{"paper_id":"6c8666a7-d135-4309-85c1-8eef8470c6ee","body_text":"International Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 9, September 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nTo Study \nt\nhe Histomorphological Spectrum \na\nnd \nRole \no\nf B\nC\nl2 \na\nnd Ki67 \ni\nn Cases \no\nf Abnormal \nUterine Bleeding \na\nt \na\n \nTertiary Care Centre\n \n \nDr. Nidhi Verma\n1\n, Dr. Shikha Choudhary\n2\n, Dr. Deepali Mittal\n3\n, Dr. Aruna Verma\n4\n \n \n1\nProfessor, Department of Pathology, LLRM Medical College, Meerut\n \n \n2\nJunior \nR\nesident, Department of Pathology, LLRM Medical College, Meerut\n \n \n3\nAssociate Professor, Department of Pathology, LLRM Medical College, Meerut\n \n \n4\nProfessor, Department of Obstetrics and \nG\nynaecology, LLRM Medical College, Meerut\n \n \n \nAbstract\n: \nIntroduction\n:\n \nAbnormal uterine bleeding (AUB) encompasses irregularities in menstrual frequency, duration, and volume, \nand is a common gynecological complaint, especially in perimenopausal women. The histopathological examination of endometrial\n \nbiopsies play\ns\n \na pivotal role in determining the underlying cause, whether functional or organic.\n \nAims and \nObjectives\n:\n \n1) \nTo evaluate the \nclinical and histomorphological spectrum \nin cases of\n \nabnormal uterine bleeding.\n \n2) \nTo study the \nrole of BCl 2 and Ki 67 in cases of \nabnormal ut\nerine bleeding\n.\n \nMethodology\n:\n \nA prospective cross\n-\nsectional study was conducted in the Department of Pathology\n,\n \nLLRM \nMedical College, Meerut in collaboration with the Department of Obstetrics and Gynaecology\n, SVBP Hospital Meerut\n. A total of 150 \nendometrial biopsy samples from women aged above 18 years with AUB were an\nalyzed over a period of one year\n. Patients with \nAUB due \nto \ngestational causes or inadequate samples were excluded. Histopathological and immunohistochemical analysis was performed.\n \nResults\n:\n \nAmo\nng the 150 patients, \n76\n \ncases \n(\n50.7%\n)\n \nwere\n \nof\n \nperimenopausal\n \nage group\n, \n60\n \ncases\n \n(\n40%\n) of\n \nreproductive\n-\nage\n \ngroup\n, and \n14\n \ncases\n \n(\n9.3%\n) of\n \npostmenopausal\n \nage group\n. Menorrhagia was the most common bleeding pattern (67.3%), followed by metrorrhagia (17.3%). \nFunctional causes were predominant (64%), including proliferative \nendometrium \n(24.7%) and disordered proliferative endometrium \n(20%). Organic causes constituted 36%, with endometrial polyps (16.7%) and \nendometrial \nhyperplasia (8.6%) being most frequent. \nEndometrial carcinoma was seen in 4% of cases.\n \nBCl 2 expression\n \nwas most commonly observed in functional causes, where 43.8% of \ncases w\nere\n \npositive\n \nwhile \nKi 67 expr\nession commonly seen in organic causes where 46.3% of cases were positive.\n \nConclusion\n:\n \nAUB \nwas\n \nmost prevalent in the perimenopausal age group and \nwas\n \npredominantly due to functional endometrial c\nauses\n. Histopathological \nevaluation remains essential for accurate diagnosis and appropriate treatment, particularly to rule out hyperplasia and malig\nnancy.\n \nRecommendations\n:\n \nRoutine endometrial sampling and histopathological examination should be performed in all women with AUB, \nparticularly in perimenopausal and po\nstmenopausal groups. Immunohistochemistry should be considered in cases with atypia or suspicion \nof malignancy to enable timely diagnosis and intervention.\n \n \nKeywords:\n \nAbnormal uterine bleeding, perimenopausal women, endometrial carcinoma\n \n \n1.\n \nIntroduction \n \n \nAbnormal uterine bleeding (AUB) is a broad term that \ndescribes irregularities in the menstrual cycle involving the \nparameters of frequency, regularity, duration and volume of \nflow outside of pregnancy in reproductive\n-\naged women. \nAbnormal uterine bleeding (\nAUB) is an important clinical \nentity\n1\n. AUB has a lifetime prevalence of 30% during the \nreproductive age group\n2\n \nthat continues until menopause\n3\n. \nAUB accounts for 25% of total gynaecological surgeries\n4\n. In \na normal woman, the menstruation is characterized by\n \na \nfrequency of 24\n-\n38 days, lasting for 4.5\n-\n \n8 days, with blood \nloss ranging between 5\n-\n80 ml per cycle\n4\n. Therefore, variations \nin any of these four parameters constitute AUB. \n \n \nIn perimenopausal women, AUB is diagnosed when there is a \nsubstantial change in frequency, duration and amount of \nbleeding between periods. In post\n-\nmenopausal women, any \nvaginal bleeding one year after cessation of menses is \nconsidered abnormal and require\ns evaluation. Bleeding is said \nto be abnormal when the pattern is irregular, of abnormal \nduration or of abnormal amount (>80ml/menses)\n5\n.