Our topic at first begins while looking
at dysfunctional uterine bleeding.
What does that mean?
Your female, well, she’s
till having her menses.
She’s in her reproductive age,
but unfortunately, she’s
having bleeding abnormally.
Cause usually depends
on the age group
and that becomes important
and we will go through
those various age groups.
You can have dysfunctional uterine
bleeding and female not have
She might have dysfunctional
and a cause here could
And by endometrial,
I mean a polyp.
There could be dysfunctional
uterine bleeding and leiomyoma.
Keep in mind though,
obviously, there will be
dysfunctional uterine bleeding,
but there would be also quite a
bit of pain when she’s bleeding.
You call that dysmenorrhea.
There’ll be a number
of terms here
in uterine pathology
that sound quite alike.
dysfunctional uterine bleeding,
so on and so forth.
It is important
that you keep one
from the other.
Or there might be
which may then also result in
dysfunctional uterine bleeding.
Causes of abnormal uterine bleeding can
be remembered with the acronym “PAML-COEIN.”
PALM refers to the structural causes,
which include polyps, adenomyosis,
leiomyoma, and malignancies, such as
endometrial cancer or uterine sarcomas.
COEIN refers to nonstructural causes of
abnormal uterine bleeding,
and includes coagulopathies
(such as von Willebrand’s disease),
vulatory dysfunction (including polycystic ovarian
syndrome, primary ovarian insufficiency,
and other endocrine disorders, as well as
age-related issues, such as menopause),
endometrial (including endometriitis, pelvic
inflammatory disease, or endometrial atrophy),
, iatrogenic causes (such as contraceptives, intrauterine
devices, anticoagulants, and chemotherapy).
The last category, “not otherwise classified,” includes
rare causes, such as an arteriovenous malformation.
Now, what’s interesting
about this as well is that nowadays,
dysfunctional uterine bleeding
is going out of favor
and is being replaced by, well,
abnormal uterine bleeding.
Let me give you an example
of something that you
need to know here.
It’s a pathophysiology question.
For example, in the first phase
of your menstrual cycle,
you have estrogen,
do you remember?
The first phase of
your menstrual cycle.
This estrogen is then responsible
for the proliferation
of the endometrium, isn’t it?
Proliferation of the
This proliferation --
Picturing this by the way,
a rise in thickness or increase
in thickness of the endometrium.
When the thickness of the
then my goodness, you need to make
that you keep the tissue alive.
Anytime that you have such a
growth that’s taking place,
you have to make sure that you have
equivalent amounts of blood supply.
Do you remember this
This will be really good time
to make sure that you
go back in physio
and take a look at
the menstrual cycle.
And at this point, I will at least ask
you to take a look at the hormones
and the changes that are
taking place within the uterus,
of your menstrual cycle.
So far, I have explained to you
or I have reviewed the
What may then happen in an
anovulatory cycle is the following:
You have a really
maybe the spiral arteries
that are responsible for
nourishing your endometrium
are not present or
Would you tell me the
name of the hormone
that’s responsible for
and patency of your spiral artery?
Did you say progesterone?
What if progesterone
Spiral arteries would not be patent.
What then happens to the
And is she ovulatory
If you missed that point,
and you didn’t exactly
follow what I’m saying,
probably good idea for you
to press repeat right now,
and listen to everything
that I just mentioned.
Alongside with this, keep a picture
of your menstrual cycle open
and follow at least what
I just mentioned here,
with the proliferative phase.