Adenomyosis-is a lesion characterized by presence in

myometrium thickness of outbreaks consisting of glands and

endometrial stroma,located at distance of the junction
endometrium-miometru.Appears more frequently in
perimenopause,being a lesion detected in 20% of gynecological
cases surgical resolved.Rare is depistated by transcervical
endometrial resection,when semple cantains fragments of
miometru with basal endometrium and a variable quantity of
functional endometrium.Frequently,the diagnostic of adenomyosis
is made retrospective.on the hysterectomy piece.Clinical,associate
with the abnormal menstrual bleeding-abundance and prolonged
and dysmenorrheal,appearce frequently with one week before
installing of menses.Histopathological analysis of parts of
hysterectomy bulletins,we had certainty as to 25 patiens(9,8%)
menstrual irregularities is due to adenomyosis,although clinical
and ultrasound many patients were ranging(24%).
Most patients with uterine fibroids associate with rebleeding
are treated by hysterectomy.Leiomioamele are responsible,in our
study,by abnormal uterine bleeding,majority share in 127
patients(49,65%),apropiatede data results of studies from DHQ
Hospital and Nishtar Hospital Multan-54,8% and Bombay Hospital
54%.
Nonspecific chronic endometritis were found in etiology of
abnormal uterine bleedingin 19 patients(7,5%) the studied group of
menopausal transition,reporting a statistically lower rate than to
other sources of literature:Jordan University-14%,g. Michail et.-
20,7%.
Clinical,chronic endometritis,usually manifested by vaginal
bleeding intermenstrual and sometimes with menorrhagia,being
diagnosed in 3-10% of women with irregular uterine bleeding
whom endometrial biopsy is performed.Recent studies who
followed the diagnosis of chronic endometritis combination with
clinical data indicated the absence of statistically significant
associations with symptoms(abnormal uterine bleeding,chronic
pelvic pain),they were reported only in pathological inflammatory
history of patients(reproductive tract infections,salpingitis).
Sensitivity of endometrial biopsy for detection of uterine
abnormalities is reported in the literature to 96%.
Dilation and curettage of the uterus are considered the gold
standard for the diagnosis of endometrial cancer,but can not be
seen as a therapeutic gesture for abnormal uterine
bleeding;more,limited access to the region of the uterine
horns,therefore biopsy perihisteroscopica is superior.

Conclusion
The diagnosis of perimenopause bleeding and prognostic
evaluation is based on the histopathological exam of the
endometrium after biopsy.
Special attention should be given to women who shows
endocrinometabolic risk profile for this type of cancer.
The study group,menstrual irregularity was evidenced mainly in
the age group 46-52 years(64,5%) and a large percentage of 35%
in multiparous.
The clinically dominant symptom was represented by
menometroragii 34% noting that in 62,1% of cases symptoms
consist in association of abnormal uterine bleedingclinical
events:menorrhagia-hypermenorea,menorrhagia-polimenoree
menorrhagia –intermenstrual bleeding.
In our study,leiomiofibroamele ,were the most common cause
of abnormal uterin bleeding(49,6%) in terms of histopathological.
The abnormal uterin bleeding are a result of conditions
hiperestrogenice where the endometrium is in proliferative
phase(in our study 3,12%)and untreated may develop endometrial
adenocarcinoma.
Progesterone hormone therapy was applied to 64% of patients.
Option to substitute progestin menopausal hormone therapy
remains an individual decision that requires careful consideration
of symptoms,risk factors,and the risk/ benefit ratio.