\n \n \nAUB has varied presentations like heavy menstrual bleeding, \nfrequent cycles, irregular cycles, post\n-\ncoital bleeding and \npost\n-\nmenopausal bleeding. The Federation of Gynaecology \nand Obstetrics (FIGO), in 2011, devised a classification \nnamed PALM\n-\nCOEIN for th\ne etiology of AUB. PALM \naccounts for structural features like polyps, adenomyosis, \nleiomyoma and malignancy. COEIN advised non\n-\nstructural \ncauses like coagulation defect, ovulatory dysfunction, \nendometrial causes, iatrogenic causes and non\n-\nclassified \nones\n6\n.\n \n \nBCL2 family is the best characterized protein family involved \nin the regulation of apoptotic cell death, consisting of anti\n-\napoptotic members and pro\n-\napoptotic members. BCL2 family \nof protein act\ns\n \nas a critical life\n-\ndeath decision point within the \ncommon pathway of apoptosis. BCL2 is an anti\n-\napoptotic \ngene that regulates the mitochondrial membrane\n7\n \n. The \nproduct of the Bcl\n-\n2 (B\n-\ncell lymphoma/ leukaemia 2) gene \nwas first identified from the t(14;18) translocation occurring \nin most cases of follicular lymphom\na.\n8\n-\n10 \nThe t(14;18) \ntranslocation juxtaposes the Bcl\n-\n2 gene (chromosome 18) \nwith the immunoglobulin heavy chain gene, leading to \nderegulated expression of Bcl\n-\n2. These findings suggest that \noverexpression of Bcl\n-\n2 plays a major role in the occurrence \nof B\n-\ncell ma\nlignancies, and that Bcl\n-\n2 is a protooncogene. It \nPaper ID: SR25920133229\nDOI: https://dx.doi.org/10.21275/SR25920133229\n1096 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 9, September 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nhas been demonstrated that Bcl\n-\n2 can extend the survival of \nsome hematopoietic cell lines and neuronal cells despite \ngrowth factor deprivation.\n11\n-\n13 \nThis effect occurs through the \ninhibition of apoptosis, i.e. programmed cell death, which is \ninvolved in the homeostasis of many tissues.\n14\n-\n17\n \n \n \nKi67 is one of the most commonly used biomarker for \nassessing cell proliferation. Ki67 is a DNA\n-\nbinding protein \nthat is mainly distributed in the nucleus and is related to cell \nproliferation. Ki67 is usually distributed in the nucleus, and \nits main role is\n \nto maintain the DNA structure during cell \nmitosis. The primary structure of Ki67 is not known. Ki67 is \nabsent in quiescent cells (Go). \n18\n-\n19\n \n \nAim \na\nnd Objectives\n \n1)\n \nTo evaluate the\n \nclinical and histomorphological\n \nspectrum\n \nin cases\n \nof Abnormal Uterine Bleeding. \n \n2)\n \nTo study the \nrole of BCl 2 and Ki 67 in\n \ncases of Abnormal \nUterine Bleeding\n \n \n2.\n \nMaterial \na\nnd Methods\n \n \nThe study was conducted at the Department of Pathology, \nLLRM Medical College, Meerut in collaboration with the \nDepartment of Obstetrics and gynaecology, SVBP Hospital, \nLLRM Medical College, Meerut. The sources of data for the \nstudy consisted of endometrial\n \nbiopsies tissue samples \npreserved in 10% \nneutral \nbuffered formalin. These samples \nwere received in the histopathology laboratory and were \nprocessed routinely.\n \n \nStudy Design: \nThis study was designed as a prospective \ncross\n-\n \nsectional study. \n \n \nStudy Place: \nThe study was conducted \nat\n \nthe Department of \nPathology, Lala Lajpat Rai Memorial Medical College, \nMeerut. \n \n \nStudy Duration: \nThe study was carried out over a period of \none year\n. This duration included the time for patient \nrecruitment, data collection, laboratory analysis, and data \nevaluation.\n \n \nSample Size:\n \nThe study included a total of 150 cases\n \n \nInclusion Criteria: \n \n•\n \nPatients age more than 18 years with history of AUB for a \nperiod of 6 months or above.\n \n•\n \nAdequate clinical details \n \n•\n \nAdequate endometrial specimens received in the form of \nendometrial curettage and endometrial biopsy. \n \n \n \n \n \n \nExclusion Criteria: \n \n•\n \nPatients of AUB due to gestational causes like incomplete \nabortion, missed abortion and retained products of \nconception. \n \n•\n \nInadequate clinical details, autolysed tissue and \ninadequate material, will also be excluded from the study.