Endometrial Malignancy and Hyperplasia as Causes of Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) can depend on various causes, and there are various risk factors, which mostly depend on the woman’s age. In the reproductive years, abnormal uterine bleeding may result from pregnancy, miscarriage, ectopic pregnancy, hormonal disorders, cervical or endometrial polyps, or, more rarely, endometrial hyperplasias and even occasional carcinomas. In contrast, in the postmenopausal age, the most common cause of abnormal uterine bleeding is the presence of endometrial polyps, followed by endometrial atrophy. Although less common, but more critical for women’s health, are endometrial hyperplasia, with or without atypia, and endometrial cancer. The International Federation of Gynecology and Obstetrics has developed two AUB classification systems to standardize definitions, nomenclature, and underlying categories of etiology. Histological diagnosis is mandatory for the planning of clinical cares. Nevertheless, according to the American College of Obstetricians and Gynecologists (ACOG) in their 2012 Practice Bulletin, biopsy accuracy is estimated at 100% only if the sample is adequately obtained and when the endometrial process is global. Several modalities serve to obtain endometrial samples, including but not limited to classic dilation and curettage procedures (D&C), hysteroscopy, and suction piston sampling. However, sampling with miniature endometrial biopsy outpatient devices like Pipelle is the first-choice approach. Office-based device such as Pipelle endometrial sampling is widely used to diagnose endometrial cancer in women with abnormal uterine and postmenopausal bleeding. The method became very useful due to the ease and simplicity of the procedure, the availability of a device, and the high sensitivity in detecting endometrial cancer. However, none of the abovementioned methods allow scraping the whole uterine cavity; therefore, the clinician must choose the appropriate technique for each patient.