OPTIMIZATION OF DIAGNOSIS AND MANAGEMENT STRATEGIES FOR ABNORMAL UTERINE BLEEDING IN THE PREMENOPAUSAL PERIOD

Abstract

Objective: To evaluate and optimize a standardized algorithm for the diagnosis and management of abnormal uterine bleeding (AUB) in premenopausal women, aiming to improve diagnostic accuracy for significant endometrial pathology and streamline therapeutic interventions. Methods: A prospective observational study was conducted at the clinical base of the 2nd Department of Obstetrics and Gynecology, Andijan State Medical Institute. A total of 133 premenopausal women (aged 40-55) presenting with AUB were included. All patients underwent a standardized diagnostic protocol involving detailed history, transvaginal ultrasonography (TVUS), followed by office hysteroscopy and directed endometrial biopsy, regardless of endometrial thickness. This "optimized" pathway was compared conceptually to traditional management (e.g., blind D&C). Diagnostic accuracy (sensitivity, specificity) of the algorithm for detecting intrauterine pathology (polyps, fibroids, hyperplasia, malignancy) was the primary outcome. Results: The mean age of the 133 patients was 47.8 ± 3.4 years. TVUS alone identified suspected pathology in 78.9% (n=105) of cases, but findings were non-specific in 21.1% (n=28). The optimized algorithm (TVUS + hysteroscopy) yielded a definitive diagnosis in 98.5% (n=131) of cases. Histopathology revealed endometrial polyps in 34.6% (n=46), submucosal fibroids in 27.8% (n=37), disordered proliferative endometrium in 15.0% (n=20), endometrial hyperplasia in 18.0% (n=24, of which 7 were atypical), and endometrial carcinoma in 4.5% (n=6). Hysteroscopy identified focal lesions missed by ultrasound in 12.8% of cases. The algorithm demonstrated a sensitivity of 98.2% and specificity of 95.1% for detecting significant intrauterine pathology requiring intervention, far exceeding historical rates of blind curettage. Conclusion: An optimized diagnostic algorithm incorporating universal office hysteroscopy with directed biopsy provides superior diagnostic accuracy compared to traditional pathways for premenopausal AUB. This approach ensures timely identification of endometrial hyperplasia and malignancy, prevents unnecessary interventions, and allows for targeted, minimally invasive treatment.