Dysfunctional uterine bleeding pathophysiology: Difference between revisions

Jump to navigation Jump to search
(added endometriosis to the table)
m (edited link)
Line 19: Line 19:
!Pathophysiology
!Pathophysiology
|-
|-
|'''[[Polyps]]'''
|'''[[Endometrial polyp|Polyps]]'''
|Endometrial polyps are overgrowths of [[endometrial tissue]]. They can vary in size and eventually result in obstruction to the endometrial outflow path<ref name="pmid32491756">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume=  | issue=  | pages=  | pmid=32491756 | doi= | pmc= | url= }}</ref> which may lead to unexpected bleeding
|Endometrial polyps are overgrowths of [[endometrial tissue]]. They can vary in size and eventually result in obstruction to the endometrial outflow path<ref name="pmid32491756">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume=  | issue=  | pages=  | pmid=32491756 | doi= | pmc= | url= }}</ref> which may lead to unexpected bleeding
|-
|-
Line 37: Line 37:
|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|hypothalamic axis]] and also contribute to DUB. Although not entirely understood, endometrial bleeding may be due to [[hypoxia]], [[Cervicitis|inflammation]] and [[vasoconstriction]]<ref name="pmid118662412">{{cite journal| author=Livingstone M, Fraser IS| title=Mechanisms of abnormal uterine bleeding. | journal=Hum Reprod Update | year= 2002 | volume= 8 | issue= 1 | pages= 60-7 | pmid=11866241 | doi=10.1093/humupd/8.1.60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11866241  }}</ref> that play a role in shedding and subsequent [[scarring]].<ref name="pmid26803558">{{cite journal| author=Whitaker L, Critchley HO| title=Abnormal uterine bleeding. | journal=Best Pract Res Clin Obstet Gynaecol | year= 2016 | volume= 34 | issue=  | pages= 54-65 | pmid=26803558 | doi=10.1016/j.bpobgyn.2015.11.012 | pmc=4970656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26803558  }}</ref>
|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|hypothalamic axis]] and also contribute to DUB. Although not entirely understood, endometrial bleeding may be due to [[hypoxia]], [[Cervicitis|inflammation]] and [[vasoconstriction]]<ref name="pmid118662412">{{cite journal| author=Livingstone M, Fraser IS| title=Mechanisms of abnormal uterine bleeding. | journal=Hum Reprod Update | year= 2002 | volume= 8 | issue= 1 | pages= 60-7 | pmid=11866241 | doi=10.1093/humupd/8.1.60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11866241  }}</ref> that play a role in shedding and subsequent [[scarring]].<ref name="pmid26803558">{{cite journal| author=Whitaker L, Critchley HO| title=Abnormal uterine bleeding. | journal=Best Pract Res Clin Obstet Gynaecol | year= 2016 | volume= 34 | issue=  | pages= 54-65 | pmid=26803558 | doi=10.1016/j.bpobgyn.2015.11.012 | pmc=4970656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26803558  }}</ref>
|-
|-
|'''[[Endometriosis]]'''  
|'''[[Endometriosis]]'''
|The Sampson theory of retrograde [[menstruation]], the coelomic [[metaplasia]] theory, and the [[lymphatic]] and [[vascular]] dissemination theory explain the implantation and invasion of the [[Endometrium|endometrial tissue]] outside the [[uterine cavity]]. [[Immunological|Immunologic]] factors and [[genetic]] factors are also thought to play a role in the pathogenesis of [[endometriosis]].<ref name="Bulun2009">{{cite journal|last1=Bulun|first1=Serdar E.|title=Endometriosis|journal=New England Journal of Medicine|volume=360|issue=3|year=2009|pages=268–279|issn=0028-4793|doi=10.1056/NEJMra0804690}}</ref>
|The Sampson theory of retrograde [[menstruation]], the coelomic [[metaplasia]] theory, and the [[lymphatic]] and [[vascular]] dissemination theory explain the implantation and invasion of the [[Endometrium|endometrial tissue]] outside the [[uterine cavity]]. [[Immunological|Immunologic]] factors and [[genetic]] factors are also thought to play a role in the pathogenesis of [[endometriosis]].<ref name="Bulun2009">{{cite journal|last1=Bulun|first1=Serdar E.|title=Endometriosis|journal=New England Journal of Medicine|volume=360|issue=3|year=2009|pages=268–279|issn=0028-4793|doi=10.1056/NEJMra0804690}}</ref>
|-
|-

