A Pilot Study on Thickened Blood Vessels in Endometrial Curettage in Dysfunctional Uterine Bleeding

Background: Dysfunctional uterine bleeding (DUB) is a common disease. About 10% of patients registered with DUB in Gynecology OPD for treatment in developing countries. There has been a change in the rhythmic cyclic menstruation that causes excessive and irregular bleeding. Lack of ovulation or oligo-ovulation leads to permanent estrogenic effects without opposing the progesterone effects. Other causes of the estrogen domain may have similar effects. The relative estrogen domain causes several changes in the uterine vascular system that causes menstrual bleeding. Objective:  To determine the frequency and significance of thickened blood vessels in curettage of the endometrium in dysfunctional uterine bleeding. Materials and methods: It was a Retrospective cross-sectional pilot study conducted at Department of Gynecology and Obstetrics, Jinnah Hospital Lahore for one-year duration from January 2017 to December 2017.Hematoxylin and eosin (H&E) stained sections 30 consecutive incident cases of endometrial curettage due to dysfunctional uterine bleeding were examined by an optical microscope, with particular regard to the number of thickened blood vessels. All patients with history of endometrial curettage with dysfunctional uterine bleeding were included while curettage of uterine mucosa in patients with a specific etiology, such as endometritis, atypical hypertrophy, retained products, intrauterine devices (intrauterine device) were excluded. Results: Over 50% of patients were perimenopausal, i.e. 40-55 years of age. All endometrial procedures included thickened blood vessels. On average, there were about 8 blood vessels thickened by curettage of the endometrium. Conclusion: Estrogen-induced vascular lesions result in greater permeability, which can lead to the accumulation of various plasma proteins with increased intramural vascular thickening. These thickened veins may not contract properly, causing excessive bleeding and prolongation.