Uterus

Nontumor

Abnormal uterine bleeding



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PubMed search: Abnormal uterine bleeding

Nat Pernick, M.D.
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Cite this page: Pernick N. Abnormal uterine bleeding. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/uterusdub.html. Accessed December 3rd, 2022.
Definition / general
Clinical features
  • Can classify based on ovulatory or nonovulatory cycles
  • If patient ovulates, may be due to inadequate proliferative phase, inadequate secretory phase, irregular shedding or membranous dysmenorrhea
  • Inadequate proliferative phase: disparity between clinical menstrual cycle date and microscopic changes (usually delayed morphologic changes of proliferation)
  • Inadequate secretory phase: discrepancy of 2+ days between microscopy and clinical cycle date; biopsy shows underdeveloped secretory endometrium or secretory and proliferative endometrium in same specimen; also irregular shedding; due to low progesterone; associated with infertility, amenorrhea; treat with hormones
  • Irregular shedding: bleeding 7+ days due to lag in shedding of secretory endometrium, which is normally completed by day 4 of menstruation; should do biopsy on day 5+ of menstruation; biopsy shows retained secretory endometrium, fragmented menstrual endometrium, proliferative endometrium; occurs in 10 - 17% of dysfunctional uterine bleeding cases; associated with luteal phase defect
  • Membranous dysmenorrhea: rare, endometrial cast passed during menstruation, resembles decidua; may be due to exogenous progesterone
  • Anovulatory cycle: proliferative endometrium during chronological secretory phase; usually causes endometrial hyperplasia
Terminology
  • Previously called dysfunctional uterine bleeding (DUB)
Treatment
  • If other causes are ruled out, progesterone plus reassurance; optional therapy includes mid cycle estrogen (mid cycle bleeding), and late cycle progestin (late cycle bleeding), combined high dose estrogen and high dose progestin
  • Treatment goals are to stop bleeding, replace iron loss, prevent future bleeding
Microscopic (histologic) description
  • Fibrin clumps in endometrial stroma (not present in normal menstrual stroma), stromal crumbling (fragmented pieces with dense stromal cellularity)
  • Exogenous hormones cause predecidual stroma, edema and wimpy tubular glands of different sizes
  • Plasma cells are common if focal stromal breakdown is present but this likely represents a physiologic process, not infection (Hum Pathol 2007;38:581, Mod Pathol 2001;14:877)
Microscopic (histologic) images

Contributed by Asmaa Gaber Abdou, M.D.
Endometrial curette of perimenopausal bleeding of hormonal effect: characteristic atrophic glands and decidualized stroma Endometrial curette of perimenopausal bleeding of hormonal effect: characteristic atrophic glands and decidualized stroma Endometrial curette of perimenopausal bleeding of hormonal effect: characteristic atrophic glands and decidualized stroma Endometrial curette of perimenopausal bleeding of hormonal effect: characteristic atrophic glands and decidualized stroma

Endometrial curette of perimenopausal bleeding of hormonal effect: characteristic atrophic glands and decidualized stroma



Contributed by @MirunaPopescu13 on Twitter
Abnormal uterine bleeding Abnormal uterine bleeding Abnormal uterine bleeding Abnormal uterine bleeding

Abnormal uterine bleeding

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