Abstract: Background: Premalignant endometrial lesions are clinically important because they represent precursor changes that may progress to endometrial carcinoma if not detected and managed in time. Obesity and diabetes mellitus are recognized metabolic risk factors that contribute to endometrial proliferation through hyperestrogenism, insulin resistance, and chronic inflammatory changes. Women with these conditions frequently present with abnormal uterine bleeding and may harbor underlying premalignant endometrial pathology.

Aim: To determine the prevalence of premalignant endometrial lesions in obese and diabetic women presenting to a tertiary care hospital and to assess their association with demographic, clinical, laboratory, and ultrasonographic factors.

Material and Methods: This hospital-based descriptive cross-sectional study was conducted on 110 women who were obese and/or diabetic and underwent endometrial evaluation at a tertiary care hospital. Women aged 18 years and above presenting with abnormal uterine bleeding, postmenopausal bleeding, menstrual irregularities, infertility with suspected endometrial pathology, or increased endometrial thickness on ultrasonography were included. Detailed clinical history, physical examination, laboratory investigations, ultrasonographic findings, and histopathological reports were recorded on a structured proforma. Endometrial samples were obtained by pipelle biopsy, dilatation and curettage, or endometrial curettage as clinically indicated. Histopathological findings were categorized into benign, premalignant, and malignant lesions.

Results: The mean age of the participants was 46.18 ± 9.24 years, and the mean body mass index was 35.86 ± 4.18 kg/m². Among the study population, 61.82% were diabetic and 43.64% were hypertensive. The most common presenting complaint was abnormal uterine bleeding (34.55%), followed by postmenopausal bleeding (21.82%). Histopathological examination revealed hyperplasia without atypia in 25.45%, atypical hyperplasia/endometrial intraepithelial neoplasia in 14.55%, and endometrial carcinoma in 5.45% of women. The overall prevalence of premalignant endometrial lesions was 40.00%. Significant associations were observed between premalignant lesions and age greater than 40 years, postmenopausal status, higher BMI, diabetes, longer duration of diabetes, hypertension, increased endometrial thickness, heterogeneous endometrial pattern, poor glycemic control, and postmenopausal bleeding.

Conclusion: Premalignant endometrial lesions were highly prevalent among obese and diabetic women in this study. Increasing age, obesity severity, diabetes-related factors, and abnormal sonographic findings significantly increased the risk of premalignant pathology. Early endometrial assessment in high-risk women, especially those presenting with abnormal uterine bleeding or postmenopausal bleeding, may facilitate timely diagnosis and help prevent progression to endometrial carcinoma.