Post on 01-Jun-2018
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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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