\n \n \nMethod \no\nf Collection \no\nf Data \n \nAll the patients included in this study were subjected to \nstandard diagnostic criteria, including detailed history, \nphysical examination, histological examination and, \nsubsequently, Immunohistochemical analyses. Written \ninformed consent was obtained from a\nll the patients included \nin the study.\n \n \n \nThe results were presented as frequency and percentages. \n \n \n3.\n \nObservations \na\nnd Results\n \n \nThe present study was done \nat\n \nthe Department of Pathology, \nin collaboration with department of Obstetrics and \nGynecology, LLRM medical college, attached to SVBP \nHospital, Meerut. A total of 150 cases of endometrial biopsies \nwere studied from June 2023 to Ma\ny\n \n202\n4\n.\n \nAll cases were \ndistributed in three categories according to their age group.\n \n \nTable 1: \nAge \ngroup \ndistribution of AUB patients\n \nAge\n \ngroup\n \nof AUB patient\n \nFrequency\n \nPercentage (%)\n \nReproductive (18\n-\n40 years)\n \n60\n \n40\n \nPerimenopausal (41\n-\n50 years)\n \n76\n \n50.7\n \nPostmenopausal (>50 years)\n \n14\n \n9.3\n \nTotal\n \n150\n \n100\n \n \nTable 1. represents the age group distribution of patients \npresented\n \nwith abnormal uterine bleeding\n \n. Among the 150 \nAUB \ncases\n, the majority, 50.7% cases (n=76), belonged to the \nperimenopausal age group (41\n-\n50 years). The reproductive \nage group (18\n-\n40 years) accounted for 40% (n=60) of cases, \nwhile the postmenopausal group (>50 years) had the least \nproportion of cases, comprising\n \n9.3% (n=14).\n \n \nTable 2: \nBleeding pattern distribution in AUB patients\n \nBleeding pattern in AUB patient\n \nFrequency\n \nPercentage (%)\n \nMenorrhagia\n \n101\n \n67.3\n \nMe\ntrorrhagia\n \n26\n \n17.3\n \nHypomenorrhea\n \n14\n \n9.3\n \nPost\n-\nmenopausal bleeding\n \n9\n \n6\n \nTotal\n \n150\n \n100\n \n \nTable 2. represents the distribution of \ndifferent \nbleeding \npatterns among patients \npresented\n \nwith abnormal uterine \nbleeding. Among the 150 \ncases\n, the most frequently observed \nbleeding pattern was menorrhagia, affecting 67.3% (n=101) \nof cases. Metrorrhagia was reported in 17.3% (n=26) of \ncases\n, \nwhile hypomenorrhea accounted for 9.3% (n=14)\n \nof cases\n. \nPostmenopausal bleeding, though less common, was seen in \n6% (n=9) of cases.\n \n \n \n \n \n \n \n \nPaper ID: SR25920133229\nDOI: https://dx.doi.org/10.21275/SR25920133229\n1097 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 9, September 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nTable 3: \nHistomorphological\n \nspectrum of AUB patients\n \n \nHistomorphological\n \ndiagnosis\n \nFrequency\n \nPercentage\n \n(%)\n \nFunctional\n \ncauses\n \n(n\n \n=\n \n96,\n \n64%)\n \n \nProliferative\n \nphase\n \n37\n \n24.7\n \nDisordered\n \nproliferative\n \nphase\n \n30\n \n20\n \nSecretory\n \nphase\n \n24\n \n16\n \nAtrophic\n \nendometrium\n \n5\n \n3.3\n \nOrganic\n \ncauses\n \n(n\n \n=\n \n54,\n \n36%)\n \nBenign\n \ncauses\n \nEndometrial\n \npolyp\n \n25\n \n16.7\n \nChronic\n \nnon\n \nspecific\n \nendometritis\n \n8\n \n5.3\n \nGranulomatous\n \nendometritis\n \n2\n \n1.3\n \nHyperplasia\n \n/\n \nCarcinoma\n \nEndometrial\n \nhyperplasia\n \nwithout\n \natypia\n \n11\n \n7.3\n \nEndometrial\n \nhyperplasia\n \nwith\n \natypia\n \n2\n \n1.3\n \nEndometrial\n \ncarcinoma\n \n6\n \n4\n \n \nTotal\n \n150\n \n100\n \n \nTable 3. represents the histomorphological\n \ndiagnosis of \npatients with abnormal uterine bleeding, categorized into \nfunctional and organic causes. Among the 150 cases, \nfunctional causes were more prevalent, accounting for 64% \n(n=96) of case\ns\n. Within this category, the proliferative phase \nendometrium was observed in 24.7% (n=37) of cases, while \nthe secretory phase endometrium was identified in 16% \n(n=24) of patients. Disordered proliferative endometrium, a \ncondition often associated with hormo\nnal imbalances, was \nfound in 20% (n=30) of cases, While atrophic endometrium \nwas seen in a smaller proportion, comprising 3.3% (n=5) of \ncases. In contrast, organic causes were diagnosed in 36% \n(n=54) of cases. The most common pathology