Upload
navani-tharan
View
240
Download
0
Embed Size (px)
Citation preview
8/9/2019 Normal and Abnormal Menstruation
1/20
NORMAL AND ABNORMAL
MENSTRUATION
8/9/2019 Normal and Abnormal Menstruation
2/20
MENSTRUAL CYCLE
Menstruation is the cyclical uterine
bleeding occurring during the
reproductive age between menarche tomenopause with cyclical changes in the
endometrium which may be regarded as
a periodic preparation for fertilization and
pregnancy.
Normal Duration : 28 days
8/9/2019 Normal and Abnormal Menstruation
3/20
HYPOTHALAMO-PITUITARY
OVARIAN AXIS+
FSH ESTROGEN
-
GnRH
+
LH PROGESTRONE-
(Hypothalamus) (pituitary) (ovary)
8/9/2019 Normal and Abnormal Menstruation
4/20
PHASES OF MENSTRUATION
PHASES :
1. MENSTRUATION 1-4 DAYS2. PROLIFERATIVEPHASE 5-13 DAYS
3. PHASE OF OVULATION 14TH DAY
4. SECRETORYPHASE 15-28 DAYS
8/9/2019 Normal and Abnormal Menstruation
5/20
PROLIFERATIVEPHASE
This phase is due to estrogen
Corresponds to proliferative phase or
estrogenic phase of ovarian cycle Starts when regeneration of endometrium
is complete lasts until the 14th day of 28
days cycle
At the end of menstruation the
endometrium is represented by basal
layer and its thickness is about 1mm
8/9/2019 Normal and Abnormal Menstruation
6/20
The uterine glands are short,straight,simple
tubular glands.
Uterine glands grow in length and about the
10th day the glands become slightly sinous
and their columnar epithelium becomestaller than before.
Epithelial cells also increase in number bymitosis and stromal blood vessels of the
endometrium also grow with increase in
number of coils.
8/9/2019 Normal and Abnormal Menstruation
7/20
8/9/2019 Normal and Abnormal Menstruation
8/20
OVULATION
Occurs at the 14th day.
Due to action of LH,the graffian follicle
ruptures and ovulates forming CORPUS
LUTEUM.
8/9/2019 Normal and Abnormal Menstruation
9/20
LUTEALPHASE
Due to the action of progesterone
Begins on the 15th day until the onset ofmenstruation
CHANGES :1. Development of subnuclear vacuolation -
Day 17
2. Uterine glands become tortuous (cock
screw) and glycogen appears in theglandular lumen
Endometrial thickness : 8-10mm Day 19
3. Stromal edema-Day 21.
8/9/2019 Normal and Abnormal Menstruation
10/20
Perivascular cuffing Day 23
Coiled arteries becoming more closelywound,lymphocyte infilteration occur Day
25
MENSTRUAL PHASE
Lasts for 3-5 days
Superficial endometrium becomes ischemic
due to vasoconstriction and blood stasis
Tissue sloughs off and blood vessels open
up
8/9/2019 Normal and Abnormal Menstruation
11/20
8/9/2019 Normal and Abnormal Menstruation
12/20
HEMOSTASIS
Achieved in a normal menstruation by 2
mechanisms:
Formation of platelet plug
Constriction of spiral arterioles
Vasoconstriction is brought about by means
of prostaglandins
8/9/2019 Normal and Abnormal Menstruation
13/20
DEFICIENTHEMOSTASIS
DUETO: Disturbance in prostanoid metabolism
Increased fibrinolysis in endometrium
NORMAL:
In proliferative phase the endometrium
synthesizes equal amount ofPGE2 & PGF2
In luteal phase PGF2 increases due toestradiol & progesterone
PGF2 : PGE2 =2:1
8/9/2019 Normal and Abnormal Menstruation
14/20
Endometrium PGF2, PGE2 & PGD2
Myometrium PGE2 from arachidonic acid &
endoperoxidases.
PHOSPHOLIPID
FREE ARACHIDONIC ACID
ENDOPEROXIDES
PGE2 PGF2
PGI2
8/9/2019 Normal and Abnormal Menstruation
15/20
1. First, PGF2 produces vasoconstriction
2. Endoperoxides from endometrium are
deviated to the myometrium whichproduces PGI2
3. This then diffuses back into endometriumwhich causes vasodilation followed by
vasoconstriction of spiral arterioles
preceding menstruation
8/9/2019 Normal and Abnormal Menstruation
16/20
WITHDRAWAL OFPROGESTERONE
BREAKDOWN OF LYSOSOMES
RELEASE OFPHOSPHOLIPASE A2
PROSTANOID CASCADE
PREDOMINATION OF VASOCONSTRICTORPROSTANOIDS
ORDERLY BLEEDING
8/9/2019 Normal and Abnormal Menstruation
17/20
ABNORMALHEMOSTASIS IN DUB
Failure in vasoconstriction due to
excessive secretion ofPGE2 & increase in
PG
E2 :PG
F2.
Failure in formation of adequate
thrombotic plugs due to PGI2 excess.
Increased fibrinolysis due to increase in
the tissue plasminogen activator.
8/9/2019 Normal and Abnormal Menstruation
18/20
Increased endometrial lysosomal enzymeswith excessive prostanoid formation.
Failure in vascular endothelial proliferationdue to relaxin.
Delay in endometrial regeneration.
8/9/2019 Normal and Abnormal Menstruation
19/20
8/9/2019 Normal and Abnormal Menstruation
20/20