Previous studies describing menses duration and heaviness of flow during the menopausal transition (MT) have been short in duration and limited to white women. We estimated the frequency of and risk factors for prolonged bleeding, spotting and heavy bleeding during the MT in an ethnically diverse population.

The International Federation of Gynecology and Obstetrics (FIGO) systems for nomenclature of symptoms of normal and abnormal uterine bleeding (AUB) in the reproductive years (FIGO AUB System 1) and for classification of causes of AUB (FIGO AUB System 2; PALM-COEIN) were first published together in 2011. The purpose was to harmonize the definitions of normal and abnormal bleeding symptoms and to classify and subclassify underlying potential causes of AUB in the reproductive years to facilitate research, education, and clinical care. The systems were designed to be flexible and to be periodically reviewed and modified as appropriate.To review, clarify, and, where appropriate, revise the previously published systems.To a large extent, the process has been an iterative one involving the FIGO Menstrual Disorders Committee, as well as a number of invited contributions from epidemiologists, gynecologists, and other experts in the field from around the world between 2012 and 2017. Face-to-face meetings have been held in Rome, Vancouver, and Singapore, and have been augmented by a number of teleconferences and other communications designed to evaluate various aspects of the systems. Where substantial change was considered, anonymous voting, in some instances using a modified RAND Delphi technique, was utilized.© 2018 International Federation of Gynecology and Obstetrics.

Introduction: Abnormal Uterine Bleeding (AUB) is a common gynaecological issue affecting a large number of women of reproductive age group, especially during perimenopause. The International Federation of Gynaecology and Obstetrics (FIGO) developed a new classification system, PALM-COEIN, to standardize the terminology, diagnosis, and investigations of the causes of AUB. Therefore, this study aimed to investigate the structural (PALM) and functional (COEIN) component of the PALM-COEIN system in perimenopausal women complaining of AUB.\nMethods: This observational cross-sectional study was done at Gandaki Medical College, Pokhara among 100 perimenopausal women (aged 40 years and above till 1 year beyond menopause) admitted with complaints of AUB. After thorough history and examination, a clinical diagnosis was made as per PALM– COEIN classification. Analysis was done on the relative contributions of the different causes of the PALM and COEIN components. Then, endometrial sampling and hysterectomy specimen was assessed by histopathology.\nResults: A total of 100 women of perimenopausal age groups were studied. PALM and COEIN groups accounted for 72% and 28% respectively. Leiomyoma was the commonest cause of AUB (39%) followed by polyp (22%). Majority of the women (58%) were between 40-44 years of age, 89% were multiparous women. Overweight women (BMI of 25 to 29.99) were 47%. Proliferative endometrium (37.14%) was the most common histopathological finding, followed by secretory endometrium (22.85%).\nConclusions: In perimenopausal women with abnormal uterine bleeding, leiomyoma was the most common structural cause, and proliferative endometrium was the most common non-structural cause. None of the cases were found to have malignancy or coagulopathy

Background: Endometrial hyperplasia (EH) is a frequently encountered gynecological disorder marked by abnormal proliferation of the endometrial lining, often due to prolonged estrogen stimulation without progesterone opposition. It is a precursor to endometrial carcinoma, particularly in high-risk groups such as perimenopausal and postmenopausal women. Abnormal uterine bleeding is the most common clinical presentation. While transvaginal sonography (TVS) and transabdominal sonography (TAS) are routinely used for endometrial evaluation, their diagnostic reliability remains debated.\nObjective: To assess the effectiveness of TVS and TAS in identifying endometrial hyperplasia in perimenopausal and postmenopausal women presenting with abnormal uterine bleeding.\nMethods: A descriptive cross-sectional study was conducted at DHQ Hospital Kasur over three months following ethical approval. A total of 122 women aged ≥40 years, either perimenopausal or postmenopausal, presenting with abnormal uterine bleeding were included using non-probability convenient sampling. Exclusion criteria were recent pregnancy, confirmed malignancy, chemo/radiotherapy, and uterine fibroids. All participants underwent ultrasound using Toshiba Nemio XG equipment—TAS with a 2–5 MHz probe and TVS with a 5–9 MHz probe. Endometrial thickness, echotexture, and clinical symptoms were recorded. Data were analyzed using SPSS v25.0 to calculate sensitivity, specificity, and predictive values.\nResults: Out of 122 participants, 71 (58.2%) were below 50 years and 88 (72.1%) were postmenopausal. Clinical symptoms included pelvic pain (74.6%), heavy bleeding (64.8%), and spotting (35.2%). TAS was performed in 113 cases (92.6%) and TVS in 19 cases (15.6%). Abnormal endometrial thickness was observed in 75 women (61.5%). TVS showed a sensitivity of 100% and specificity of 32.9%, while TAS demonstrated 40% sensitivity and 96.3% specificity. Positive and negative predictive values of TAS were 84.2% and 76.7%, respectively. No statistically significant association was found between clinical symptoms or menopausal status and ultrasound findings (p > 0.05).\nConclusion: Although both TVS and TAS detect endometrial abnormalities, neither modality alone effectively predicts clinical symptom patterns or endometrial thickness. TVS is more suitable for detecting abnormalities, while TAS provides better specificity. A combined diagnostic strategy is advised to ensure accurate assessment and management.