in this group \nwas en\ndometrial polyp, detected in 16.7% (n=25) of cases. \nEndometrial hyperplasia without atypia was found in 7.3% \n(n=11) of cases while endometrial hyperplasia with atypia \nwas observed in 1.3% (n=2) of cases. Among inflammatory \nconditions, chronic non\n-\nspecific \nendometritis was present in \n5.3% (n=8) of cases, while granulomatous endometritis was \nseen in 1.3% (n=2) of patients. Endometrial carcinoma, was \nidentified in 4% (n=6) of cases. This histomorphological \nanalysis of present study showed that functional cause\ns form \nthe majority of AUB cases ( 64 %), while cases with organic \npathology were only 36 %. This emphas\nises\n \nthe need for \nthorough histopathological evaluation in patients presenting \nwith abnormal uterine bleeding.\n \n \n \nTable 4:\n \nCorrelation between Histomorphological diagnosis and BCL\n-\n2 expression in AUB patients\n \n \nHistomorphological diagnosis\n \nBCL\n-\n2 expression\n \nTotal\n \n \nNo. and %\n \nPositive\n \n \nNo. and %\n \nNegative \n \nNo. and %\n \nFunctional causes\n \n(n = 96, 64%)\n \n \nProliferative phase, n\n \n(%)\n \n25 (67.6)\n \n12 (32.4)\n \n37 (100)\n \nDisordered proliferative endometrium, n\n \n(%)\n \n5 (16.7)\n \n25 (83.3)\n \n30 (100)\n \nSecretory phase, n\n \n(%)\n \n12 (50)\n \n12 (50)\n \n24 (100)\n \nAtrophic endometrium, n\n \n(%)\n \n0 (0)\n \n5 (100)\n \n5 (100)\n \n \nTotal Functional causes, \nn\n \n(%)\n \n42 [43.8]\n \n54 [56.2]\n \n96 [100]\n \nOrganic causes\n \n(n = 54, 36%)\n \nBenign causes\n \nEndometrial polyp, n (%)\n \n7 (28)\n \n18 (72)\n \n25 (100)\n \nChronic non\n-\n \nspecific endometritis, n\n \n(%)\n \n1 (12.5)\n \n7 (87.5)\n \n8 (100)\n \nGranulomatous endometritis, n\n \n(%)\n \n0 (0)\n \n2 (100)\n \n2 (100)\n \nHyperplasia/ \nCarcinoma\n \nEndometrial hyperplasia without atypia, n\n \n(%)\n \n4 (36.4)\n \n7 (63.6)\n \n11 (100)\n \nEndometrial hyperplasia with atypia, n\n \n(%)\n \n0 (0)\n \n2 (100)\n \n2 (100)\n \nEndometrial carcinoma, n\n \n(%)\n \n2 (33.3)\n \n4 (66.7)\n \n6 (100)\n \n \nTotal organic causes, \nn\n \n(%)\n \n14 [25.9]\n \n40 [74.1]\n \n54 [100]\n \n \nGrand Total\n \n56\n \n94\n \n150\n \n \nChi\n-\nsquare value = 4.693            p\n-\nvalue = 0.0303 (Significant)\n \n \nTable\n \n4\n \nrepresents the distribution of BCL\n-\n2 expression \namong patients \nof\n \nabnormal uterine bleeding based on \nhistomorphological\n \nfindings, categorized into functional and \norganic causes. Among the 150 patients, BCL\n-\n2 expression \nwas more commonly observed in functional causes, where \n43.8% (n=42) of cases were BCL\n-\n2 positive, while 56.2% \n(n=54) were \nBCL\n-\n2 \nnegative. Within this group, the highest \nBCL\n-\n2 positivity was seen in the proliferative phase \nendometrium, where 67.6% (n=25) of cases exhibited \npositive expression, whereas 32.4% \ncases (n=12) were \nnegative. In the secretory phase, positivity was found in 50% \n(n=12) of cases, while t\nhe remaining 50%  cases (n=12) were \nnegative. Disordered proliferative endometrium had a lower \npositivity rate, with only 16.7% cases (n=5) showing BCL\n-\n2 \nexpression, while the majority, 83.3% cases (n=25), were \nnegative.  Among organic causes, BCL\n-\n2 positi\nvity was \nsignificantly lower, with only 25.9% (n=14) of cases showing \npositive expression, while 74.1% cases (n=40) were negative. \nWithin this category, chronic non\n-\nspecific endometritis \nexhibited BCL\n-\n2 positivity in only 12.5% (n=1) of cases, \nwhile 87.5% \ncases\n \n(n=7) were negative. Granulomatous \nendometritis and endometrial hyperplasia with atypia showed \nno BCL\n-\n2 positivity, with all cases being negative. \nEndometrial polyps had a positivity rate of 28% cases (n=7), \nwhile 72% cases (n=18) were negative. Endometria\nl \nhyperplasia without atypia showed BCL\n-\n2 expression in \n36.4% (n=4) of cases, while 63.6% (n=7) were negative. \nAmong malignant cases, endometrial carcinoma exhibited \nBCL\n-\n2 positivity in 33.3% (n=2) of cases, whereas 66.7% \n(n=4) were negative. The chi\n-\nsquare value (4.693) and p\n-\nvalue (0.0303) indicate that the observed difference in BCL\n-\n2 expression across different histomorphological diagnoses \nwas statistically significant at the 5% level of significance. \nThis suggests that BCL\n-\n2 expression is signifi\ncantly higher in \nfunctional causes, particularly in proliferative phase \nendometrium, as compared to its expression in organic causes \nPaper ID: SR25920133229\nDOI: https://dx.doi.org/10.21275/SR25920133229\n1098 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 9, September 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nincluding hyperplasia, malignancy and inflammatory \nconditions.