Pathophysiology of DUB

8/9/2019 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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Pathophysiology of DUB