Abnormal Uterine Bleeding / Dysfunctional Uterine

Bleeding
Dysfunctional uterine bleeding : abnormal bleeding from uterus
in the absence of organic uterine lesion
Types :

Menorrhagia : prolonged bleeding at the time of periods

Metrorrhagia : irregular bleeding between the periods

Post menopausal bleeding

Causes by age
group

Causes :
1. Ovulatory Failure
Anovulatory cycles due to :

Hypothalamic pituitary axis, adrenal, or thyroid

dysfunction

Functional ovarian lesion producing excess estrogen

Malnutrition, obesity, and debilitating disease

Severe physical or emotional stress

Anovalulatory results in excessive estrogen relative to

progesterone

Endometrium goes through proliferative phase but is not

followed by secretory phase

Endometrium glands appear disorderly, stroma cells (which

need the progesterone for growth) scarce (insufficient for the
demand)

Endometrium breakdown & abnormal bleeding

2. Inadequate Luteal Phase -> lack of progesterone
3. Contraceptive-Induced Bleeding
Older oral contraceptives containing synthetic estrogens &
progestins induced the abnormal endometrium responses
4. Endomyometrial Disorders

Chronic endometritis
-

Caused by pelvic inflammatory disease, frequently

due to N. gonorrhoeae & C. trachomatis

Endometrial polyps
-

hemispheric lesions range from 0.5 to 3 cm in

diameter

composed of endometrial resembling the basalis with

small muscular arteries

most commonly are detected around the time in

menopause

Leiomyomas
-

Benign tumor that arise from smooth muscle in

myometrium

Sign : menorrhagia with or without metrorrhagia