12/06/2025
and causes of uterine bleeding
1. Functional Causes (Hormonal Imbalance):
These are related to steroid withdrawal bleeding and changes in endometrial histology due to hormonal fluctuations:
• Normal menstruation: Occurs after a drop in estrogen and progesterone.
• Estrogen–progesterone imbalance: Leads to abnormal secretory endometrium.
• Estrogen excess: Causes hyperplastic or anaplastic endometrium.
• Estrogen deficiency (e.g., old age): Results in hypoplastic endometrium.
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2. Pathologic Causes:
A. Local Uterine Disorders:
• Benign conditions:
• Endometrial polyps
• Fibroids (submucosal)
• Adenomyosis
• Endometritis
• Endocervical polyps
• Malignant conditions:
• Adenocarcinoma
• Uterine sarcoma
• Cervical or endocervical cancer
• Trauma and infections:
• Erosion, chancres, pelvic inflammatory disease (PID)
B. Local Ovarian or Adnexal Disorders:
• Tumors:
• Granulosa cell tumor
• Theca cell tumor
• Cysts
• Endometriosis
• Tubal or pelvic inflammation
C. Pregnancy-Related Disorders:
• Ectopic pregnancy
• Placental issues:
• Premature separation
• Placenta previa
• Trophoblastic diseases:
• Hydatidiform mole
• Choriocarcinoma (choriocarcinoma/chorioepithelioma)
• Abortion
D. Systemic Conditions:
• Endocrine disorders:
• Hyperprolactinemia
• Hypo/hyperthyroidism
• Cushing syndrome
• Liver dysfunction:
• Advanced liver disease
• Bleeding disorders:
• Blood dyscrasias
• Bleeding diatheses
• Debilitating conditions: General health deterioration
lewaa Ahed
