11.9 · Female reproductive: Menstrual disorders & benign growths

Dysfunctional uterine bleeding (DUB)

Heavy or irregular bleeding in the absence of disease, usually associated with anovulatory cycles

DUB mechanism

Ovulation does not occur so progesterone is not produced; continued estrogen creates a very thick endometrium that eventually exceeds estrogen support, causing heavy bleeding

When DUB is most common

Prior to menopause or just following menarche

Dysmenorrhea

Painful menstruation

Primary dysmenorrhea

Due to monthly release of prostaglandins from the endometrium

Secondary dysmenorrhea

Related to pelvic pathological conditions such as endometriosis and can occur any time in the cycle

Amenorrhea

Lack of menstruation

Primary amenorrhea

No menarche, caused by a hypothalamic-pituitary-ovarian axis disorder such as a pituitary tumor

Secondary amenorrhea

Cessation of menses for at least 6 months after establishing normal cycles, caused by ovarian, pituitary or hypothalamic dysfunction, anorexia nervosa, stress, or pregnancy

Endometriosis

Presence of functioning endometrial tissue outside the uterus, primarily in the abdominal and pelvic cavities

Possible causes of endometriosis

Retrograde menstruation, remnants from embryonic development, or spread through lymph or blood

Endometriosis pathology

Ectopic endometrium follows the same monthly growth, breakdown, and bleeding pattern, causing inflammation and pain and possibly fibrosis, scarring, and adhesions