Anovular bleeding is usually excessive. In the absence of growth limiting progesterone due to anovulation, the endometrial growth is under the influence of estrogen throughout the cycle. There is inadequate structural stromal support and the endometrium remains fragile.
Thus, with the withdrawal of estrogen due to negative feedback action of FSH, the endometrial shedding continues for a longer period in asynchronous sequences because of lack of compactness.
- Cystic glandular hyperplasia
This type of abnormal bleeding is usually met in premenopausal women.
The basic fault may lie in the ovaries or may be due to disturbance of the rhythmic secretion of the gonadotropins. There is slow increase in secretion of estrogen but no negative feedback inhibition of FSH.
The net effect is gradual rise in the level of estrogen with concomittant phase of amenorrhea for about 6–8 weeks. As there is no ovulation, the endometrium is under the influence of estrogen without being opposed by growth limiting progesterone for a prolonged period.
After a variable period, however, the estrogen level falls resulting in endometrial shedding with heavy bleeding.
Bleeding also occurs when the endometrial growth have outgrown their blood supply. Due to increased endometrial thickness, tissue breakdown continues for a long time. Bleeding is heavy as there is no vasoconstrictor effect of PGF2α. Bleeding is prolonged until the endometrium and blood vessels regenerate to control it.
Changes in the uterus: There is variable degree of myohyperplasia with symmetrical enlargement of the uterus to a size of about 8–10 weeks due to simultaneous hypertrophy of muscles.
The endometrial changes are classical. On naked eye examination, the endometrium looks thick, congested and often polypoidal(multiple polyposis).
HOMOEOPATHIC MANAGEMENT OF ANOVULAR BLEEDING: -
The medicines that may prove beneficial are: -