IDU is divided into two groups, ovulatory and anovulatory, according to the ovulation factor.
Ovulatory (ovulation) dysfunctional bleeding
Bleeding associated with the presence of ovulation in women of reproductive age is 10% of normal dysfunctional bleeding. It creates . Ovulatory dysfunctional bleeding is characterized by regular but excessive menstrual blood loss, and 90% of the blood loss occurs in the first 3 days of menstrual bleeding.
The hypothalamic-pituitary-ovarian axis is intact and the hormonal profile is normal. It is not different from cycles.
The decrease in estrogen and progesterone levels in the late luteal phase causes separation and reepithelialization in the functional layer of the endometrium.
Ovulatory. The mechanism of dysfunctional bleeding is:
1) increased local prostaglandin synthesis
2) abnormal receptor regulation,
3)increase in local fibrinolytic activity,
4)increase in tissue plasminogen activator,
5) It has been shown that the rate of vasoconstrictor (PGF2a) vasodilator (PGE2) in the endometrium is high in favor of vasodilators.
Ovulatory dysfunctional bleedings are in order
1) oligomenorrhea
2)polymenorrhea
3)ovulation bleeding
4)luteal phase failure
5)prolongation of corpus luteum activity includes bleeding such as:
Oligomenorrhea: Due to relative (FSH) deficiency, follicle development is delayed and the follicular phase is prolonged. As a result, bleeding (oligomenorrhea) occurs at intervals longer than 35 days.
Polymenorrhea: These are bleedings that occur regularly in less than 21 days and are characterized by shortening of the follicular phase. Generally, due to the hypersensitivity of the immature ovary to gonadotropins, the follicular phase is shortened and frequent menstrual bleeding (polymenorrhea) occurs.
Ovulation bleeding: Inter-cycle spotting as a result of the relative decrease in estrogen following ovulation in the middle of the cycle. bleeding.
Luteal phase failure: Dysfunctional bleeding may occur in luteal phase failure caused by insufficiency of progesterone secretion. Luteal phase insufficiencies Bleeding due to menstrual bleeding usually occurs in the form of premenstrual spotting, sometimes characterized by menorrhagia.
Prolongation of corpus luteum activity: In corpus luteum persistence, which occurs as a result of the continuation of progesterone production despite the absence of pregnancy, It occurs in the form of long cycles (oligomenorrhea) or prolongation of menstrual bleeding (menorrhagia).
Anovulatory dysfunctional bleedings - 90% of IDUs are generally caused by anovulatory causes. Anovulatory dysfunctional bleeding is seen especially in adolescents, obese patients in the premenopausal period, and patients with PCOS.
During the perimenopausal transition, progressive oocyte depletion and abnormal follicle development lead to anovulatory cycles.
Causes of anovulation
Physiological
Adolescence
Perimenopause
Lactation
Pregnancy
Pathological
Hyperandrogenic anovulation (e.g., PCOS, CAD, or androgen-secreting tumors)
Hypothalamic dysfunction (e.g., secondary to anorexia nervosa)
Hyperprolactinemia
Thyroid disease
Primary pituitary disease
Premature ovarian failure
Iatrogenic (for example, due to radiation or chemotherapy)
Drugs
The most common cause of anovulation (without ovulation) is pregnancy. It is frequently observed in adolescents due to the incomplete development of the hypothalamic-pituitary-ovarian axis within a 2-year period. Classically, during this period, although the hypothalamic-pituitary-ovarian axis has enough FSH secretion to cause estrogen synthesis from the ovaries and consequently proliferation in the endometrium, it is not mature enough to fully develop follicles, achieve ovulation and maintain cyclic menses. The endometrium is stimulated by estrogen for a long time without the suppressive effect of progesterone. This leads to continued proliferation of the endometrium. In women who do not ovulate, the endometrium continues to proliferate as there will be no progesterone secretion. Constantly take estrogen As a result of weight loss or decreased estrogen levels, the endometrium sheds and bleeds. This type of withdrawal or breakthrough bleeding is the most common form of dysfunctional bleeding. It constitutes a significant portion of 90% of dysfunctional bleeding. By definition, anovulatory women are always in the follicular phase of the ovarian cycle and the proliferative phase of the endometrial cycle. Differential diagnosis The diagnosis of anovulatory DUB is based on the exclusion of other causes. The possibility of pregnancy and pregnancy complications should always be kept in mind and ruled out. Although abnormal bleeding is frequently seen in patients using hormonal contraception and other forms of external hormone therapy, it should not be forgotten that there may be an underlying pathology (cervical and endometrial polyps, myomas, adenomyosis, malignancies of the cervix and endometrium).
The possibility of a coagulation disorder should be kept in mind, it is especially important in adolescents whose menstrual history is short and incomplete.
The most common cause of abnormal uterine bleeding in adolescents is anovulation, but up to one third of them have a coagulation disorder.
Coagulation disorders are often accompanied by cyclic heavy and long bleeding periods.
The same pattern can be seen in women receiving anticoagulant therapy
Coagulation disorders are not as rare as often perceived and can be found in 10-20% of women with unexplained menorrhagia.
Tendency to abnormal bleeding. It should be questioned whether medications and herbal products that may be beneficial, such as glucocorticoids, ginkgo, tamoxifen and anticoagulants, should be taken.
Other less common diagnostic possibilities include serious systemic diseases (kidney or liver failure), genital trauma and foreign objects.
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