Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory
infertility, being found in ~75% of cases.
Given her young age, obesity, and anovulatory
status, endometrial ablation has a greater likelihood of failure.
The cause of bleeding in proliferative phase is anovulatory
cycles, such cases shows progressive rise of oestrogen to comparatively high levels, which is then followed by sudden fall in oestrogen due to feedback inhibition of pituitary or of FSH secretion and bleeding results and the cause of bleeding in secretory endometrium is ovulatory dysfunctional uterine bleeding.
Differential Diagnosis of Menorrhagia in an Adolescent Anatomic abnormality Genital neoplasm (sarcoma botryoides) Genital trauma or laceration Severe vaginitis (especially streptococcal) Foreign body Prolapsed urethra Bleeding abnormality Platelets Platelet dysfunction Thrombocytopenia Clotting disorder Hemophilia A von Willebrand's disease Afibrinogenemia Hypoprothrombinemia Dysfibrinogenemia Induced disorder Ingestion of antiplatelet drugs (aspirin) Hormonal abnormality Anovulatory
bleeding Pregnancy complication Threatened abortion An appropriate evaluation would include a detailed history and physical examination.
Because of their anovulatory
cycles, women with PCOS have an increased ratio of estrogen to progesterone.
infertility patients could save thousands of dollars and lessen their chances of conceiving multiple gestations if they agreed to try a 2-month regimen of monophasic oral contraceptives before giving clomiphene citrate a second chance, Dr.
(3) The common factors responsible for infertility in females are anovulatory
disorder, tubal factors, endometriosis, uterine and cervical factors.
Causes Organic Anatomic * Infection * Uterine fibroids * Bleeding disorders * Endometrial polyps * Organ dysfunction * Endometrial hyperplasia * Pregnancy Endocrinologic Iatrogenic * Thyroid and adrenal * Intrauterine devices gland dysfunction * Steroid hormones * Pituitary tumors * Chemotherapy agents * Anovulatory
cycles * Medications (eq.
Indications for endometrial aspiration include new onset of unexplained excessive bleeding; spotting or bleeding between menstrual periods; age >35 years; PCOS, anovulatory
cycles or other risk factors; or a family history of hereditary nonpolyposis colorectal carcinoma.
PCOS falls in the category ofWHOtype II anovulation (norm-gonaddotrophic norm-estrogenic anovulation) and accounts for 85% of anovulatory
Obesity and insulin resistance are closely linked to the development of PCOS and its clinical features2 PCOS is the most common cause of anovulatory
infertility in women3.
Endometrial sampling should be performed on all women aged over 45 years who are suspected of having anovulatory
uterine bleeding (6).