\n \n \n \nTable 5:\n \nCorrelation between Histomorphological diagnosis and Ki 67 expression in AUB patients\n \n \nHistomorphological diagnosis\n \nKi 67 expression\n \nTotal\n \nPositive\n \nNegative\n \nFunctional causes\n \n(n = 96, 64%)\n \n \nProliferative phase, n\n \n(%)\n \n16 (43.2)\n \n21 (56.8)\n \n37 (100)\n \nDisordered proliferative endometrium, n (%)\n \n4 (13.3)\n \n26 (86.7)\n \n30 (100)\n \nSecretory phase, n (%)\n \n10 (41.7)\n \n14 (58.3)\n \n24 (100)\n \nAtrophic endometrium, n(%)\n \n0 (0)\n \n5 (100)\n \n5 (100)\n \n \nTotal Functional causes, \nn\n \n(%)\n \n30 [31.3]\n \n66 [68.7]\n \n96 [100]\n \nOrganic causes\n \n(n = 54, 36%)\n \nBenign\n \nEndometrial polyp, n (%)\n \n9 (36)\n \n16 (64)\n \n25 (100)\n \nChronic non\n-\n \nspecific endometritis, n\n \n(%)\n \n1 (12.5)\n \n7 (87.5)\n \n8 (100)\n \nGranulomatous endometritis, n\n \n(%)\n \n0 (0)\n \n2 (100)\n \n2 (100)\n \nHyperplasia and \nCarcinoma\n \nEndometrial hyperplasia without atypia, n\n \n(%)\n \n10 (90.9)\n \n1 (9.1)\n \n11 (100)\n \nEndometrial hyperplasia with atypia, n\n \n(%)\n \n1 (50)\n \n1 (50)\n \n2(100)\n \nEndometrial carcinoma, n\n \n(%)\n \n4 (66.7)\n \n2 (33.3)\n \n6 (100)\n \n \nTotal organic causes, \nn\n \n(%)\n \n25 [46.3]\n \n29 [53.7]\n \n54 [100]\n \n \nGrand Total\n \n55\n \n95\n \n150\n \n \nChi\n-\nsquare value = 3.37             p\n-\nvalue = 0.0664 (Not significant)\n \n \nTable \n5\n \nrepresents the distribution of Ki\n-\n67 expression among \npatients \nof\n \nabnormal uterine bleeding (AUB) based on \nhistomorphological findings, categorized into functional and \norganic causes. Among the 150 patients, Ki\n-\n67 expression \nwas more commonly observed in organic causes, where \n46.3% (n=25) of cases were Ki\n-\n67 positive, w\nhile 53.7% \n(n=29) were negative. In contrast, functional causes showed \nlower positivity, with only 31.3% (n=30) exhibiting Ki\n-\n67 \nexpression, while the majority, 68.7% (n=66), were negative. \nWithin the functional category, proliferative phase \nendometrium had a Ki\n-\n67 positivity rate of 43.2% (n=16), \nwhile 56.8% (n=21) were negative. The secretory phase \nendometrium exhibited a similar trend, with Ki\n-\n67 positivity \nin 41.7% (n=10) of cases and neg\nativity in 58.3% (n=14). \nDisordered proliferative endometrium had a much lower Ki\n-\n67 expression, with only 13.3% \ncases \n(n=4) showing \npositivity, while 86.7% (n=26) were negative. Atrophic \nendometrium showed no Ki\n-\n67 positivity, with all cases \n(100%, n=5) \nw\nere\n \nnegative\n.\n \nAmong organic causes, \nendometrial hyperplasia without atypia exhibited the highest \nKi\n-\n67 expression, with 90.9% (n=10) of cases showing \npositivity, while only 9.1% (n=1) were negative. Endometrial \ncarcinoma \nshowed Ki67 positivity in\n \n66.7% (n=4) of cases \nshowing Ki\n-\n67 positivity, while 33.3% \ncases \n(n=2) were \nnegative. Endometrial hyperplasia with atypia exhibited Ki\n-\n67 positivity in 50% (n=1) of cases, while the remaining 50% \n(n=1) negative. Endometrial polyps had \nKi 67\n \npositivity \nin \n36%\n \ncases\n \n(n=9)\n \nwhile 64% (n=16) were negative. Chronic \nnon\n-\nspecific endometritis and granulomatous endometritis \nshowed very low or no Ki\n-\n67 expression, with positivity rates \nof 12.5% (n=1) and 0% (n=0) respectively. The chi\n-\nsquare \nvalue (3.37) and p\n-\nvalue (0.0664) indica\nte that the observed \ndifference in Ki\n-\n67 expression across different \nhistomorphological diagnoses was not statistically significant \nat the 5% level of significance. This suggests that while Ki\n-\n67 expression tends to be higher in cases of hyperplasia \nand \nmalignancy, the association between histomorphological \ndiagnosis and Ki\n-\n67 expression is not statistically significant, \nindicating that additional factors may influence its expression \nin AUB cases.\n \n \n \n \nPaper ID: SR25920133229\nDOI: https://dx.doi.org/10.21275/SR25920133229\n1099 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 9, September 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \n \n \n4.