The underlying mechanism is often a hormonal disturbance: reduced levels of progesterone cause high levels of prostaglandin F2-alpha and cause<unk> ly heavy flow as progesterone stabilizes the endometrium and inhibits synthesis of prostaglandin F2-alpha; increased levels of tissue plasminogen activator (t-PA), a fibrinolytic enzyme, lead to more fibrinolysis. Ovulatory Ten percent of cases occur in women who are ovulating, but progesterone secretion is prolonged because estrogen levels are low. This causes irregular shedding of the<unk>  lining and break-through<unk> . Some evidence has associated ovulatory DUB with more fragile blood vessels in the uterus.It may represent a possible endocrine dysfunction, resulting in menorrhagia or metrorrhagia. Mid-cycle<unk>  may indicate a transient estrogen decline, while late-cycle<unk>  may indicate progesterone deficiency. Anovulatory About 90% of DUB events occur when ovulation is not occurring (anovulatory DUB). Anovulatory menstrual cycles are common at the extremes of reproductive age, such as early puberty and perimenopause (period around menopause). In such cases, women do not properly develop and release a mature egg. When this happens, the corpus luteum, which is a mound of tissue that produces progesterone, does not form. As a result, estrogen is produced continuously, causing an overgrowth of the uterus lining. The period is delayed in such cases, and when it occurs menstruation can be very heavy and prolonged. Sometimes anovulatory DUB is due to a delay in the full maturation of the reproductive system in teenagers. Usually, however, the mechanisms are unknown. The cause can be psychological stress, weight (obesity, anorexia, or a rapid change), exercise, endocrinopathy, neoplasm, drugs, or it may be otherwise unknown.
Abnormal uterine bleeding
Ectopic pregnancy
Vaginal bleeding
Obstetrical bleeding
Vaginal discharge
Heavy menstrual bleeding
Intermenstrual bleeding
Postpartum bleeding