Clinical and Histopathological Correlation of Hysterectomy Specimen in Abnormal Uterine Bleeding according to PALMCOEIN Classification

Background: Abnormal Uterine Bleeding (AUB) defined as “bleeding that is abnormal in volume, regularity or timing for past 6 months.” It accounts for two thirds of Hysterectomies in premenopausal women. Hysterectomy is indicated when patient symptoms are not improving with medical management. According to FIGO, Causes of AUB is classified as structural and nonstructural causes under PALM – COEIN classification (Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified). Aims: (1) To analyze the clinical causes of AUB. (2) To correlate clinical and histopathological findings in AUB patients undergoing hysterectomy. Methodology: This study is a retrospective observational study. Women who underwent hysterectomy in view of AUB at Trichy SRM Medical college and Hospital over a period of six months from September 2021 to February 2022 were included in the study. About 50 women who underwent hysterectomy in view of AUB during that study period were included in the study. Details like demographic details, duration of AUB, menstrual abnormalities, parity, comorbidities, clinical findings, ultrasound findings, histopathological findings were collected from Medical Records Department (M.R.D) and entered in proforma. The causes of AUB were analyzed, their clinical findings were correlated with post-hysterectomy histopathological findings. Statistical analysis done using SPSS software version 22. Clinical and histopathological correlation was done, p value of <0.05 was considered significant. Results: Majority of the study participants were in the age group of 41-50 years (46%). Dysmenorrhea was reported in 30% of study population. 80% of the women were multiparous. About 54% of cases had anemia. Fibroid was the most common clinical diagnosis(AUB-L) about 48% for which hysterectomy was done. The most common endometrial histopathology was secretory endometrium seen in 46% of cases. There was significant correlation between clinical diagnosis and hysterectomy histopathology findings. Conclusion: Histopathology is mandatory for confirming diagnosis and for further optimal management.