Pathophysiology of DUB

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    Pathophysiology of DUB

    1. Anovulatory

    Metropathia Haemorrhagica.

    Threshold Bleeding..!vulatory """

    #diopathic ovulatory Menorrhagia.

    $uteal Phase Defect.

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    Anovulatory DUB

    #n some adolescent girls and perimenopausal %omen&!varian follicles develop'()H )timulation* and produce

    estrogen in varia+le amount leading to proliferation of

    endometrium

    Dominant follicle may not develop due to insufficient $H

    surge no ovulation,no development of corpus $uteum

    """ no progesterone """ no secretory changes in

    endometrium - estrogen still secreted +y follicles'granulosa cells*

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    Anovulatory DUB

    Unopposed estrogenic stimulation and some time

    hyper ' super threshold * level of estrogen results in

    over gro%th of endometrium'hyperplasia*

    """"resulting in prolonged cycle and increased +lood

    loss during period.

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    Anovulatory DUB

    hen endometrium over gro%s its +lood supply& lac/ ofprogesterone causes decrease P0 vasodilators initially

    and avascular necrosis of functional endometrium occur &

    endometrium is shade off $ac/ of vasoconstrictors"""P0fa and throm+o2ane results in e2cessive +lood loss

    %hich is pain less and prolonged for 3"43days 'As

    irregular shading of endometrium continues for such along time *.

    Persistent (ollicles undergo the formation of follicular

    cysts.

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    Anovulatory DUB Metropathia Hamorrhagica Accounts for 536 of DUB- at Pu+ertal and perimenopausal age &Patient has

    varia+le period of amenorrhoea follo%ed +y prolonged& heavy& painless +leeding

    .

    Prolonged Unopposed strogen

    Proliferative ndometrium

    )imple Hyperplasia

    7omple2 Hyperplasia

    7omple2 Hyperplasia %ith Atypia

    Adenocarcinoma

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    ndometrium in Metropathia Haemorrhagica

    Usually reveals cystic hyperplasia' simplehyperplasia %ithout atypia* called s%iss cheese

    appearance

    - Hyperplastic glands and stroma.- 7ystic or irregularly dilated glands.

    - Thic/ %alled& tortuous& dilated spiral arterioles

    and veins.

    - #nfarction and throm+osis of +lood vessels.

    - 8ecrosis of functional endometrium

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    Metropathia Haemorrhagica

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    Progress And 7ourse of Metropathia Haemorrhagica

    #ncidence of malignancy """

    simple cystic Hyperplasia"""16

    7omple2 hyperplasia %ith atypia"""96

    #t is further increased in perimenopausal %omen %ho areo+ese& dia+etic&on therapy& hypertensive and relatively

    infertile & H:! 7a endometrium in family and had P7!D.

    ;oung 0irls %ho are o+ese %ith or %ithout P7!D are prone tohave metropathia Haemorrhagica of early changes %hich are

    reversi+le %ith progesterone : !cs therapy.

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    Atypia 'hyperchromatic& large& varia+le si

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    ndometrial Hyperplasia %ith 8uclear Atypia

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    The endometrial adenocarcinoma in the polyp atthe left is moderately dierentiated, as a glandularstructure can still be discerned. Note thehyperchromatism and pleomorphism of the cells,

    compared to the underlying endometrium withcystic atrophy at the right.

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    Threshold Bleeding

    This is often seen in perimenopausal %omen . There is

    insufficient development of ovarian follicles resulting in

    lo% estrogen level not a+le to sustain endometrium or

    trigger $H surge ' no ovulation *. )uch %omen can have prolonged and e2cessive +leeding

    due to a+sence of progesterone and lac/ of P0(a and

    thom+o2ane.

    Bleeding P= in these %omen can +e controlled %ith cyclic

    > P 7om+ination Therapy as +oth are at lo% level .

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    !vulatory DUB

    More common in %omen of reproductive age group '1"

    ?3 years * .

    Accounts for 36 cases of DUB. Patient usually present 7yclic e2cessive +leeding :

    premenstrual spotting.

    Periods are associated %ith Pain .

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    $uteal Phase Defect #nadeuate (unctioning of corpus luteum can

    result in""

    "" insufficient and erratic production of

    Progesterone. As %ell as alteration in the ratio of

    P0 @ P0(

    """resulting in irregular and patchy secretory

    changes in the endometrium

    Both pathophysiological deficit leads to irregular

    ripening and or irregular shading of endometrium

    .

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