\n \nDiscussion\n \n \nIn present study, the highest incidence of AUB was observed \nin perimenopausal women (50.7%), followed by \nreproductive\n-\nage women (40%) and postmenopausal women \n(9.3%). This is consistent with studies by Soleymani et al \n(2014)\n20\n \n,Sinha et al. (2018)\n21\n, Khare et al. (2018)\n22\n \n, Muzaffar \net al. (2018)\n23\n \n,Behera et al. (2020)\n24\n \n,Chaudhary SA Nath P. \net al. (2020)\n25\n \nand Sweta et al (2023)\n26\n \nwho reported that \nperimenopausal women constitute the largest proportion of \nAUB cases due to hormonal fluctuations, anovulatory cycles, \nand declining ovarian function, which leads to unopposed \nestrogen stimulation\n1,2\n. However, some studies, such as those \nby Doraiswami et al. (2011)\n27\n, reported a slightly lower \nprevalence of AUB in perimenopausal women (45%) and a \nhigher incidence in postmenopausal women (15%)\n3\n. Deka et \nal. (2018)\n28\n \nreported higher incidence in reproductive age \ngroup (34%).\n \nThe differences \nin findings could be due to \nvariations in study populations, healthcare\n-\nseeking behavior, \nand referral biases. Additionally, in regions with a higher life \nexpectancy and increased prevalence of metabolic disorders \nsuch as obesity and diabetes, postmenopaus\nal AUB cases may \nbe more frequent.\n \n \nStudies\n \nDoraiswami et \nal (2011)\n27\n \nSinha K et al \n(2018)\n21\n \nDeka et al \n(2018) \n28\n \nBehera et al \n(2020)\n24\n \nChoudhary\n \nSANath \net al (2020)\n25\n \nPresent study \n(2025)\n \nAge group\n \nPerimenopausal \n(41\n-\n50yr)\n \n(45%)\n \nPerimenopausal \n(41\n-\n50yr)\n \n(58%)\n \nPerimenopausal \n(41\n-\n50yr)\n \n(34%)\n \nPerimenopausal \n(41\n-\n50yr)\n \n(43.25%)\n \nReproductive \n \n(41\n-\n50yr)\n \n(46%)\n \nPerimenopausal \n \n(41\n-\n50yr)\n \n(50.7%)\n \n \nThe most common bleeding pattern in present study was \nmenorrhagia (67.3%), which aligns with the findings of \nChattarsal et al. (2017)\n29\n, Mukhopadhyay et al (2018)\n30\n, \nKotagasti et al.\n \n(2019)\n31\n, and Dangal et al. (2019)\n32\n,\n \nBehera et \nal (2020)\n33\n, Choudhary SA Nath et al.\n \n(2020)\n34\n \nwhere \nmenorrhagia was the predominant symptom in AUB cases. \nThe high prevalence of menorrhagia among different studies \nis likely due to the hormonal imbalance associated with \nperimenopause, particularly estrogen dominance without \nadeq\nuate progesterone opposition, leading to excessive \nendometrial proliferation and irregular shedding. However, \nthe prevalence of metrorrhagia (17.3%) and postmenopausal \nbleeding (6%) in present study was slightly lower than that \nreported by Jairajpuri et al. (2020)\n35\n, who found metrorrhagia \nin 22% and postmenopausal bleeding in 10% of cases. The \nvariation may be attributed to differences in the inclusion \ncriteria, where some studies included more elderly patients or \nthose with endometrial hyperplasia and mal\nignancy, \nconditions more frequently associated with postmenopausal \nbleeding.\n \n \nStudies\n \nChattarsal et al. \n(2017)\n29\n \nSinh K et al \n(2018)\n21\n \nMukhopadhyay \net al (2018)\n30\n \nBehera et al \n(2020)\n24\n \nChaudhary SA Nath \net al (2020)\n25\n \nPresent study \n(2025)\n \nBleeding \npattern\n \nMenorrhagia\n \n(45.5%)\n \nMenorrhagia\n \n(47.7%)\n \nMenorrhagia\n \n(53%)\n \nMenorrhagia\n \n(57.12%)\n \nMenorrhagia\n \n(58.45%)\n \nMenorrhagia\n \n(67.3%)\n \n \nThe present study found that functional causes were more \ncommon (64%) than organic causes (36%). Among the \nfunctional causes, proliferative\n-\nphase endometrium (24.7%) \nwas the most common finding, which is consistent with \nDangal et al. (2019)\n36\n, who reported similar rates of \nproliferative\n-\nphase endometrium in perimenopausal women. \nThe predominance of functional causes in AUB cases \nsuggests that hormonal dysregulation remains the leading \nfactor in the pathogenesis of AUB. Disordered proliferative\n \nendometrium w\nas observed in 20% of cases, which is similar \nto findings by Abdullah et al. (18%) (2021)\n37\n. This condition \nis often associated with chronic estrogen stimulation without \nprogesterone counter action, leading to an irregular \nendometrial response. The high prevalence of this pattern, as \nreported among different studies, suggests that many AUB \ncases\n \nresult from anovulatory cycles, particularly