Definition - Iirregular uterine bleeding that occurs in the
absence of pathology or medical illness
- Diagnosis of exclusion
Risk Factors Differential diagnosis Epidemiology Aetiology - Disruption in
the normal cyclic pattern of ovulatory hormonal stimulation to the
endometrial lining
- Usually is associated with anovulatory menstrual cycles but
also can present in patients with oligo-ovulation
- Possibilities:
- Estrogen breakthrough bleeding
- Estrogen withdrawal bleeding
- Oral contraceptives, progestin-only preparations, or postmenopausal steroid replacement therapy
- Failure to
mount an ovulatory luteinizing hormone (LH) surge in response to rising
estradiol levels (adolescents)
Clinical features - Uunpredictable or episodic heavy or light bleeding despite a normal
pelvic examination
- Without moliminal symptoms
- Nothing else!
Pathophysiology - Constant, noncycling estrogen levels stimulate
endometrial growth
- Proliferation without periodic shedding causes the
endometrium to outgrow its blood supply
- Tissue breaks down and
sloughs from the uterus
- Subsequent healing of the endometrium is
irregular and dyssynchronous
InvestigationsManagementa) conservativeb) medical c) surgicalPrognosis |
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