M. JAYAPRABA I OG

DUB

ANOVULATORY OVULATORY(80%) (20%)

• PUBERTY MENORRHAGIA OVULATORY POLYMENORRHOEA• REPRODUCTIVE AGE OVULATORY OLIOMENORRHOEA

GROUP MENORRHAGIA• METROPATHIA HEMORRHAGICA OVULATORY MENORRHAGIA

ANOVULATORY

PUBERTY MENORRHAGIA :-

Few cycles following menarche are anovulatory

Immature hypothalamo – pituitary – ovarian axis

Underactivity of ovarian function

Immature follicles & no ovulation

Only oestrogen secretion

Oestrogen level reaches critical threshold level

Hormone withdrawal

Shedding of endometrium (Breakthrough bleeding)

REPRODUCTIVE AGE GROUP MENORRHAGIA :-

Following pregnancy & abortion

Disturbed hypothalamo – pituitary – ovarian axis

Hormonal imbalance

Bleeding

METROPATHIA HAEMORRHAGICA :-

Exact cause is not known

Disturbance in Hypothalamus or Anterier pituitary

FSH is continuously secreted without LH surge

Mature follicle

Increased level of oestrogen

Short period of amenorrhoea

Withdrawal of oestrogen

Continues bleeding

BLEEDING IN METROPATHIA HAEMORRHAGICA

MICROSCOPIC FEATURES :-

Cystic glandular hyperplasia (Swiss cheese pattern)

Absence of secretory hypertrophy

Areas of necrosis are scattered over superficial layers of endometrium

OVARY :-

Cysts are present

Corpus luteum absent

Diffuse polyp in the endometrium

Pic. 1 in MH

Pic. 2 in MH

Pic. 3 in MH

OVULATORY OVULATORY OLIGOMENORRHOEA :-

Prolonged proliferative phase with normal secretory phase

Infrequent cycles are present

Occurs in adolescence & preceding menopause

Endometrium normal

OVULATORY POLYMENORRHOEA:-

Ovary is normally functioning but matures quickly affecting follicular phase than

luteal phase

Short proliferative phase

Menstrual bleeding occurs every 2-3 weeks

Normal Endometrium

Occurs in few cycles following menarche, abortion & delivery

CORPUS LUTEAL ABNORMALITY :-

D/T Irregular Ripening,

Deficient corpus luteum

Decreased progesterone secretion

Endometrial support of progesterone is inadequate

Breakthrough bleeding before actual date of menstruation(Spotting / brownish discharge premenstrually)

ENDOMETRIUM:-

Contains both proliferative & secretory phases

Changes are seen in superficial zone of endometrium

IRREGULAR SHEDDING:- (HALBAN’S DISEASE)

Persistent corpus luteum even after menstruation

Menstruation comes on time but prolonged

ENDOMETRIUM:-

Curettage on 2nd / 3rd day of menstruation shows secretory edomentrium

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