Abnormal uterine bleeding (AUB) is a prevalent clinical concern, particularly in women approaching or beyond menopause. With a myriad of possible etiologies ranging from benign hyperplasia to malignant transformations, accurate diagnosis becomes crucial. This study aims to examine the histopathological patterns of the endometrium in peri- and postmenopausal women presenting with abnormal uterine bleeding and correlate these findings with endometrial thickness (ET) measured by transvaginal sonography (TVS).

Endometrial cancer is the most common gynaecological neoplasia in western countries. Diagnosis of endometrial cancer requires an endometrial biopsy. A good quality endometrial biopsy allows not only the identification of the pathology, but also preoperative histologic subtype classification. Endometrial biopsy can be performed under direct hysteroscopic visualisation, but also using blind sampling techniques.To compare endometrial biopsy performed under direct hysteroscopic visualisation versus blind sampling for the diagnosis of endometrial hyperplasia and cancer.Systematic review and meta-analysis. Electronic databases were searched from their inception until March 2022.We included all studies comparing endometrial biopsy performed under direct hysteroscopic visualisation versus blind endometrial sampling.Sample adequacy, failure rate to detect endometrial cancer or endometrial hyperplasia, and rate of detection of endometrial cancer. The summary measures were reported as relative risk (RR) with 95% of confidence interval (CI).Four studies with a total of 1,295 patients were included. Endometrial biopsy under direct hysteroscopic visualisation was associated with a significantly higher rate of sample adequacy (RR 1.13, 95% CI 1.10 to 1.17), and significantly lower risk of failure to detect endometrial cancer or endometrial hyperplasia (RR 0.16, 95% CI 0.03 to 0.92) compared to blind endometrial sampling. However, there was no significant difference between endometrial biopsies taken under direct hysteroscopic visualisation or blindly, with or without a preceding diagnostic hysteroscopy, in the rate of detection of endometrial cancer (RR 0.18, 95% CI 0.03 to 1.06).Hysteroscopic endometrial biopsy under direct visualisation is associated with significantly higher rate of sample adequacy and is comparable to blind endometrial sampling for the diagnosis of endometrial cancer and precancer.Hysteroscopic endometrial biopsy under direct visualisation would be expected to reduce diagnostic failure for endometrial cancer compared to blind endometrial sampling.

Even though uterine fibroids are a widespread condition, the range of approved medical treatment options remains limited. In fact, only a few drugs are officially approved for the therapy of fibroids. In both the USA and the European Medicines Agency region, selected gonadotropin‐releasing hormone (GnRH) antagonists have been approved for this indication. GnRH analogs are primarily indicated for the preoperative management of uterine fibroids, largely because of their unfavorable long‐term adverse effect profile. The previously approved therapy with ulipristal acetate had to undergo extensive restrictions because of safety concerns. Nevertheless, there are additional medications that may be used in clinical practice. These include combined oral contraceptives, oral progestins, the levonorgestrel‐releasing intrauterine system (LNG‐IUS), and tranexamic acid. Although not specifically approved for the treatment of fibroids, these agents can reduce the intensity of bleeding in cases of heavy menstrual bleeding and thereby improve symptoms and lead to an improved quality of life for the patients.