"* Corresponding author: Tawakalt Opeyemi Olagunju-Moshood\nCopyright © 2023 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. \nSonographic evaluation of abnormal uterine bleeding among non-pregnant women in \nLagos, Southwest, Nigeria \nTawakalt Opeyemi Olagunju-Moshood 1, *, Joseph Chukwuemeka Eze 2 and Anthony Chukwuka Ugwu 2 \n1 Department of Radiodiagnosis, Federal Medical Centre, Ebute-Metta, Lagos State, Nigeria. \n2 Department of Radiography, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe \nUniversity, Awka, Anambra state, Nigeria. \nInternational Journal of Science and Research Archive, 2023, 10(01), 446 –457 \nPublication history: Received on 11 August 2023; revised on 20 September 2023; accepted on 23 September 2023 \nArticle DOI: https://doi.org/10.30574/ijsra.2023.10.1.0774 \nAbstract \nAbnormal uterine bleeding (AUB) is the direct cause of a significant healthcare burden for women and society at large. \nAround 30% of women will experience AUB during their reproductive years, prompting them to seek medical attention. \nAbnormal Uterine Bleeding can significantly impact their quality of life, often causing frequent work absences and \npotentially requiring surgical treatment. It's crucial to accurately diagnose the underlying cause of AUB in this age group \nto ensure proper and effective management. This study aims to evaluate AUB among non-pregnant women in Lagos \nusing transvaginal ultrasound. A descriptive cross-sectional study of 152 non-pregnant women of reproductive age (16 \nto 55 years) with abnormal uterine bleeding for a period of five months. A purposive sampling technique was used to \nrecruit the subjects. Data was analysed using SPSS version 20.0. Sonographic evaluation reveals positive findings in 97 \ncases (63.8%) out of 152 cases studied. Seventy cases (46%) had structural abnormalities with the highest being \nLeiomyoma (41.4%), followed by Adenomyosis (3.9%), and Endometrial Polyp (0.6%). The age group 26 – 35 years \npresented most with abnormal uterine bleeding cases (48.6%). The major clinical history was absent menstrual \nbleeding with findings depicting normal endometrium. There was a positive and moderate correlation between age and \nparity of subjects with AUB.  \nThe study found that Transvaginal ultrasound effectively identifies AUB's structural causes. It is recommended as the \ninitial assessment method due to its safety, affordability, and widespread availability in healthcare settings. \nKeywords: Abnormal uterine bleeding; Transvaginal ultrasound; Leiomyoma; Adenomyosis, Endometrial polyps  \n1. Introduction\nAbout one-third of the outpatient gynaecological visits and referrals for ultrasound investigations are due to abnormal \nuterine bleeding[1]. Abnormal uterine bleeding accounts for more than 70% of all gynaecologic consults in \nperimenopausal and postmenopausal years [2] and in 30% of women during their reproductive years.[3] Abnormal \nuterine bleeding (AUB) is a variation from the normal menstrual cycle and includes changes in regularity, frequency of \nmenses, duration of flow, or the amount of blood loss. Abnormal uterine bleeding can also be categorized and further \nsubdivided based on the volume of menstruation, regularity, frequency, duration, chronicity, and timing related to \nreproductive status [4]. Any significant deviation from a woman’s established m enstrual cycle is considered abnormal \nuterine bleeding. This can manifest as bleeding between menstrual periods (metrorrhagia), irregular cycle length with \nor without varying durations and amounts of bleeding (menometrorrhagia), an increased frequency of bleeding \nepisodes (polymenorrhea), or a reduced number of bleeding episodes (oligomenorrhea). Additionally, abnormal uterine \nbleeding often involves an increase in blood volume during menstruation, a condition known as menorrhagia[5]. \nAbnormal uterine bleeding is a common and debilitating condition and a direct cause of a significant healthcare burden \n\n\nInternational Journal of Science and Research Archive, 2023, 10(01), 446–457 \n447 \nfor women, their families, and society as a whole [3]. Women with abnormal uterine bleeding in whom no clear aetiology \ncan be identified are diagnosed as having dysfunctional uterine bleeding; which is a diagnosis of exclusion and can only \nbe made after pregnancy, iatrogenic causes, systemic conditions and obvious genital tract pathology have been ruled \nout [6].  \nThe existing terminology used in medical and historical literature to describe menstrual bleeding lacks consistency and \ncan be confusing. To enhance effective communication among healthcare practitioners, it is crucial to establish \nstandardized universal terminology when addressing Abnormal Uterine Bleed ing (AUB). This standardization is \nessential for guiding research and education in the field [7]. As a result, the International Federation of Gynecology and \nObstetrics (FIGO) Menstrual Disorders Working Group, an international expert consensus committee, has developed \nnew terminology guidelines for AUB [8]. The suggested nomenclature for AUB seeks to simplify the descriptions of this \nclinical presentation and eliminate terms such as menorrhagia, metrorrhagia, and dysfunctional uterine bleeding. The \nterminology endorsed by the FIGO Menstrual Disorders Working Group consensus statement [8]  is based on four \nparameters that describe variations in AUB as follows: volume - which can be heavy, normal or light; regularity - which \ncan be irregular, regular or absent ; frequency - which can be frequent, normal or infrequent; and duration of flow – \nwhich can be characterized as prolonged, normal or shortened. Other forms of abnormal bleeding include \nintermenstrual bleeding, premenstrual bleeding and breakthrough bleedin g. \nTransvaginal ultrasound is the preferred method for evaluating AUB due to several advantages over other alternative \ndiagnostic approaches. The hormonal assay is costly, and endometrial biopsies are highly invasive. In contrast, \ntransvaginal ultrasound i s non -invasive, relatively cost -effective, affordable for patients, and provides information \nabout both the uterus and ovaries. \nA woman’s menstrual cycle serves as a vital sign of her overall health and well -being. Normal menstrual bleeding \nindicates good health and the absence of uterine pathology [9]. However, menstrual disorders are a common reason for \nmedical consultations among reproductive -age women, affecting up to 30% of women during their reproductive years \n[10]. Abnormal uterine bleeding is report ed in 9 to 14 per cent of women between menarche and menopause, leading \nto financial burden and reduced quality of life [11]. The World Health Organisation has noted that 18 million women \naged 30 to 55 years perceive their menstrual bleeding as excessive, resulting in healthcare costs [12]. Abnormal uterine \nbleeding hurts quality of life, often leading to missed workdays, surgical interventions like hysterectomy, and significant \nstrain on health care systems.  \nThe study aims to evaluate abnormal uterine bleeding among non -pregnant women using transvaginal ultrasound at \nLagos University Teaching Hospital (LUTH) in Lagos, southwest, Nigeria. The research will provide insight into current \nopinions on abnormal uterine bleeding and adopted nomenclature. It wil l also investigate the most common age group \naffected by abnormal uterine bleeding and assess structural abnormalities that contribute to this condition in women. \nAdditionally, the study aims to establish relationships between parity and the age of women w ith abnormal uterine \nbleeding, evaluate ultrasound findings based on age groups, and determine associations between clinical history and \nsonographic findings. The research will facilitate improved communication between referring clinicians and \nsonographers. and help sonographers tailor ultrasound techniques based on patient age while promoting the use of \ntransvaginal ultrasound for accurate diagnoses. \nThe study was conducted in the Radiodiagnosis Department of Lagos University Teaching Hospital, Lagos, sout hwest \nNigeria, among women experiencing abnormal uterine bleeding from September 2018 to January 2019.  \n2. Material and methods \nA descriptive cross -sectional study was conducted at the Radiodiagnosis Department, Lagos University Teaching \nHospital (L UTH), Lagos State, southwest, Nigeria. Lagos is a state located in the southwestern geopolitical zone of \nNigeria, approximately on longitude 20 42’E and 32 2’E respectively, and between latitudes 60 22’N and 60 2’N .  \n2.1. Population of the study \nThe study was c onducted among non -pregnant women who visited the gynaecology department at Lagos University \nTeaching Hospital (LUTH), with clinical indications of abnormal uterine bleeding from September 2018 to January 2019. \n2.2. Sampling Technique \nA purposive sampling technique was used as subjects who met the inclusion criteria were recruited for this study.  \n\nInternational Journal of Science and Research Archive, 2023, 10(01), 446–457 \n448 \n2.3. Sample size determination \nThe sample size was calculated using the formula developed by Yamane and used by Elugwu et al. (2023). \n= 𝑁\n1 + 𝑁(𝑒)2 \nWhere n is the sample size, N is the population size and e is the level of precision (0.05). \nThe average number of gynaecologic visits within five (5) months in the study centre (LUTH) was eight hundred and \ntwenty (820). According to Singh et al., 2013 which states 30% of gynaecology visit of women of reproductive age was \ndue to abnormal uterine bleeding, the population of patients with abnormal uterine bleeding during the 5 -month \nduration of the study was estimated as;  \nSample Population= 30% (Singh et al., 2013) x 820 (new gynaecology visits for 5-months) \n= 30/100 x 820 \n= 246 \nThus, the sample population (N) of women with abnormal uterine bleeding was estimated at 246.  \nAccording to Yamane and Elugwu et al (2023) formula above; inputting the values,  \n \nSample size, 𝑛 =\n246\n1 + 246 (0.05)2 \n𝑛 = 246\n1 +  0.615 \nn =152.32 ≈ 152. \n2.4. Ethical approval \nBy the Helsinki Declaration, ethical approval was obtained from the Health Research and Ethical Committee of Lagos \nUniversity Teaching Hospital (LUTH), Lagos  \n2.5. Informed consent \nInformed consent was obtained from all participants. The significance and objectives of the study were clearly \nexplained, they were assured of the confidentiality of the data obtained and the right to withdraw from the study at any \ntime. \n2.6. Inclusion criteria \nAll no n-pregnant women with clinical indications of abnormal uterine bleeding, referred for pelvic transvaginal \nultrasound at the Radiodiagnostic Department of Lagos University Teaching Hospital, Lagos and who gave informed \nconsent were included in the study. \n2.7. Exclusion criteria \nPregnant women with vaginal bleeding or spotting, women on hormonal contraceptive use, women with clinical \nsymptoms of pelvic infection, women with Postmenopausal bleeding, and women who refused to give consent.  \n2.8. Data collection instrument \nAll ultrasound scans were performed using E-CUBE 5 (2005) and Toshiba Model UIDM-580A with 3.5MHz and 6.5MHz \ncurvilinear and endovaginal transducers. A data capture sheet was drafted for the documentation of data.  \n \n\nInternational Journal of Science and Research Archive, 2023, 10(01), 446–457 \n449 \n2.9. Data collection procedure \nThe patients selected for the study received counselling regarding the examination procedure. They were then asked to \nchange into an examination gown and lie down in a supine position. Ultrasound gel was applied to the suprapubic area \nfor the transabdominal ultrasound,  which provided a panoramic view of the uterus. Subsequently, patients were \ninstructed to fully empty their urinary bladder. Following this, patients assumed a supine position with their legs flexed \n(lithotomy position) for the transvaginal ultrasound. A p illow was placed under the gluteal region to facilitate the \nmanipulation of the transducer. \nFor the transvaginal ultrasound, the transducer was coated with gel and covered with a sterile barrier. The transducer \nwas gently inserted into the vagina, with the patient appropriately covered throughout the procedure except during the \ninsertion when direct visualization was necessary. Both sagittal and transverse views of the uterus were obtained using \nvarious scanning techniques, including scanning, panning, and fanning. The examination focused on assessing the size, \nshape, and contour, as well