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Heavy menstrual bleeding is common and debilitating but the causes remain ill defined. Rates of obesity in women are increasing and its impact on menstrual blood loss (MBL) is unknown. Therefore, we quantified BMI and MBL in women not taking hormones and with regular menstrual cycles and revealed a positive correlation. In a mouse model of simulated menstruation, diet-induced obesity also resulted in delayed endometrial repair, a surrogate marker for MBL. BrdU staining of mouse uterine tissue revealed decreased proliferation during menstruation in the luminal epithelium of mice on a high-fat diet. Menstruation is known to initiate local endometrial inflammation and endometrial hypoxia; hence, the impact of body weight on these processes was investigated. A panel of hypoxia-regulated genes (VEGF, ADM, LDHA, SLC2A1) showed consistently higher mean values in the endometrium of women with obesity and in uteri of mice with increased weight vs normal controls, although statistical significance was not reached. The inflammatory mediators, Tnf and Il6 were significantly increased in the uterus of mice on a high-fat diet, consistent with a pro-inflammatory local endometrial environment in these mice. In conclusion, obesity was associated with increased MBL in women. Mice given a high-fat diet had delayed endometrial repair at menstruation and provided a model in which to study the influence of obesity on menstrual physiology. Our results indicate that obesity results in a more pro-inflammatory local endometrial environment at menstruation, which may delay endometrial repair and increase menstrual blood loss.

Background: The overall clinical significance of the finding of endometrial abnormalities in predicting premalignant/malignant endometrial lesions is still incompletely determined. For this reason the management, surgical or expectant, of women in which an endometrial abnormality has been detected is debated.Methods: This retrospective study was carried out on 1020 consecutive women, 403 premenopausal and 617 postmenopausal, who underwent operative hysteroscopy in a University Hospital for suspected endometrial abnormalities, which were detected by transvaginal ultrasound (TVS) and/or office hysteroscopy. In these women, the clinical characteristics and findings at TVS and hysteroscopy were evaluated in relation to the presence/absence of premalignant/malignant endometrial lesions at pathology report.Results: The clinical characteristics considered were significantly different when the study women were compared according to their menopausal status. Premalignant/malignant lesions were found in 34/1020 (3.33%) women. Complex hyperplasia with atypia and endometrial cancer were detected in 22 (2.15%) and 12 (1.17%) cases, respectively. The postmenopausal women had a significantly higher risk of premalignant/malignant lesions than premenopausal women (O.R. = 5.098 [95% C.I.: 1.782-14.582], P < 0.005). This risk was even higher when abnormal uterine bleeding (AUB) was present (O.R. = 5.20 [95% C.I.: 2.38-11.35], P < 0.0001). The most significant associations with premalignant/malignant endometrial lesions were BMI, AUB in postmenopause, overall polyp size, atypical aspect of endometrial polyps at hysteroscopy, postmenopausal status, diabetes mellitus and patient age.Conclusions: The results of the present study suggest that the proper, aggressive or expectant, management of endometrial abnormalities should take into account both ultrasonographic and hysteroscopic findings together with the specific clinical characteristics of the patients. [ABSTRACT FROM AUTHOR]

During the last twenty years, the diagnostic approach to endometrial pathology has radically evolved. For over a century, intrauterine blind biopsy techniques were considered the gold standard procedure for the histopathological diagnosis of intrauterine diseases. The advent of hysteroscopy, which made it possible to directly visualize the uterine cavity, and the subsequent miniaturization of the instruments allowing its use in the office setting without anesthesia are considered game-changers. To date, it is feasible to retrieve a targeted eye specimen of endometrial tissue with little or no discomfort for the patient in the office setting. To pursue this aim, several technological upgrades have improved the diagnostic accuracy of hysteroscopic endometrial biopsy. In this paper we provide an up-to-date review of the latest evidence regarding indications, instrumentations, and techniques for hysteroscopic endometrial biopsy, to help the operator in providing an adequate endometrial sampling for histopathological analysis. [ABSTRACT FROM AUTHOR]

