Premenopausal abnormal uterine bleeding and risk of endometrial cancer 

Pennant, M., Mehta, R., Moody, P., Hackett, G., Prentice, A., Sharp, S., & Lakshman, R. (2017, February). Premenopausal abnormal uterine bleeding and risk of endometrial cancer. Retrieved March 16, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5297977/ 

I chose to present this article together with my case presentation of an 18-year-old female presenting to the emergency room with dizziness after several months of abnormal uterine bleeding (AUB). This article is a systematic review that aimed to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with AUB. Biopsies are often done in pre-menopausal women with AUB but the risk of endometrial cancer and atypical hyperplasia is not clear. They searched articles on PubMed, Embase, and Cochrane library for studies on rates of endometrial cancer and atypical hyperplasia in premenopausal women with AUB.

They included 65 articles in their analysis. They found the risk of endometrial cancer to be 0.33% with a 95% CI, n=29,059 with a total of 97. The risk of atypical endometrial hyperplasia was 1.31% with 95% CI, n=15.772 with a total of 2017 cases. The risk of endometrial cancer was lower with heavy menstrual bleeding as compared to women experiencing intermenstrual bleeding (0.11%, n=8352 with a total of 9 cases vs. 0.52%, n=3109 with a total of 14 cases). 

They concluded that the risk of endometrial cancer and atypical endometrial hyperplasia in premenopausal women with AUB is low, and premenopausal women should initially be treated with medical management. If conventional medical management fails the next steps should include further investigation such as with an endometrial biopsy.  The younger the patient is the lower the risk of endometrial cancer and atypical hyperplasia. 

The article acknowledged that further research needs to be done in certain areas. The current data does not specify an age and which there is an increased risk and therefore further research is necessary to determine an age for referral for further workup following failure of conventional treatment. The review did not find data on risks associated with comorbidities such as HNPCC or Lynch syndrome both of which are associated with higher risks of endometrial cancer. Another limitation to this systematic review were the studies included, the objective of many of the studies included was not to determine the rates of endometrial cancer, and were reported incidentally. However this is strength in this review, because it included many studies. 

This entry is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.