Dysfunctional uterine bleeding pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Arooj Naz
Overview
Dysfunctional uterine bleeding is a condition that affects many women worldwide, especially because it has a wide range of underlying causes.
Pathophysiology
Dysfunctional uterine bleeding can be classified into acute and chronic causes.[1]
- Acute Dysfunctional uterine bleeding: Acute bleeding can develop in one of two ways. Either bleeding can develop acutely on which immediate intervention is required to prevent excessive blood loss, or it can be imposed upon chronic uterine bleeding. The latter often refers to menstrual irregularities that developed of 6 months or longer.
- Chronic Dysfunctional uterine bleeding
At the end of the menstrual cycle, progesterone levels fall significantly leading to a breakdown of the functional layer of the endometrium. This leads to the phenomenon known as the menstrual cycle. This cycle can become irregular due to several causes, especially any derangements in the architectural structure of the endometrium. Common underlying causes include polyps, adenomyosis, leiomyoma, malignancy or hyperplasia, coagulopathies, ovulatory dysfunction, endometrial disorders and iatrogenic causes. DUB that is due to underlying ovulatory causes occurs due to defects in local endometrial functions whereas anovulatory is often due to systemic disorders, endocrine or neurological imbalances. By understanding the pathophysiology of these conditions, one can understand the cause of dysfunctional uterine bleeding.[2]
Leiomyoma
Malignancy and hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial disorders
Iatrogenic
Iatrogenic causes refer to inadvertent injuries induced my physicians. Such causes include unopposed and continuous exposure to estrogen and progesterone therapy, as is seen with contraceptive medications, GnRH agonists, and SERMs.[3]
Ovulatory
Ovulatory causes are due to unopposed effects of estrogen which result in continued thickening and proliferation of the endometrium. When there is an imbalance between estrogen and progesterone hormone levels, heavy menstrual bleeding as well as alteration in bleeding patterns and frequency are noted. Although drugs are considered an anovulatory cause, those drugs that affect dopamine levels interfere with the hypothalamic axis and also contribute to DUB. Although not entirely understood, endometrial bleeding may be due to hypoxia, inflammation and vasoconstriction[4] that play a role in shedding and subsequent scarring.[5]
Anovulatory
Blood supply of Endometrium
References
- ↑ "StatPearls". 2022. PMID 30422508.
- ↑ Munro MG (2001). "Dysfunctional uterine bleeding: advances in diagnosis and treatment". Curr Opin Obstet Gynecol. 13 (5): 475–89. doi:10.1097/00001703-200110000-00006. PMID 11547028.
- ↑ Whitaker L, Critchley HO (2016). "Abnormal uterine bleeding". Best Pract Res Clin Obstet Gynaecol. 34: 54–65. doi:10.1016/j.bpobgyn.2015.11.012. PMC 4970656. PMID 26803558.
- ↑ Livingstone M, Fraser IS (2002). "Mechanisms of abnormal uterine bleeding". Hum Reprod Update. 8 (1): 60–7. doi:10.1093/humupd/8.1.60. PMID 11866241.
- ↑ Whitaker L, Critchley HO (2016). "Abnormal uterine bleeding". Best Pract Res Clin Obstet Gynaecol. 34: 54–65. doi:10.1016/j.bpobgyn.2015.11.012. PMC 4970656. PMID 26803558.