A Unique Case Series of Endometrial Vascular Dystrophy: Rising Incidence and Association With Uterine Pathologies

Endometrial vascular dystrophy (EVD) is a rare hysteroscopic finding characterized by abnormal, tortuous, and dilated endometrial vessels, most often associated with abnormal uterine bleeding (AUB). Despite its potential clinical impact, global literature on EVD remains scant. This case series describes three women diagnosed with EVD. Case 1 involved a 41-year-old multiparous woman presenting with heavy menstrual bleeding in the current cycle, which was earlier than usual; hysteroscopy revealed diffuse bluish, tortuous vessels coexisting with an isthmocele. Case 2 was a 50-year-old nulliparous woman with prolonged AUB and a history of MRI-guided high-intensity focused ultrasound ablation (MR-HIFU); hysteroscopy demonstrated diffuse EVD. Case 3 reported a 45-year-old woman on intermittent exogenous progesterone for a year, whose EVD distribution was sparse and observed alongside intrauterine adhesions. In each case, histopathology confirmed secretory endometrium with or without dilated glands. All the patients had symptom management. Notably, EVD changes coexisted with diverse endometrial pathological entities but were absent in isthmocele regions. A novel possible association of EVD with post-HIFU uterine changes was observed. This series illustrates the diagnostic value of hysteroscopy in identifying EVD as an under-recognized cause of AUB and highlights its possible coexistence with other endometrial pathologies. EVD appears benign and often self-limiting; however, its expanded recognition is essential, and further research is warranted to elucidate its long-term clinical significance, associations, and targeted management strategies.