Clinical Predictors of Endometrial Hyperplasia in Premenopausal Women with Abnormal Uterine Bleeding
Keywords:
abnormal uterine bleeding, body mass index, endometrial thickness, endometrial hyperplasia, prediction model, polycystic ovary syndromeAbstract
Background: Abnormal uterine bleeding (AUB) is common prior to menopause, and the risk of endometrial hyperplasia is highly variable. Knowing which predictors can be easily obtained may help in stratifying the risk for clinically indicated endometrial assessment. Methods: The study was a prospective analytical cross-sectional study conducted in Babylon Province, Iraq, during January to June 2026, which involved 320 women of reproductive age (18–49 years) with AUB undergoing clinically indicated endometrial sampling. Before histopathology, demographic, reproductive, metabolic, bleeding related and transvaginal ultrasonographic variables were recorded. The main outcome was endometrial hyperplasia without atypia and atypical hyperplasia/endometrial intraepithelial neoplasia (EIN); carcinoma was reported separately. Logistic regression and receiver operating characteristic (ROC) analysis were performed, using bootstrap internal validation. Results: Hyperplasia without atypia was found in 50 women (15.6%), atypical hyperplasia/EIN in 18 (5.6%) and carcinoma in 7 (2.2%). In the primary analysis (excluding carcinoma) of 313 women, 68 (21.7%) were found to have hyperplasia. Independent predictors were age (adjusted odds ratio [aOR] per year, 1.08; 95% confidence interval [CI], 1.03–1.13), body mass index (BMI; aOR per kg/m², 1.10; 95% CI, 1.04–1.17), polycystic ovary syndrome (PCOS; aOR, 2.31; 95% CI, 1.15–4.64), diabetes mellitus (aOR, 2.48; 95% CI, 1.14–5.39), chronic anovulation (aOR, 2.57; 95% CI, 1.27–5.21), and endometrial thickness (aOR per mm, 1.29; 95% CI, 1.18–1.41). The combined model had an apparent area under the ROC curve (AUC) of 0.871 and a bootstrap-corrected AUC of 0.858; calibration was acceptable. Conclusions: Age, BMI, PCOS, diabetes, chronic anovulation and endometrial thickness were able to identify premenopausal women with AUB with increased probability of histologically confirmed endometrial hyperplasia.
