Uterine Pathology 2

Question 1

What is dysfunctional uterine bleeding and what are the subtypes?

Answer 1

• Abnormal uterine bleeding in the absence of a well-defined organic abnormality in the uterus
• Includes:
  
  • ​anovulatory cycles
  • inadequate luteal phase (luteal phase deficiency)
  • oral contraceptives
  • post-menopausal changes

Question 2

What are anovulatory cycles and how do they contribute to uterine bleeding?

Answer 2

• ​prolonged estrogen stimulation without subsequent progestational or secretory (postovulatory) phase
• defined as “unopposed estrogen”

Question 3

How does an inadequate luteal phase (luteal phase deficiency) lead to uterine bleeding?

Answer 3

• multifactorial disorder with many etiologies that result in abnormal development or early regression of the corpus luteum
• leads ot inadequate progesterone secretion
• histology of endometrium lags at least 2 days behind postovulatory day

Question 4

How do oral contraceptives contribute to uterine bleeding?

Answer 4

​common pattern is atrophic glands and decidualized stroma “asynchrony”

Question 5

How do post-menopausal changes contribute to uterine bleeding?

Answer 5

• ​loss of estrogen stimulation and cystic atrophy occurs with unopposed estrogen
• followed by absence of estrogen stimulation so that cystically dilated glands show atrophic cellular changes