Should body mass index replace age to drive the decision for endometrial sampling in premenopausal women with abnormal uterine bleeding?

ABSTRACT

OBJECTIVE: This study aimed to evaluate risk factors for endometrial intraepithelial neoplasia/malignancy in premenopausal women with abnormal uterine bleeding or oligomenorrhea. Specifically, we aimed to elucidate whether body mass index (BMI) or age confers a higher risk. STUDY DESIGN: A retrospective cohort study was performed at a large academic center examining risk factors for endometrial hyperplasia/malignancy in premenopausal women undergoing endometrial sampling. RESULTS: Of the 4170 women ages 18-51 who underwent endometrial sampling from 1987 to 2019, 77 (1.85%) were found to have endometrial intraepithelial neoplasia or malignancy. Clinical predictors of EIN/malignancy in this population included obesity (OR 3.84, 95%, p < .001), Body mass index [(OR30 vs. 252.11, p < .001) and OR35 vs. 30 1.65, p < .001], Diabetes (OR 3.6, p-value <.001), hormonal therapy use (OR 2.93, p < .001), personal history of colon cancer (OR 9.90, p = .003), family history of breast cancer (OR 2.65, p < .001), family history of colon cancer (OR 3.81, p < .001), and family history of endometrial cancer (OR 4.92, p = .033). Age was not significantly associated with an increased risk of disease. Adjusting for other factors, a model using BMI to predict the risk of EIN/malignancy was more discriminative than a model based on age. CONCLUSIONS: Increased BMI, may be more predictive of endometrial hyperplasia/malignancy than age in premenopausal women with abnormal uterine bleeding. Modification of evaluation guidelines in a contemporary demographic setting could be considered.