Abstract：
Abnormal uterine bleeding (AUB) is the most common and frequent presenting complaint in Gynaecology in all age group especially in perimenopausal and postmenopausal women. The spectrum of AUB in women of our country includes a wide varieties of organic pathology. The objective of this study was to assess the role of endometrial thickness as a predictor of endometrial malignancy among the women presenting with AUB. This cross-sectional descriptive type of observational study was conducted among 122 women of perimenopausal (40-50 years) and 87 women of postmenopausal (>50 years) age group presenting with AUB in the Obstetrics and Gynaecology department of Mymensingh Medical College Hospital, Bangladesh from February 2020 to August 2021. These patients were subjected to a detailed history and meticulous general, systemic and local examination. The relevant investigations like Transvaginal Sonography (TVS) followed by endometrial biopsy by dilatation and curettage were done in all study participants. Most of the women were in the age group 41-45 years in perimenopause and 51-55 years in postmenopause. Mean±SD was 45.8±4.1 years in perimenopause and 56.3±6.4 years in postmenopause. There was statistical significance in developing endometrial malignancy regarding risk factors of nulliparity, Hypertention (HTN), Diabetes mellitus (DM) and hormone intake between perimenopause and postmenopause. Endometrial thickness was measured in perimenopause and postmenopause. Mean±SD of Endometrial thickness (ET) in perimenopause and postmenopause was 11.3±4.4mm and 7.2±6.3mm with statistical significance (p<0.001). Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) and accuracy of TVS were 85.5%, 67.4%, 81.2%, 73.8% and 78.7% in perimenopause and 85.9%, 20%, 89%, 75% & 83.9% in postmenopause. Cut off limit of ET in detection of endometrial malignancy was 18.5mm with sensitivity 74.8% and specificity 63.6% in perimenopause and 12.2mm with sensitivity 81.0% and specificity 65.8% in postmenopausal women. Women with AUB, endometrial malignancy should be suspected when endometrial thickness on TVS >18.5mm and >12.2mm in perimenopause and postmenopausal age group respectively. TVS has high sensitivity in detection of endometrial malignancy both in perimenopausal and postmenopausal women with AUB and TVS is a reliable, noninvasive method.
摘要：
异常子宫出血（AUB）是所有年龄段妇科中最常见和最常见的主诉，尤其是围绝经期和绝经后妇女。我国妇女的AUB谱包括各种有机病理学。这项研究的目的是评估子宫内膜厚度作为AUB患者子宫内膜恶性肿瘤预测因子的作用。这项横断面描述性观察性研究是在Mymensingh医学院附属医院妇产科的122名围绝经期（40-50岁）妇女和87名绝经后（>50岁）妇女中进行的，孟加拉国从2020年2月到2021年8月。对这些患者进行了详细的病史和细致的一般，系统和局部检查。在所有研究参与者中进行了相关的调查，例如经阴道超声检查（TVS），然后通过扩张和刮宫进行子宫内膜活检。大多数妇女在围绝经期为41-45岁，绝经后为51-55岁。围绝经期平均值±SD为45.8±4.1年，绝经后平均值为56.3±6.4年。子宫内膜恶性肿瘤的发病因素有统计学意义，高血压(HTN)，围绝经期和绝经后之间的糖尿病（DM）和激素摄入量。在围绝经期和绝经后测量子宫内膜厚度。围绝经期和绝经后子宫内膜厚度(ET)的平均值±SD分别为11.3±4.4mm和7.2±6.3mm,差异有统计学意义(p<0.001)。灵敏度,特异性，阳性预测值（PPV），阴性预测值（NPV）和TVS的准确性为85.5％，67.4%,81.2%,围绝经期分别为73.8%和78.7%和85.9%,20%,89%,75%和83.9%在绝经后。围绝经期ET检测子宫内膜恶性肿瘤的截断值为18.5mm，敏感性为74.8％，特异性为63.6％，绝经后妇女为12.2mm，敏感性为81.0％，特异性为65.8％。女性AUB，围绝经期和绝经后年龄组分别在TVS>18.5mm和>12.2mm时，应怀疑子宫内膜恶性。TVS对围绝经期和绝经后妇女子宫内膜恶性肿瘤的检测具有较高的敏感性,非侵入性方法。
