Perimenopausal bleeding: Patterns, pathology, response to progestins and clinical outcome

Area of Science:

• Gynecology
• Reproductive Endocrinology

Background:

• Abnormal uterine bleeding (AUB) is common in perimenopausal women.
• While often dysfunctional, organic endometrial lesions necessitate accurate diagnosis and management.

Purpose of the Study:

• To evaluate the response to progestin therapy in perimenopausal patients with endometrial lesions.
• To determine the clinical outcomes of abnormal uterine bleeding in this demographic.

Main Methods:

• Prospective observational study of 400 perimenopausal patients with abnormal uterine bleeding and diagnosed endometrial lesions.
• Histopathological diagnosis and follow-up of patients receiving progestin therapy.

Main Results:

• Menorrhagia was the most frequent bleeding pattern (67.5%).
• Simple endometrial hyperplasia without atypia was the most common pathology (31%).
• Progestin therapy led to regression in 70.4% of non-atypical hyperplasia cases, with persistence in 26.7% and progression to atypia in 2.9%.

Conclusions:

• Perimenopausal bleeding has diverse origins, with organic endometrial lesions being a significant concern.
• Endometrial sampling and expert interpretation are crucial for optimal clinical outcomes.
• Low-dose progestin therapy ( < 20 mg/day) for 4-5 months appears effective for non-atypical endometrial hyperplasia.