18. PATHOPHYSIOLOGY
Endometrium normally produces Prostaglandins (PGs)
from the arachidonic acid.
Such PGs include : PGE2, PGI2, PGF2α, Thromboxane A2
PGE2 & PGI2 Vasodilation & Platelet aggregation
PGF2α, Thromboxane A2 Vasoconstriction
Platelet aggregation
Progesterone is responsible for the production of PGF2α
19. • In PRE-OVULATORY phase, endometrial proliferation
occurs under the effect of estrogen. (PGF2α /PGE2 : 1)
• In POST-OVULATORY phase, progesterone causes
endometrial differentiation and stabilisation.
(PGF2α/PGE2=2:1)
• As long as progesterone (in optimum levels) is provided by corpus
luteum, this phase maintains.
• Once corpus luteum ceases to function MENSES
20. Absence of progesterone
Absence of PGF2α
Relative in PGE2
Tissue Plasminogen
Activator ( TPA)
Endothelin
PATHOGENESIS
21. DYSFUNCTIONAL UTERINE BLEEDING
Abnormal heavy menstrual bleeding in the
absence of organic lesions of the genital tract
Absence of pregnancy
It’s due to changes in HORMONE levels
23. ANOVULATORY - DUB
CAUSE FOR ANOVULATION CAN BE
• Hyper androgenic anovulation ( PCOS, CAH, Androgen producing tumours)
• Hypothalamic dysfunction ( stress, anorexia, exercise)
• Hyperprolactinemia
• Hypothyroid
• Primary pituitary disease
• Premature ovarian failure
• Secondary to radiation and chemotherapy
24. ANOVULATORY - DUB
PATHOGENESIS
• ESTROGEN WITHDRAWAL (sudden decrease in estrogen levels- following bilateral
oophorectomy, cessation of exogenous estrogen therapy, or just before ovulation in the normal menstrual cycle)
• ESTROGEN BREAKTHROUGH (Estrogen breakthrough bleeding occurs when excess
estrogen causes the endometrium to grow in an undifferentiated manner; thick without stromal support)
• PROGESTERONE BREAKTHROUGH (when the progesterone/estrogen ratio is
high, leading to an atrophic and ulcerated endometrium; progestogen only pills)
26. OVULATORY - DUB
PATHOGENESIS
• LUTEAL PHASE INSUFFICIENCY
• Irregular ripening ( deficient progesterone support- resulting in breakthrough bleeding
before actual menstruation)
• PROLONGED LUTEAL FUNCTION
• Irregular shedding ( lag in shedding of secretory endometrium; prolonged 7+ days)
Primary pathology of HEMOSTATIC processes
Hinweis der Redaktion
NO DYSMENORRHOEA
PERSISTENT PROLIFERATIVE ENDOMETRIUM IN THE SECOND HALF OF CYCLE.
NO INCREASE IN PGF2 ( LACK OF PROGESTERONE)
DECREASED PGF2/E2 RATIO WITH RELATIVE INCREASE IN E2 - VASODILATOR & ANTI PLATELET