Should BMI Rather than Age Guide the Decision for Endometrial Sampling in Premenopausal Women with AUB

Study Objective Screening guidelines for endometrial hyperplasia/malignancy are based on a patient population predating the current obesity epidemic. With the rise in obesity and related malignancies, the objective of this study is to evaluate various risk factors for endometrial hyperplasia/malignancy in premenopausal women with AUB or oligomenorrhea. Specifically the study aims to elucidate whether obesity or age confers higher risk of disease in the premenopausal population. Design Retrospective cohort study. Setting Large urban academic center. Patients or Participants Premenopausal women undergoing endometrial sampling for AUB or oligomenorrhea. Interventions Endometrial sampling via office biopsy or dilation and curettage. Measurements and Main Results A cohort of women (N = 7001) ages 18-51 who underwent endometrial sampling for AUB or oligomenorrhea were identified from a large deidentified database of clinical records from approximately 1990 to 2019 unique to our institution. A preliminary convenience sample (N= 250) was analyzed and a total of 13 cases (5.6%) of hyperplasia or malignancy were noted. Mean age was found to be 42.6 overall in this sample and 45.9 in those with disease. Mean BMI of the sample was found to be 31.8 overall and 40.7 in those with disease. Logistic regression was performed and revealed that BMI (coefficient = 0.096, p = 0.001) was a significant predictor of malignancy/hyperplasia in this population while age (coefficient = 0.018, p = 0.102) was not. Conclusion While both age and obesity are risk factors for endometrial hyperplasia and malignancy in the postmenopausal population, obesity appears to be a risk factor for disease in the premenopausal while age does not. Our study suggests that BMI may be a more important risk factor to prompt screening. Further study of risk factors for endometrial malignancy in a contemporary demographic setting is needed.