ENDOMETRIAL BIOPSY IN DUB

OBJECTIVE: To determine the incidence of abnormal endometrial histolog y in women with dysfunctional uterine bleeding and to evaluate the pre dictive value of risk factors for endometrial cancer in women with dys functional uterine bleeding (DUB). STUDY DESIGN: We conducted a retros pective review of 310 women with DUB who underwent endometrial biopsy. The risk factors for abnormal endometrial histology included menstrua l cycle irregularity, diabetes, nulliparity, hypertension, weight grea ter than or equal to 100 kg and age greater than or equal to 40 years. The incidence of endometrial abnormalities was determined, and the pr edictive value of combinations of risk factors was assessed using step wise logistic re giession. RESULTS: Twenty-one patients (6.7%) had abn ormal endometrial biopsies. Menstrual cycle irregularity (P=.0001), ag e greater than or equal to 40 years (P=.022) and hypertension (P=.058) were independently significant risk factors for abnormal endometrial histology. The probability of abnormal endometrial histology in a prem enopausal woman with DUB whose cycle was regular was < 1%. The presenc e of menstrual cycle irregularity increased the probability of abnorma l endometrial histology to 14.3%. CONCLUSION: The patient who presents with DUB and a history of menstrual cycle irregularity warrants an en dometrial biopsy, regardless of age. The current clinical emphasis on age (especially greater than or equal to 40 years) as justification fo r endometrial biopsy is unwarranted in patients with DUB. More careful selection of patients for endometrial biopsy will mean that fewer wom en are unnecessarily exposed to the discomfort and risk of complicatio ns associated with endometrial biopsy.