Clinicopathological Profile and Diagnostic Concordance of Abnormal Uterine Bleeding in Women Aged after 40 Years: A Hospital-Based Cross-Sectional Study in Bangladesh

Quazi Rubyata Sania, Umme Tania Nasrin, N. Laila
In: TAJ: Journal of Teachers Association · 2026 · vol. 39(2) , pp. 202–209 · doi:10.70818/taj.v39i2.0695 · W7163143649
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This study evaluated the clinicopathological profile of abnormal uterine bleeding in Bangladeshi women over 40, finding strong diagnostic agreement between clinical, ultrasonographic, and histopathological findings, with malignancy associated with endometrial thickness ≥20 mm.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-06 ⓘ

This hospital-based retrospective cross-sectional study evaluated the clinicopathological profile of abnormal uterine bleeding (AUB) in 50 women aged over 40 in Bangladesh who underwent hysterectomy, comparing clinical impressions and transvaginal ultrasonography (endometrial thickness) with histopathology. The authors found menorrhagia (64%) and anemia (92%) were common, fibroids were the most frequent clinical diagnosis (46%) and were confirmed in 48% by histopathology, while adenomyosis showed higher histopathology prevalence than clinical and ultrasound estimates (18% vs 8% and 10%). Overall diagnostic agreement between clinical/USG and histopathology was strong (Cohen’s kappa κ=0.82), with a significant association between endometrial thickness and histopathology (p<0.001), and carcinoma occurring at endometrial thickness ≥20 mm. The study’s key limitation is that it is based on a small, hospital-based sample restricted to women who had hysterectomy. This paper is centrally about endometriosis and adenomyosis—specifically adenomyosis as part of the structural causes of abnormal uterine bleeding assessed via clinical, ultrasound, and histopathological concordance.

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Abstract

Background: Abnormal uterine bleeding (AUB) in women aged after 40 years is a common gynecological problem and is frequently associated with underlying structural pathology, including leiomyoma, adenomyosis, endometrial hyperplasia and malignancy. In this age group, the risk of endometrial carcinoma increases, necessitating accurate and timely diagnosis through a combination of clinical, radiological and histopathological evaluation. Objective: To evaluate the clinicopathological profile of AUB and assess diagnostic concordance between clinical, ultrasonographic and histopathological findings in women aged after 40 years in a tertiary care setting in Bangladesh. Study Design: This hospital-based retrospective cross-sectional study was conducted at Sir Salimullah Medical College & Mitford Hospital, Dhaka, over 6 months (May–October 2014). Fifty women aged more than 40 years with AUB who underwent hysterectomy were included. Clinical features, ultrasonographic findings including endometrial thickness, and histopathological diagnoses were analyzed. Diagnostic agreement was assessed using Cohen’s kappa (κ), and associations were evaluated using the chi-square test (P < .05). Results: The mean age was 45.8 ± 4.6 years, with most patients aged 41–45 years (56%). Menorrhagia (64%) and anemia (92%) were common. Fibroid uterus was the leading clinical diagnosis (46%) and was confirmed in 48% on histopathology. Adenomyosis was detected in 8% clinically, 10% on USG, and 18% on histopathology. It showed histopathology Proliferative endometrium (44%) and carcinoma (4%) were observed. Diagnostic agreement was strong (κ = 0.82), with significant association between endometrial thickness and histopathology (p < 0.001); carcinoma occurred at ≥20 mm. Conclusion: AUB in women aged after 40 years is commonly associated with significant structural pathology and malignancy risk. The strong correlation between clinical, radiological, and histopathological findings in this Bangladesh-based population reinforces the reliability of a multimodal diagnostic approach, enhancing diagnostic precision and informing appropriate clinical decision-making.

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