as the appearance of the myometrium, endometrium, and cervix. The ovaries were examined \nfor their echogenicity and position, with any masses or abnormalities carefully eval uated for their origin, echotexture, \nsize, shape, and relationship to adjacent structures. Lastly, the cul -de-sac was examined for the presence of any fluid. \n2.10. Method of Data Analysis \nData collected were analysed using Microsoft Excel 2013 version and Statistical Package for Social Sciences version 20. \nFrequency, percentage, mean and standard  deviation were used to analyse patients’ demographics such as age and \nparity. Frequency and percentage were used to analyse the clinical history and ultrasound findings. Pearson correlation \nwas used to show the relationship between parity and age of women with abnormal uterine bleeding. A frequency table \nwas used to analyse the ultrasound findings based on the age group of patients. The Pearson correlation coefficient was \nused to show the relationship between clinical history and ultrasound findings.  \n3. Results  \nA total of one hundred and fifty-two (152) women with a clinical history of abnormal uterine bleeding were included in \nthis study.  \nTable 1 shows that th e mean age + SD of subjects included was 33 + 7.30 years. The age range of 17 – 51 years was \nevaluated with 27 patients from the age group 16 – 25 years, 73 patients from the age group 26 – 35 years, 44 patients \nfrom the age group 36 – 45 years and 8 patients from the age group of 46 – 55 years. The incidence of AUB was highest \nwithin the age group 26 to 35 years with 73 cases (48.0%) and least among 46 – 55 years with 8 (5.3%).  \nTable 2 shows the parity distribution of patients, the highest cases of 66 (43 %) were nulliparous and the least parity \nbeing 4 cases (2.6%) was parity V. This incidence is also commonest among nulliparous 66 (43.2%) followed by parity \nII 29 (18.4%).  \nTable 3 shows that, out of forty (40) patients who presented with heavy menstrual bleeding, fourteen (14) of them had \nassociated prolonged menstrual bleeding. Thirty-two patients (21%) had a clinical history of absent menstrual bleeding \nfollowed by twenty-six patients (17.1%) with heavy menstrual bleeding. The least clinical indication w as patients with \ninfrequent menstrual bleeding (0.6%). \nTable 1 Distribution of patients according to age \nAge Group (yrs) Frequency Percentage (%) Mean age + SD \n16 – 25 27 17.7% 23.27 + 2.245 \n26 – 35  73 48.0% 30.55 + 2.900 \n36 – 45 44 30.0% 39.77 + 2.589 \n46 – 55  8 5.3% 48.87 + 1.615 \n \n \n\nInternational Journal of Science and Research Archive, 2023, 10(01), 446–457 \n450 \nTable 2 Distribution of patients according to parity \nParity Frequency Percentage (%) \n0 66 43.0% \nI 21 13.8% \nII 28 18.4% \nIII 23 15.1% \nIV 10 6.6% \nV 4 2.6% \n \nTable 3 Distribution of Patient’s clinical history \nClinical History Frequency Percentage (%) \nAbsent Menstrual Bleeding 32 21.0 \nFrequent Menstrual Bleeding 5 3.3 \nHeavy Menstrual Bleeding 26 17.1 \nHeavy and Prolonged MB 14 9.2 \nInter Menstrual Bleeding 8 5.2 \nInfrequent Menstrual Bleeding 3 1.9 \nIrregular Menstrual Bleeding 23 15.1 \nProlonged Menstrual Bleeding 20 13.1 \nShortened Menstrual Bleeding  21 13.8 \nTotal 152 100% \nTable 4 shows the distribution of ultrasound findings in the uterus. Abnormal ultrasound findings in the uterus were \nnoted in 97 (63.8%) patients, with 70 (46.1%) having structural abnormalities while other non -structural findings \naccounted for 27 cases (17.8%). Fifty-five 55 (36.2%) patients had no structural abnormalities seen in the uterus during \nevaluation. \nTable 5 shows the rel ationship between parity and the age of the patient. The parity is highest at 26 – 35 years and \nslows down at 36 – 45 years after which there is a decline in the parity with age. Whereas the incidence of abnormal \nuterine bleeding was high among the nullipa rous 66 (43.2%) and low among the parity IV (5.1%) and V (3.8%). The \ncorrelation between age and parity of patients with AUB was calculated. There is a positive and moderate correlation \nbetween age and parity of women with abnormal uterine bleeding and thi s is supported by Pearson’s correlation of \n0.577 at a p-value of 0.01 level. \nTable 6 shows ultrasound findings according to age group. The majority of the findings were among the 26 – 35 years \nand then 36 -45 years. Thirty -one (31) patients in the 26 -35 years age group had uterine myoma, twenty -five (25) in \nthe 36 – 45 years age group had uterine myoma and only one (1) patient had uterine myoma among 16 – 25 years.  \nTable 7 shows an association between clinical history and ultrasound findings. Normal endometrium/uterus was \nsignificantly associated with absent menstrual bleeding with 21.0% (32 cases) of patients who reported absent menses, \nand 12.5% (19 cases) had normal uterus/endometrium. Also, out of 15.1% who reported irregular menses, 7.9% had a \nnormal uterus, 13.8% (21 cases) reported shortened menstrual bleeding, and 7.2% had a normal uterus. 39.5% (60 \ncases) of heavy, prolonged and heavy/prolonged had 25.6% (39 cases).  \n\nInternational Journal of Science and Research Archive, 2023, 10(01), 446–457 \n451 \nThere is a positive but weak association between clinical history and sonograp hic findings and this is supported by \nPearson’s correlation r = 0.197 and statistical significance at p < 0.05.  \nTable 4 Ultrasound findings \nUltrasound Findings Number of cases (Percentage %) \nNormal Uterus/findings 55 (36.2%) \nUterine Myoma 63 (41.4%) \nAdenomyosis 6 (3.9%) \nEndometrial Polyp 1 (0.6%)  \nOthers non-structural findings  27 (17.8%) \n \nTable 5 Relationship between parity and age of patient \nParity 16 – 25 26 – 35 36 – 45 46 – 55 Total Correlation \n(r), p-value \n0 21 (13.8%) 35 (22.9%) 8 (5.2%) 2 (1.3%) 66 (43.2%) \nr = 0.577, p = 0.05 \nI 2 (1.3%) 12 (7.8%) 7 (4.6%) 0 (0.0%) 21 (13.7%) \nII 2 (1.3%) 19 (12.4%) 8 (5.2%) 0 (0.0%) 29 (18.9%) \nIII 1 (0.6%) 8 (5.2%) 14 (9.2%) 0 (0.0%) 23 (15.0%) \nIV 0 (0.0%) 0 (0.0%) 5 (3.2%) 3 (1.9%) 8 (5.1%) \nV 0 (0.0%) 0 (0.0%) 3 (1.9%) 2 (1.9%) 5 (3.8%) \nTotal 26 (17.1%) 74 (48.6%) 45 (29.6%) 7 (4.6%) 152 (100.0%) \n \nTable 6 Ultrasound Findings as per Age Group \n AGE GROUPS \nULTRASOUND FINDINGS 16 – 25 26 – 35 36 – 45 46 – 55 Total \nUterine Myoma 1 31 25 6 63 \nAdenomyosis 0 1 5 0 6 \nEndometrial Polyp 0 0 1 0 1 \nTotal 1 32 31 6 70 \n \n \n \n \n \n\nInternational Journal of Science and Research Archive, 2023, 10(01), 446–457 \n452 \nTable 7 Association between Clinical History and Ultrasound Findings  \n Sonographic findings  \n \nClinical History \nNormal Uterus \nUterine \nMyoma \nAdenomyosis \nEndometrial \npolyp \nTotal \nIrregular  12 8 1 0 21 \nInfrequent 2 1 0 0 3 \nShortened 11 7 0 0 18 \nAbsent 19 5 1 0 25 \nHeavy 2 20 1 0 23 \nHMB/PMB 0 8 2 0 10 \nProlonged 4 11 0 0 15 \nFrequent 2 1 1 1 5 \nInter  3 2 0 0 5 \nTotal 55 63 6 1 125 \n4. Discussion \nIn this study, a total of 152 patients participated, and their data were analysed. The majority of patients with abnormal \nuterine bleeding fell within the age group of 26 to 35 years. This age range corresponds to a period when women are \nparticularly concerned about their menstrual health due to its association with fertility and childbearing. Conversely, \nthere was a rare occurrence of cases among patients aged 46 to 55 years. This could be attributed to the approaching \nmenopausal stage (climacteric period) when women tend to be less concerned about their menstrual health due to age \nand reduced expectations of fertility. Another possible reason for this finding could be that patients in this older age \ngroup were evaluated and treated earlier, reducing the incidence in later age groups. This contrasts with the findings of \nAdedokun et al., where the most common age group was 35 to 46 years. The difference may be because Adedokun et al. \nfocused solely on leiomyoma as a cause of abnormal uterine bleeding, excluding other categories included in this study. \nAdditionally, it contrasts with Doraiswami et al., where the most common age group was 41 to 50 years, likely because \ntheir study population was in the perimenopausal age range.  \nStructural abnormalities causing a bnormal uterine bleeding were evaluated in this study based on the FIGO PALM \nCOEIN classification. Approximately one -third of cases showed no structural causes or displayed normal endometrial \npatterns, including proliferative, secretory, and atrophic phase s. Proliferative phase bleeding may result from \nanovulatory cycles, while secretory phase bleeding may be due to ovulatory dysfunction and this finding aligns with \nChoudhary et al. The most common structural abnormality observed was leiomyoma, consistent w ith several other \nstudies, such as those conducted by Pillai and Verma et al.  \nThe occurrence of Adenomyosis cases in this study is in line with the findings of Choudhary et al. However, it contrasts \nwith the findings of Jonathan et al., where fewer Adenomy osis cases were reported. This difference may be attributed \nto the age range and racial differences in the populations studied. Endometrial polyps were observed in only one patient, \nconsistent with the study by Critchley et al. Similarly, Dreisler et al. f ound few cases of polyps, particularly among \npremenopausal women. The study revealed that polyps significantly correlate with advancing age. The lower incidence \nof endometrial polyps in younger age groups may be due to spontaneous regression mechanisms cha racteristic of the \ncycling endometrium in the reproductive age group. No cases of endometrial hyperplasia were recorded in this study, \npossibly because most patients belonged to younger age groups and were in a premenopausal state. Additionally, the \nprevalence of risk factors such as diabetes, obesity, and a sedentary lifestyle was low among this population.  \n\nInternational Journal of Science and Research Archive, 2023, 10(01), 446–457 \n453 \nA positive and moderate correlation was found between the age and parity of subjects with abnormal uterine bleeding. \nAs the patient's age increased, th ere was a corresponding increase in parity and the occurrence of abnormal uterine \nbleeding. The major structural abnormalities were observed among patients with parity II and in the age group of 26 to \n35 years. This finding is consistent with Pillai's 2014  findings. However, a majority of patients with leiomyoma as a \nfinding of AUB were nulliparous and of increased age, as reported by Ezeama et al. This contrast with Ezeama et al.'s \nfindings may be attributed to differences in marriage age between patients from the eastern and western regions of \nNigeria, where parity II was more common among the patients studied, while nulliparity was more common in the \neastern region. \nSignificant positive ultrasound findings were most common among the age group of 26 to 35 years, followed by the age \ngroup of 36 to 45 years. Uterine myoma was the most common pathology, followed by adenomyosis. There was an \nincrease in the occurrence of abnormal uterine bleeding from the twenties, with a decline observed from the late fifties. \nThe age group with positive findings aligns with the majority of previous studies, such as those conducted by Choudhary \net al. and Adedokun et al. Therefore, evaluating patients aged 26 to 45 years for structural abnormalities causing \nabnormal uterine bleeding is crucial, as significant positive findings were recorded within this age range. No significant \npositive ultrasound findings were noted among younger age groups, possibly because their AUB symptoms may be \nattributed to ovarian dysfunction. \nA positive but fair correlation was found between clinical history and ultrasound findings. The most common clinical \nhistory associated with AUB was absent menstrual bleeding, which is not surprising, as this age group may experience \nhypothalamus-pituitary-ovarian axis immaturity and fluctuations, leading to non -structural causes like endometritis \nand ovulatory dysfunction. Heavy menstrual bleeding was the most common presentation clinically and was \nsignificantly associated with leiomyoma on ultrasound, consistent w ith studies by Pillai, Doddamani et al., Verma et al., \nand Jonathan et al. In cases presenting with heavy or prolonged menstrual bleeding, leiomyoma and adenomyosis were \nthe most common findings. This finding aligns with Adedokun et al., where uterine myoma was significantly associated \nwith heavy, prolonged, or heavy/prolonged menstrual bleeding. Adenomyosis was significantly associated with \nheavy/prolonged menstrual bleeding, consistent with Jonathan et al. Only one subject with frequent menstrual bleeding \nwas found to have an endometrial polyp, similar to Dreisler et al.'s findings in premenopausal women. However, \ncontrary to this study, Dreisler et al. reported that most patients with endometrial polyps did not present with frequent \nbleeding, possibly due to asymptomatic polyps. This demonstrates that clinical history does not always determine the \nexact structural pathology. \n5. Conclusion \nIn summary, the sonographic evaluation revealed positive findings in 97 out of 152 cases studied, accounting for 63.8% \nof the total cases. Among reproductive-age women, 70 cases (46%) exhibited structural abnormalities, with leiomyoma \nbeing the most common at 63 cases (41.4%), followed by adenomyosis at 6 cases (3.9%), and endometrial polyp at 1 \ncase (0.6%). The a ge group of 26 to 35 years had the highest incidence of abnormal uterine bleeding, with 74 cases \n(48.6%), while nulliparous women showed a high incidence of 66 cases (43.2%). This could be attributed to findings in \nthe adnexa and Pouch of Douglas, as well as the observation of a normal uterus. \nBased on this study, we conclude that ultrasonography is a convenient and relatively cost -effective method for initially \nidentifying various causes of abnormal uterine bleeding. It demonstrates high diagnostic accurac y in detecting \nendometrial lesions, structural factors contributing to abnormal uterine bleeding and associated pathologies.  \nTherefore, it is recommended that all cases of abnormal uterine bleeding undergo assessment with transvaginal \nultrasound, and further evaluation should be tailored to the individual's presenting complaints and age.Top of Form  \nCompliance with ethical standards \nAcknowledgement \nThanks to Moshood Olasumbo for assisting with proofreading of this work.  \nDisclosure of conflict of interest \nThere is no conflict of interest associated with this study. \n\nInternational Journal of Science and Research Archive, 2023, 10(01), 446–457 \n454 \nStatement of ethical approval \nThis study has received ethical approval from the Lagos University Teaching Hospital Health Research Ethics \nCommittee, with the assigned number: ADM/DCST/HREC/2056. \nStatement of informed consent \nInformed consent was obtained from all participants who were included in this study.  \nReferences \n[1] Khare A, Bansal R, Sharma S, Elhence P, Makkar N, Tyagi Y. 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Eur J Gynaecol Oncol. \n2000 Jan 1, 21(2):180–3.  \n[60] Doddamani UG, Doddamani GB, Katageri G, Mall apur A. Clinicopathological Correlation of Endometrium in \nAbnormal Uterine Bleeding. Scholars Journal of Applied Medical Sciences (SJAMS) Sch J App Med Sci [Internet]. \n2014, 2(1A):46–9. Available from: www.saspublishers.com \n \n\nInternational Journal of Science and Research Archive, 2023, 10(01), 446–457 \n457 \nAuthor’s short biography \n \nTawakalt Opeyemi Olagunju -Moshood is a highly proficient senior Radiographer who \nspecializes in Sonography and has a profound interest in women's health and fertility treatment. \nShe holds a B.Sc (Hons) Degree in Radiography and a postgraduate Diploma in Sonography, \namassing nearly a decad e of valuable experience in this field. She is renowned for her meticulous \nattention to detail and unwavering commitment to medical protocols.  \n \nDr. Joseph Chukwuemeka Eze  is a Reader in the Radiography Department within the Faculty of \nHealth Science and Technology at Nnamdi Azikiwe University. He earned his PhD in 2016 from the \nUniversity of Nigeria, Nsukka, specializing in Medical Imaging with a focus on Ultrasonography. \nWith approximately two decades of experience, Dr. Eze is a highly skilled and practi sing \nsonographer. \n \nDr. Anthony Chukwuka Ugwu  is a Reader in the Radiography Department within the Faculty of \nHealth Science and Technology at Nnamdi Azikiwe University. He completed his Ph.D. in 2014 at \nthe University of Nigeria, Nsukka. Dr. Ugwu is a se asoned and proficient sonographer with over \ntwo decades of practical experience in the field.","source_license":"CC0","license_restricted":false}