A study to determine association of ovarian morphology with endometrial morphology and postmenopausal bleeding conducted in a tertiary care hospital

Postmenopausal ovaries are chiefly composed of stroma and continue to have potential for hormonal synthesis. Ovarian stromal hyperplasia and endometrial hyperplasia/cancer are often identified concurrently, suggesting that ovarian morphology may represent a marker of cancer risk among older women.

An observational analytical cross-sectional study was conducted. Morphology of endometrium and ovary was studied in the specimens of total abdominal hysterectomy with unilateral/bilateral salpingo-oopherectomy in females with postmenopausal bleeding.

Forty two specimens of total abdominal hysterectomy with bilateral hysterectomy were studied. Age of patients ranged from 45 to 80 years. Majority of patients were in the age group 45-55 years. Average duration of menopause was 6.2 years ranging from 1.5years to 30 years. Most common endometrial pathology noted was proliferative endometrium (20, 47.6%) followed by primary endometrial malignancy and endometrial polyp (14.3%). Majority of the ovaries were unremarkable (35.8%). Most common change noted was stromal hyperplasia (31.4%).

The study did not find statistically significant association between stromal hyperplasia/large ovary and high risk endometrial pathology. Metrics

Cytology of the normal endometrium cycling and postmenopausal. Available at: https://www.karger. com/WebMaterial/ShowFile/893368. Accessed on 20 October 2021. Stacey ME. Histology for pathologists. Philadelphia: Wolters Kluwer Health/Lippincott; 2012. Davison SL, Bell R, Donath S, Montalto JG, Davis SR. Androgen levels in adult females: changes with age, menopause and oophorectomy. J Clin Endocrinol Metab. 2005;90:3847-53. Jongen VHWM, Sluijmer AV, Heineman MJ. The postmenopausal ovary as an androgen-producing gland; hypothesis on the etiology of endometrial cancer. Maturitas. 2002;43:77-85. Elfayomy AK, El Tarhouny SA. Ovarian volume assessment in relation to histologic findings and sex hormone levels in women with postmenopausal bleeding and thickened endometrium. Ann Saudi Med. 2012;32(6):588-92. Kurman RJ, Ellenson LH, Ronnette BM eds. Blaustein’s Pathology of Female Genital tract. 5th ed. New York: Springer Verlag; 2002. Hendrickson MR, Longacre TA, Kempson RL eds. Sternberg’s Diagnostic Surgical Pathology. 4th ed. Philadelphia: Lippincott Williams; 2004. Bentley RC, Mutter GL , Robboy SJ eds. Robboy’s pathology of the female reproductive tract. 2nd ed. USA: Elsevier; 2009. Zaino R, Carinelli SG, Ellenson LH, Eng C, Katabuchi H, Konishi I, et al. WHO classification of tumours of female reproductive organ. 4th ed. France: international agency for research on cancer; 2014. Pavlik EJ, DePriest PD, Gallion HH, Ueland FR, Reedy MB, Kryscio RJ et al. Ovarian volume related to age. Gynecol Oncol. 2000;77(3):410-2. Callen P. Ultrasonography in obstetrics and gynaecology, 5th ed. Philadelphia: Saunders; 2008. Adeeb N, Nur-Azurah AG, Ong FB, Seri SS, Shamsuddin K, Noor-Aini MY. Normograms of ovarian volume, uterine size and endometrial thickness in urban midlife Malaysia women. Med Health. 2007;2(1):66-79. Purandare CN, Khadilkar SS, Doshi HU. Menopause; current concepts. 1st ed. India: Jaypee Brothers; 2004. Kumar P, Malhotra N. Jeffcoat’s principles of gynaecology. 7th ed. New Delhi: Jaypee Brothers Medical Publishers; 2008. Gredmark T, Kvint S, Havel G, Mattson L. Histopathological findings in women with postmenopausal bleeding. Bri J Obstet Gynaecol. 1995;102:133-6. Jongen VH, Hollema H, Van Der Zee AG, Santema JG, Heineman MJ. Ovarian stromal hyperplasia and ovarian vein steroid levels in relation to endometrioid endometrial cancer. BJOG. 2003; 110(7):690-5. Jongen VH, Sluijmer AV, Heineman MJ. The postmenopausal ovary as an androgen-producing gland; hypothesis on the etiology of endometrial cancer. Maturitas. 2002;43(2):77-85. Fogle RH, Stanczyk FZ, Zhang X, Paulson RJ. Ovarian androgen production in postmenopausal women. J Clin Endocrinol Metab. 2007;92(8):3040-3. Havelock JC, Rainey WE, Bradshaw KD, Carr BR. The postmenopausal ovary displays a unique pattern of steroidogenic enzyme expression. Human Reprod. 2005;21(1):309-17. Woll E, Hertig AT, Smith GV, Johnson LC. The ovary in endometrial carcinoma: with notes on the morphological history of the aging ovary. Am J Obstet Gynaecol. 1948;56(4):617-33. Ghosh S, Mukherjee S, Bandopadhyay G. A Study to Correlate Endometrial Hyperplasia with Ovarian Stromal Change. Rec Adv Path Lab Med. 2018;4(1): 1-5. Jones HO, Brewer JI. A study of the ovaries and endometrium of patients with fundal carcinomas. Am J Obstet Gynecol. 1941;42(2):207-17. Mossman HW, Koering MJ, Ferry D. Cyclic changes of interstitial gland tissue of the human ovary. Am J Anat. 1964:235-55. Zheleznov BI, Serov VN, Mamaeva GM. Hyperplastic ovarian processes from the clinico-morphological aspect. Akush Ginekol. 1994;45(2): 35-40. Aviram R, Gassner G, Markovitch O, Cohen I, Fishman A, Tepper R.Volumes of normal ovaries, ovaries with benign lesions, and ovaries with cancer in menopausal women: Is there an optimal cut off value to predict malignancy?. J Clin Ultrasound. 2008;36(1):1-5. Sherman ME, Madigan MP, Lacey JV, Garcia-Closas M, Potischman N, Carreon JD, et al. Ovarian volumes among women with endometrial carcinoma: associations with risk factors and serum hormones. Gynecol Oncol. 2007;107(3):431-5. Adeeb N, Nur-Azurah AG, Ong FB, Seri SS, Shamsuddin K, Noor-Aini MY. Normograms of ovarian volume, uterine size and endometrial thickness in urban midlife Malaysia women. Med Health. 2007;2(1):66-79.