This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Disorders of menstruation, Subject name: Gynaecology & Obstetrics
Massive painless vaginal bleeding after a 6-8 week period of amenorrhoea, in a premenopausal woman, is suggestive of ? 
Select and explain. 
A. Irregular ripening, B. Irregular shedding (Halban Disease), C. Metropathia haemorrhagica, D. Endometrial carcinoma
C: Metropathia haemorrhagica
Answer: C: Metropathia haemorrhagica 
Explanation: Metropathia haemorrhagical, a specialised form of anovulatory DUB, is seen in women aged 40 to 45 years. Typical symptoms are continuous painless vaginal bleeding at the onset of mensus, or preceeded by a 6-8 week period of amenorrhoea. Occasionally the woman gives a history of menorrhagia prior to this. The uterus is slightly bulky, uniformly enlarged and the uterine wall shows a mild degree of myohyperplasia, measuring upto 2.5 cm. The endometrium is thick, polypoidal and thin slender poplyps project into the uterine cavity. The endometrium shows characteristic cystic glandular hyperplasia, which appears as a swiss cheese pattern. The second feature is the absence of secretory endometrium i.e., absence of cork screw glands (as the bleeding is anovulatory,, there is no progesterone and hence no secretory changes in the endometrium) Corpus luteum is absent and one or both ovaries may contain a cyst, not larger than 5 cm. Ref: Shaw&;s textbook of Gynaecology 17th edition Pgno: 133