AUB is the most common symptom of gynecological conditions, which is defined as any type of bleeding in which the duration, frequency or amount is excessive for a woman. It is generally an indicator of possible uterine disease
8,17. Previous studies have shown that the prevalence of AUB varies in different populations (between 10% and 30%) (18, 19). It frequently enforces medical intervention in order to improve the comfort of the patient's life
20,21. In the AUB conditions that do not respond to medical or small surgical treatments, the last choice is hysterectomy. These patients have either structural diseases like benign/ malignant situations (40%) or dysfunctional uterine bleeding (DUB) in the absence of demonstrable structural or organic abnormalities (60%). Most of the DUB patients can be treated medically, rarely hysterectomy is needed to be applied (0.05%-0.09%). In our study 14 patients (0.77%) underwent hysterectomy because of the DUB in parallel with the literature
1,17-22.
The leading reason of hysterectomy was presented as leiomyomas (or fibroids in other words) in the literature 1-7,23. Pavone et al. declared that leiomyomas accounted for 40%-60% of all the hysterectomies, this was compatible with our results (47.82%). There were also subtypes of the leiomyomas diagnosed as seperately from the usual leiomyomas accounting 3.64%. Total rate is also compatible with the Pavone et al’s results. Also we have found 2 leiomyosarcomas and 2 stromal sarcomas in 4 patients which were presumed leiomyomas (0.22%) in paralel with the study of Ruengkhachorn et al (0.2%) 24. This means masses that seem like leiomyomas must be closely monitored and carefully managed.
The second leading reason of hysterectomy was prolapsus uteri (24.63%) paralel to the literature 25,26. These patients were generally older than 50 years old.
Adenomyozis seemed to be the third common diagnosis with a rate of 12.84%. However in most of these patients, the diagnosis of the adenomyozis was not the only disease alone in hysterectomies. It was mostly diagnosed together with leiomyomas. This means leiomyomas and adenomyozis often coexist in the same uterus with a prevalence ranging from 15% to 57% 10,11,27.
Another group of lesions that was composed of benign lesions (endometrial/endocervical polyps, Hyperplasias without atypia, Paratubal Cysts, Simple Cysts of ovary- follicular cysts, surface epithelial inclusion cysts, cystic corpus luteum-, Endometriosis) generally do not require hysterectomy but encountered as an accompanying disease by tumors (especially leiomyoma), adenomyosis and prolapsus uteri. They were diagnosed in 28.87% of the hysterectomies 28. The next small group was composed of premalignant lesions (Endometrial hyperplasia with atypia, LSIL, HSIL,GIN) with a ratio of 1.49% and benign tumors of the ovary (fibroma, fibrothecoma, serous/ seromucinous/ mucinous cystadenomas, Benign Brenner tumor, mature teratoma) with a ratio of 6.61%.
The last group was the most important group as it was composed of borderline tumors (serous and seromucinous borderline tumors: 0.22%) and the malignant tumors (Endometrial endometrioid/serous carcinomas, ovarian fibrosarcoma, serous/mucinous carcinoma, clear cell carcinoma, granulosa cell tumor, brenner tumor, endometrioid carcinoma and metastasis of colonic carcinoma to ovary, cervical squamous/ adeno carcinomas, vaginal squamous/clear cell carcinomas and tubal serous carcinoma: 4.90%). These malignant tumors were the cases with the highest indication for hysterectomy 13-16,29,30. Fortunately malignancies occupy a very small group; however they are the most dangerous diseases that shorten the lives of the patients. So it is very important to diagnose these tumors as early as possible in order to begin the appropriate treatment quickly to provide the patients better survivals. As a result the reasons of the symptoms like AUB, pelvic pain must be researched in details for gynecological carcinomas and the cervical screening test with the cervicovaginal papanicalaou smear test must be applied to every women in fertility period for early diagnosis of cervical carcinomas.