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    Ob Aub Case

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    Jaz Butuyan
    The patient presented with heavy vaginal bleeding for 3 months. An ultrasound found a thickened endometrium and endometrial polyp. A histopathology confirmed simple endometrial hyperplasia without atypia and an endometrial polyp. Endometrial hyperplasia results from prolonged exposure to high estrogen levels and relative progesterone insufficiency. Risk factors include age during perimenopause when ovulation is irregular, obesity which converts androgens to estrogen, and hyperestrogenism from conditions like obesity that cause unopposed estrogen exposure.

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    Ob Aub Case

    Uploaded by

    Jaz Butuyan
    16 views2 pages
    The patient presented with heavy vaginal bleeding for 3 months. An ultrasound found a thickened endometrium and endometrial polyp. A histopathology confirmed simple endometrial hyperplasia without atypia and an endometrial polyp. Endometrial hyperplasia results from prolonged exposure to high estrogen levels and relative progesterone insufficiency. Risk factors include age during perimenopause when ovulation is irregular, obesity which converts androgens to estrogen, and hyperestrogenism from conditions like obesity that cause unopposed estrogen exposure.

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    OB AUB CASE

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    The patient presented with heavy vaginal bleeding for 3 months. An ultrasound found a thickened endometrium and endometrial polyp. A histopathology confirmed simple endometrial hyperplasia without atypia and an endometrial polyp. Endometrial hyperplasia results from prolonged exposure to high estrogen levels and relative progesterone insufficiency. Risk factors include age during perimenopause when ovulation is irregular, obesity which converts androgens to estrogen, and hyperestrogenism from conditions like obesity that cause unopposed estrogen exposure.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    16 views2 pages

    Ob Aub Case

    Uploaded by

    Jaz Butuyan
    The patient presented with heavy vaginal bleeding for 3 months. An ultrasound found a thickened endometrium and endometrial polyp. A histopathology confirmed simple endometrial hyperplasia without atypia and an endometrial polyp. Endometrial hyperplasia results from prolonged exposure to high estrogen levels and relative progesterone insufficiency. Risk factors include age during perimenopause when ovulation is irregular, obesity which converts androgens to estrogen, and hyperestrogenism from conditions like obesity that cause unopposed estrogen exposure.

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    MAIN DIAGNOSIS

    ·   This is due to History of heavy vaginal bleeding for 3 months lasting for 7-8
    days, consumes 6-8 pads per day fully soaked - AV/UB is the most
    frequent symptom of endometrial hyperplasia and it is also common for
    those with Endometrial Polyp
    ·   TVS: (2 weeks PTA):
    o   thickened endometrium measuring  1.78 cm (Endometrial
    Hyperplasia) with echogenic structure seemingly attached anteriorly
    (Endometrial Polyp)
    ·   Final Histopath: 
    o   Fragments consistent with Endometrial Polyp with Focal
    Hyperplastic Changes
    o   Simple Hyperplasia without atypia

    PATHOGENESIS
    Menstrual Cycle
     In the 1 phase of menstrual cycle (proliferative phase), estrogen
    st

    predominates and stimulates growth of endometrial glands and


    stroma.  
     At the end of this phase, ovulation occurs where 1 ovarian follicle
    expels the oocyte into fallopian tube and travels to uterus.
     In the 2 phase (secretory phase), the remaining structure of follicle,
    nd

    the luteal body, begins to secrete progesterone, causing the glands to


    produce secretions that acts as nutrients for a supposed developing
    embryo, and counteracting the effects of estrogen on endometrium by
    stopping it’s growth.

    Endometrial Hyperplasia
     Endometrial hyperplasia results when endometrium is exposed to high
    levels of estrogen for a prolonged time and relative progesterone
    insufficiency.
     The typical causes for endogenous estrogen excess include
    anovulatory cycles (perimenopause, polycystic ovarian syndrome
    (PCOS)), obesity, and estrogen secreting ovarian tumors.
     The exogenous causes include unopposed estrogen therapy, hormone
    replacement therapy (HRT), and tamoxifen (used in breast cancer
    treatment).

    Endometrial Polyp
     An endometrial polyp or uterine polyp is an abnormal growth containing
    glands, stroma and blood vessels projecting from the lining of the
    uterus (endometrium).
     They are found during both reproductive and postmenopausal phases
    of life, most common between age 40 and 49.
     They are believed to be related to estrogen stimulation, this may be as
    a result of an increased concentration of oestrogen receptors (ERs),
    predominantly ER-alpha in polyp glandular cells compared with normal
    endometrium, and a decreased expression of progesterone receptors
    (PRs) 
    RISK FACTORS
     Age: The perimenopause is characterized by its variability in hormonal
    level with increasing shortage of ovarian hormones and anovulation. In
    the perimenopausal period an intermittent ovulation or even a chronic
    anovulation take place, therefore the progesterone levels are low,
    because there is no corpus luteum. The ovaries are still producing
    oestrogen, which allows continued proliferation of the endometrium; the
    thickened endometrium outgrows its blood supply, undergoes focal
    necrosis and shedding begins. 
     Obesity: The extra adipose tissue converts androgens to estrogen
     Hyperestrogensim: The patient is on hyperestrogenism state where
    there is unopposed estrogen due to obesity and the risk in
    perimenopausal stage. 
     S/S of estrogen excess include…..
     But in the case, the patient only noted Heavy menses and weight
    gain.  

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