Revision as of 20:43, 9 March 2022

Dysfunctional uterine bleeding Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Dysfunctional uterine bleeding from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Dysfunctional uterine bleeding pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Dysfunctional uterine bleeding pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Dysfunctional uterine bleeding pathophysiology

CDC on Dysfunctional uterine bleeding pathophysiology

Dysfunctional uterine bleeding pathophysiology in the news

Blogs on Dysfunctional uterine bleeding pathophysiology

Directions to Hospitals Treating Dysfunctional uterine bleeding

Risk calculators and risk factors for Dysfunctional uterine bleeding pathophysiology

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. Bleeding can be acute or chronic. By understanding the pathophysiology of the causative conditions, one can understand the cause of dysfunctional uterine bleeding. These include polyps, adenomyosis, leiomyoma, malignancy or hyperplasia, coagulopathies, ovulatory dysfunction, endometrial disorders and iatrogenic causes. In ovulatory causes, unopposed estrogen and progesterone result in continued thickening and proliferation of the endometrium. Along with the effects of these hormones, hypoxia, inflammation and vasoconstriction result in shedding and subsequent scarring.

Pathophysiology

Dysfunctional uterine bleeding can be classified into acute and chronic causes.[1]

  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.
  2. 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]

Pathophysiology of underlying conditions causing DUB
Condition causing DUB Pathophysiology
Polyps Endometrial polyps are overgrowths of endometrial tissue. They can vary in size and eventually result in obstruction to the endometrial outflow path[3] which may lead to unexpected bleeding
Adenomyosis Adenomyosis is characterized by the presence of ectopic endometrial tissue (the inner lining of the uterus) within the myometrium (the thick, muscular layer of the uterus). Although the pathophysiology is not well understood, the basic Fibroblast Growth Factor receptor/ligand system has shown to be upregulated. Hormones such as estrogen and progesterone as well as oxytocin, FSH, and prolactin also contribute to the pathogenesis of the disease by causing tissue proliferation.
Leiomyoma Also referred to as fibroids, leiomyoma are tumors of benign origin made up primarily of smooth muscle and fibrous connective tissue. They can presents as serosal, submucosal, subserosal or pedunculated masses. Leiomyoma has been linked to underlying genetic mutations including translocations (12;14)(q14-q15;q23–24), deletions (7)(q22q32) and rearrangements involving 6p21, 10q, trisomy 12.
Malignancy and hyperplasia Typical proliferation due to underlying hyperplasia or malignancy of the endometrium is an important cause of dysfunctional endometrial bleeding and warrants further investigations, especially in older women.
Coagulopathies Conditions that lead to defective blood clotting, such as Von Willebrand disease, may contribute to DUB. In vWF deficiency, there is a defect in the platelet plug formation that results in a defective platelet adhesion and clot formation.
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]
Endometriosis The Sampson theory of retrograde menstruation, the coelomic metaplasia theory, and the lymphatic and vascular dissemination theory explain the implantation and invasion of the endometrial tissue outside the uterine cavity. Immunologic factors and genetic factors are also thought to play a role in the pathogenesis of endometriosis.[6]
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.[7]

Blood supply of Endometrium

The ovarian artery arises from the aorta and descends into the retroperitoneum alongside the gonadal vein and ureter. Eventually, it anastomoses with the ovarian branch of the uterine artery at the uterus. Vasoconstriction affects these vessels may contribute to DUB.

Henry Gray (1918) Anatomy of the Human Body

References

  1. "StatPearls". 2022. PMID 30422508.
  2. 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.
  3. "StatPearls". 2022. PMID 32491756 Check |pmid= value (help).
  4. 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.
  5. 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.
  6. Bulun, Serdar E. (2009). "Endometriosis". New England Journal of Medicine. 360 (3): 268–279. doi:10.1056/NEJMra0804690. ISSN 0028-4793.
  7. 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.

Template:WH Template:WS