Other diagnostic studies helpful in detecting the underlying cause include dilatation and curettage to obtain a biopsy. Biopsies can further be studied for their underlying histological findings. hysteroscopy may also be of use in diagnosis.

Other diagnostic findings that may be useful in diagnosis include:

• Diagnostic dilatation and curettage provides more information than biopsy, but is more invasive
• Biopsy of endometrial and progesterone challenge test reveal estrogen excess
• The uterine cavirty and endometrium may be evaluated by hysteroscopy.

Pathological Imaging

Underlying Cause	Histological/ Gross Pathology Images	Findings
Endometrial Polyps[1]		Dense fibrous or smooth muscle tissue Up to 5% may be premalignant or malignant Covered by epithelial tissue[2] Contain a largely vascular core; vessels with thick walls
Adenomyosis[3]		Ectopic endometrial tissue present within the myometrial smooth muscle[4]
Leiomyoma[5]		Benign tumours made up of smooth muscle cells with fibrous connective tissue Composed of extracellular matrix[6] Encapsulated with a pseudocapsule
Malignancy[7]		Type 1: arises due to unopposed hyperestrogenism; the most common histological subtype Type 2: arises due to endometrial atrophy; subtypes include papillary serous, clear cell, squamous and undifferentiated carcinoma