- Polymenorrhea or polymenorrhagia: The condition usually occurs following childbirth and abortion, during adolescence and premenopausal period, and in pelvic inflammatory disease. The follicular development is speeded up with resulting shortening of the follicular phase. This is probably due to hyperstimulation of the follicular growth by FSH. Rarely, the luteal phase may be shortened due to premature lysis of the corpus luteum. Sometimes, it is related to stress induced stimulation.
Endometrial study prior to or within few hours of menstruation reveals secretory changes.
- Oligomenorrhea: Primary ovular oligomenorrhea is rare. It may be met in adolescence and preceding menopause.
The disturbance may be due to ovarian unresponsiveness to FSH or secondary to pituitary dysfunction. There is undue prolongation of the proliferative phase with normal secretory phase.
Endometrial study prior to or within few hours of menstruation reveals secretory changes.
Functional menorrhagia: Ovular menorrhagia is quite uncommon. Two varieties are found:
Irregular shedding of the endometrium The abnormality is usually met in extremes of reproductive period.
Normally, regeneration of the endometrium is completed by the end of third day of menstruation.
In irregular shedding, desquamation is continued for a variable period with simultaneous failure of regeneration of the endometrium. The possible explanations are :
(i) Incomplete withdrawal of LH even on 26th day of cycle → incomplete atrophy of the corpus luteum → Persistent secretion of progesterone.
(ii) Persistent LH → inhibition of FSH → suppresses ripening of the follicle in the next cycle → Less estrogen → less regeneration.
Endometrial sampling performed after 5th or 6th day of the onset of menstruation reveals a mixture of secretory and proliferative endometrium. There is total absence of any surface epithelium. Irregular ripening of the endometrium There is poor formation and inadequate function of the corpus luteum. Secretion of both estrogen and progesterone is inadequate to support the endometrial growth. As such, slight bleeding occurs and continues prior to the start of proper flow. The endocrine profile in the luteal phase shows persistent low level of urinary pregnanediol level of less than 3 mg or plasma progesterone level less than 5 ng/mL.
Endometrial study prior to or soon after spotting reveals patchy area of secretory changes amidst proliferative endometrium.
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