Background: Iraq still considered one of the countries in the region with high prevalence of TB, there are about 20000 patients, accounts for 3% of the total number of cases, and the estimated death from TB exceeds 4000 per year. TB in Iraq until nowadays considered a health, public and social problem, and because of the wars and political problems, many programs, campaigns, and researches were hundred by this situation Objective: To detect endometrial Tuberculosis in women complaining from AUB (abnormal uterine bleeding) using real time PCR method of assessment via taking an endocervical swab. Patients and methods: Prospective cross-sectional study carried at Department of obstetrics and gynecology in Baghdad teaching hospital /medical city over a period of eight months starting from Octuber2019, to Augest2020. A total of 60 women complaining from abnormal uterine bleeding(AUB) who were scheduled to have endometrial biopsy for histopathology by dilatation and curettage(D&C), endocervical swab assessed for female genital tuberculosis(FGTB) by real time PCR. Results: Out of 60 samples taken 6 were positive by real time PCR 10%, while there was only one case positive by histopathology 1.66% which was also positive by PCR the same patient gave history of pulmonary TB and received a nine month course of treatment, according to these findings the sensitivity of PCR found to be 100% while the specificity92% and an accuracy of 92%. Conclusion: Real time PCR considered one of the valuable diagnostic tools for mycobacterium tuberculosis, and because Iraq still showing high incidence of the disease, one should suspect mycobacterium tuberculosis in any women complaining from abnormal uterine bleeding and offer PCR in addition to other diagnostic modalities, luckily it will allow treatment at an early stage of the disease. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal uterine bleeding (AUB) is one of the most common reason for visits to gynecologists. Endometrial biopsy is a routine procedure in gynecological practice to detect the etiology of AUB and to exclude precancerous and cancerous lesions of the endometrium. The aim of this study was to assess the causes of AUB among women, who had undergone invasive diagnostics due to AUB. Material and methods: This study was carried among 531 women, who had undergone invasive diagnostics due to AUB between January 2018 and December 2018. Women were divided into premenopausal (with perimenopausal) and postmenopausal groups. Transvaginal ultrasound was performed. Endometrial thickness was compared with histopathological results in each subgroup and statistically analyzed. The incidence of histopathological findings and rate of anemia were also analyzed. Results: In our series of patients the most common cause of AUB based on histopathological results was endometrial polyp, both before and after menopause. The most frequent pathologies at ultrasound findings were leiomyomas and endometrial polyps. The incidence of taken together: atypical hyperplasia and endometrial cancer was significantly higher in postmenopausal group (8.58%) than in pre- and perimenopausal (1.35%, p = 0.0001). The median endometrial thickness, both before and after menopause, was significantly greater in patients with pathological than with nonpathological endometrium. 31% of women with abnormal uterine bleeding before menopause and 10% after menopause had anemia. Conclusions: Measurements of endometrial thickness seems to be acceptable initial diagnostic tool to distinguish between benign and pathological endometrial changes both before and after menopause. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal uterine bleeding should include all abnormalities of menstruation like hypermenorrhea as well as hypomenorrhea. Abnormal bleeding is synonymous only with excessive menstruation. Abnormal uterine bleeding (AUB) is one of the most common conditions for which women consult their gynaecologists. Material and methods: This was a retrospective study done in Dhiraj Hospital over a period of six month on patients presenting with AUB. Patients were selected based on clinical details. The study material included a total no. of 60 patients which were inclusive of endometrial samples. Patients with isolated endometrial causes of abnormal uterine bleeding were included for this study and those with pregnancy, profusely bleeding per vaginum, anemic patients were excluded. All specimens were transported in 10% formalin to the pathology laboratory. The gross morphology was recorded. Microscopic examination was done by two pathologist so as to reduce inter observer findings. The data collected for this study was statistically analyzed using chi-square test. Results: In the present study, maximum age occurrence was between 40-49 years, the youngest patient in this study was 22 year old and the oldest was 54 year. Majority of the patients presented with menorrhagia (50%) followed by post- menopausal bleeding (28.3%). There were 8 cases (13.3%) with polymenorrhagia and 5 patients (8.3%) with metrorrhagia. 36 (60%) normal cases were reported. The diagnosis of 9 (15%) cases of endometrial polyps and endometrial hyperplasia were 10 (16.6%) among them 2 (20%) was hyperplasia with atypia and 8 (80%) were hyperplasia without atypia, atrophic endometrium was present in 2 cases (3.3%), endometritis in 3 cases (5%). Histopathology correctly diagnosed all cases. Conclusion: Histopathological examination after Dilatation and curettage is necessary tool for ruling out the organic pathology in uterus in those patients where history, systemic and pelvic examination reveals no pathology. Dilatation and curettage findings of organic pathology like TB, endometrial carcinoma, endometrial polyp etc. will rule out at the given cases AUB. Presence of organic pathology tells the case is of AUB. Further it helps in differentiating in ovulatory and an-ovulatory cycle and therefore guides the clinician and hormonal management. [ABSTRACT FROM AUTHOR]