in \nperimenopausal women. Among the organic causes, \nendometrial polyps were the most frequent pathology \n(16.7%). This al\nigns with studies by Abdullah et al. (2021)\n37\n, \nwho found a similar frequency of polyps in AUB cases. \nHowever, some studies have reported a higher prevalence of \nendometrial hyperplasia compared to polyps. Study by \nChattarsal et al. (2017)\n38\n \nreported endometrial hyperplasia \n(25.3%) and Sajitha et al. (2014)\n39\n \nreported hyperplasia (25%) \nas the most common cause of AUB. In present study, the \nprevalence of endometrial hyperplasia (8.6%) was slightly \nlower than that reported by Munro et al. (12%) (2021)\n40\n. \nDiffer\nences in diagnostic thresholds, histological \nclassification systems, and patient selection criteria may \nexplain this discrepancy. Additionally, variations in \nenvironmental and lifestyle factors, such as obesity and \nhormone therapy use, could influence the \nfrequency of \nPaper ID: SR25920133229\nDOI: https://dx.doi.org/10.21275/SR25920133229\n1100 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 9, September 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nhyperplasia. Endometrial carcinoma was identified in 4% of \ncases, which is in agreement with the findings of Jairajpuri et \nal. (4.5%) (2020)\n41\n. However, Farquhar et al. (2022)\n42\n \nreported a slightly higher incidence (6%). This variation may \nbe due to differences in the demographic composition of study \npopulations, as endometrial carcinoma is more common in \nolder women. Additionally, improved screening techniques in \nsome regions may lead to earlier detection, resulting in higher \nreported prevalence.\n \n \nStudies\n \nBhatta et al. \n(2012)\n53\n \nSharma et al. \n(2018)\n54\n \nMukhopadhyay et \nal. (2018)\n30\n \nBehara et al. \n(2020)\n24\n \nChoudhary SA Nath \nP. et al (2020)\n25\n \nPresent study \n(2025)\n \nHistomorphological \nspectrum\n \nProliferative \nphase\n \n(26.23%)\n \nProliferative \nphase\n \n(38.8%)\n \nProliferative phase\n \n(43%)\n \nProliferative \nphase\n \n(38.7%)\n \nProliferative phase\n \n(42%)\n \nProliferative phase\n \n(24.7%)\n \n \nBCL\n-\n2 expression was positive in 37.3% of cases, with the \nhighest expression in functional causes, particularly in the \nproliferative\n-\nphase endometrium (67.6%). This is in \nagreement with findings by\n \nA.Gompel et al (1994)\n43\n, \nVaskivuo et al (2000)\n44\n, Mertens H J MM etal et al (2002)\n4\n5\n, \nJabbour et al. (2021)\n46\n, who reported that BCL\n-\n2 is highly \nexpressed in estrogen\n-\ndominant conditions, where it plays a \nrole in preventing apoptosis and promoting endometrial cell \nsurvival. However, BCL\n-\n2 expression was significa\nntly lower \nin malignancies (33.3%), which is consistent with research by \nShukla et al. (2022)\n47\n, who demonstrated that BCL\n-\n2 \ndownregulation is associated with apoptotic activation in \nendometrial carcinoma. This suggests that BCL\n-\n2 may serve \nas a biomarker to differentiate benign proliferative conditions \nfrom malignant transformations.\n \n \nKi\n-\n67 expression was positive in 36.7% of cases, with the \nhighest positivity in endometrial hyperplasia without atypia \n(90.9%) and endometrial carcinoma (66.7%). These findings \nare consistent with studies by Dehghani et al. (2021)\n4\n8\n, who \nreported that Ki\n-\n67 is a strong marker of proliferative activity \nand is significantly expressed in hyperplastic and malignant \nendometrial conditions. Study done by Robert et al. (2000)\n49\n \nreported Ki\n-\n67 had mean index high in hyperplasia without \natypia. Morsi, Hassan et al. \n(2000)\n5\n0\n \nshowed high expression \nin hyperplasia without atypia and increased expression as \ngrade of endometrial carcinoma progressed. Olega B. Ioffe et \nal. (1998)\n51\n \nshowed Ki\n-\n67 index was increased in endometrial \ncarcinoma while decrease in hyperplasia. However, in present \nstudy, Ki\n-\n67 expression in postmenopausal bleeding cases \n(66.7%) was higher than in some other studies. Feldman et al. \n(2021)\n52\n \nfound lower Ki\n-\n67 expression in postmenopausal \nendometrium unless malignancy was present. The higher Ki\n-\n67 expr\nession observed in postmenopausal cases in present \nstudy may be due to the inclusion of a higher proportion of \npremalignant lesions, which exhibit increased cellular \nproliferation.