ِAbnormal uterine Bleeding

Abnormal Uterine Bleeding
Aetiology:
Abnormal uterine bleeding can be classified into :
1. Idiopathic: where no organic pathology can be found, also called dysfunctional uterine bleeding. The principal factors implicated in the pathogenesis of menorrhagia are disordered production of prostaglandinsn ( PGE2 & PGF2? ), enhanced fibrinolytic activity & abnormalities of endometrial vascular development. It is further divided into :
a. Anovulatory: this tend to occur in women at the extremes of the reproductive life & is typified by irregular cycle. It is more common in obese women.
b. Ovulatory: more common in women aged 35 to 45 years & is typified by regular heavy & often painful menstrual periods. It may be due to an inadequate production of progesterone by the corpus luteum.

2. Secondary: to organic pathology, the major organic causes of abnormal uterine bleeding include:
• Local causes :
1. Uterine fibroid : especially submucous fibroid.
2. Adenomyosis: presence of endometrial tissue embedded within the myometrium, characterized by painful heavy periods.
3. Endocervical polyp, endometrial polyp or endometrial hyperplasia: classically cause intermenstrual bleeding due to irregular shedding of the endometrium.
4. Intrauterine contraceptive device (IUCD): periods may become heavier & longer in duration. Insertion of IUCD is thought to elevate the circulating level of plasminogen activator leading to an increase in fibrinolytic activity.
5. Pelvic inflammatory disease (PID): cause erratic menstrual bleeding due to local endometrial inflammatory response, Chlamydial infection is more likely to cause intermenstrual bleeding.
6. malignancy of the cervix, uterus & ovaries : presence of postcoital bleeding should lead to the possibility of cervical lesion in particular, including cervical ectropion. Hormone producing ovarian tumors can cause endometrial hyperplasia & menstrual irregularities.
7. Trauma: can be a cause for acute presentation of abnormal vaginal bleeding.

• Systemic causes:
1. Endocrine disorders:
? Hyper or hypothyroidism.
? Diabetes mellitus.
? Adrenal disease.
? Prolactin disorders.
2. Disorders of haemostasis: mostly found in teen-agers who present with heavy bleeding. Examples are von Willebrand s disease & idiopathic thrombocytopenic purpura (ITP).
3. Liver disorders: may interfere with metabolism of estrogen.
4. renal disease : may alter the excretion of estrogen & progesterone.