M.

JAYAPRABA
I OG
 DUB

ANOVULATORY OVULATORY
(80%) (20%)
• PUBERTY MENORRHAGIA OVULATORY POLYMENORRHOEA
• REPRODUCTIVE AGE OVULATORY OLIOMENORRHOEA
GROUP MENORRHAGIA
• METROPATHIA HEMORRHAGICA OVULATORY MENORRHAGIA
 ANOVULATORY
 PUBERTY MENORRHAGIA :-
Few cycles following menarche are anovulatory
Immature hypothalamo – pituitary – ovarian axis

Underactivity of ovarian function

Immature follicles & no ovulation

Only oestrogen secretion

Oestrogen level reaches critical threshold level

Hormone withdrawal

Shedding of endometrium (Breakthrough bleeding)

 REPRODUCTIVE AGE GROUP MENORRHAGIA :-

Following pregnancy & abortion

Disturbed hypothalamo – pituitary – ovarian axis

Hormonal imbalance

Bleeding
 METROPATHIA HAEMORRHAGICA :-

 Exact cause is not known

 Disturbance in Hypothalamus or Anterier pituitary

FSH is continuously secreted without LH surge

Mature follicle

Increased level of oestrogen

Short period of amenorrhoea

Withdrawal of oestrogen

Continues bleeding
BLEEDING IN METROPATHIA
HAEMORRHAGICA
 MICROSCOPIC FEATURES :-

 Cystic glandular hyperplasia (Swiss cheese pattern)

 Absence of secretory hypertrophy

 Areas of necrosis are scattered over superficial layers of endometrium

 OVARY :-

 Cysts are present

 Corpus luteum absent

 Diffuse polyp in the endometrium

Pic. 1 in MH
Pic. 2 in MH
Pic. 3 in MH
 OVULATORY
 OVULATORY OLIGOMENORRHOEA :-

 Prolonged proliferative phase with normal secretory phase

 Infrequent cycles are present

 Occurs in adolescence & preceding menopause

 Endometrium normal
 OVULATORY POLYMENORRHOEA:-

Ovary is normally functioning but matures quickly affecting follicular phase than
luteal phase

Short proliferative phase

Menstrual bleeding occurs every 2-3 weeks

 Normal Endometrium

 Occurs in few cycles following menarche, abortion & delivery

 CORPUS LUTEAL ABNORMALITY :-

D/T Irregular Ripening,

Deficient corpus luteum

Decreased progesterone secretion

Endometrial support of progesterone is inadequate

Breakthrough bleeding before actual date of menstruation

(Spotting / brownish discharge premenstrually)

 ENDOMETRIUM:-

 Contains both proliferative & secretory phases

 Changes are seen in superficial zone of endometrium

 IRREGULAR SHEDDING:- (HALBAN’S DISEASE)

Persistent corpus luteum even after menstruation

Menstruation comes on time but prolonged

 ENDOMETRIUM:-

 Curettage on 2nd / 3rd day of menstruation shows secretory edomentrium

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