\n \n \nStudies\n \nA.Gompel et \nal(1994)\n43\n \nOlga B. Ioff et \nal(1998)\n51\n \nRobert et \nal(2000)\n49\n \nVaskivuo et al \n(2000)\n44\n \nMorsi Hassan et \nal(2000)\n5\n0\n \nMertens HJMM \netal (2002)\n45\n \nPresent Study \n(2025)\n \nBCL\n-\n2 \nexpression\n \nIncreased in \nproliferative phase, \ndisappeared in \nsecretory phase\n \nDecrease in \nhyperplasia and \ncarcinoma\n \n-\n \nIncreased in \nproliferative \nphase, decreased \nin secretory \nphase\n \nHigh in \nhyperplasia \nwithout atypia, \nweak in \nendometrial \ncarcinoma\n \nIncreased in \nproliferative \nphase, decreased \nin secretory \nphase\n \nHigh in \nproliferative \nphase\n \nKi\n-\n67 \nexpression\n \n \nIncrease in \ncarcinoma\n \nLower \nexpression in \nhyperplasia \nwith atypia than \nin without \natypia\n \nIncreased in \nproliferative \nphase, \nd\necreased \nin secretory \nphase\n \nIncreased \nexpression in \nendometrial \ncarcinoma and \nhyperplasia \nwithout atypia\n \nIncreased in \nproliferative \nphase, decreased \nin secretory \nphase\n \nHigh in \nhyperplasia \nwithout atypia \nand endometrial \ncacinoma\n \n \n5.\n \nConclusion\n \n \nAbnormal uterine bleeding (AUB) is a common \ngynecological\n \ncomplaint affecting women of all age groups, \nwith causes ranging from hormonal imbalances to organic \npathologies such as endometrial hyperplasia and malignancy. \nHistopathological examination plays a crucial role in \ndiagnosing AUB, while immunohistochemica\nl markers like \nBCL\n-\n2 and Ki\n-\n67 provide additional insights into endometrial \ncell proliferation and apoptosis\n. The highest incidence of \nAUB was observed in perimenopausal women followed by \nreproductive\n-\nage women and postmenopausal women. \nMenorrhagia was the\n \nmost common bleeding pattern. \nFunctional causes were more prevalent than organic causes, \nwith proliferative\n-\nphase endometrium and disordered \nproliferative endometrium being the most frequently \nobserved histopathological patterns. Endometrial polyp and \nhyp\nerplasia were the leading organic cause\ns\n. Endometrial \ncarcinoma was primar\ni\nly observed in post\n-\n \nmenopausal \nwomen, so there is need for careful evalu\na\ntion in this age \ngroup.\n \n \nImmunohistochemical analysis showed BCL\n-\n2 positivity \npredominantly in functional causes such as proliferative\n-\nphase endometrium and secretory\n-\nphase endometrium. \nLower BCL\n-\n2 expression was observed in endometrial \nmalignancies, indicating its potential role \nin apoptotic \nregulation. Ki\n-\n67 expression was high in endometrial \nhyperplasia and endometrial carcinoma, suggesting its strong \nassociation with cellular proliferation. These \nfindings suggest \nBCl\n-\n2 and Ki\n-\n67 can\n \nbe\n \nused as useful marker in identifying \nhigh \nrisk cases and differentiating benign from malignant \nconditions.\n \n \n6.\n \nRecommendations\n \n \nAll women presenting with abnormal uterine bleeding, \nespecially in the perimenopausal and postmenopausal age \nPaper ID: SR25920133229\nDOI: https://dx.doi.org/10.21275/SR25920133229\n1101 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 9, September 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \ngroups, should undergo endometrial sampling for \nhistopathological evaluation. Early identification of \nfunctional versus organic causes is essential to guide timely \nmanagement. Routine use of immunohistochemistry in \nsuspicious cases can aid in detecting pre\nmalignant and \nmalignant lesions.\n \n \nFinancial support and sponsorship \n \nNil. \n \n \nConflicts of interest \n \nThere are no conflicts of interest.\n \n \nReferences\n \n \n[1]\n \nWhitaker L. Critchley HOD. Abnormal uterine \nbleeding. Best Pract Res Clin Obstet Gynaecol. 2016 \nJul;34(1):54\n-\n65 \n \n[2]\n \nMaheux\n-\nLacroix S. Mennen J, Amold A, Budden A, \nNesbitt\n-\nHawes E. Won H, et al. The need for further \nsurgical intervention following primary hysteroscopic \nmorcellation of submucosal leiomyomas in women with \nabnormal uterine bleeding. Aust NZJ Obstet Gynaecol\n. \n2018 Oct;58(5):570\n-\n5. \n \n[3]\n \nCheong Y , Cameron IT, Critchley HOD. Abnormal \nuterine bleeding. Br Med Bull 2017 Sep;123(1):103\n-\n14 \n \n[4]\n \nSinha P, Yadav N. Gupta U. Use of Hysteroscopy in \nAbnormal Uterine Bleeding An Edge Over \nHistopathological Examination. 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