List two non-structural causes of AUB.

List two non-structural causes of AUB.

• A. Adenomyosis
• B. Endometrial cancer and hyperplasia
• C. Leiomyoma
• D. Ovulatory dysfunction and coagulopathy

Answer: (D)

AUB from non-structural causes refers to bleeding driven by systemic or hormonal factors rather than a lesion in the uterine lining. Two classic non-structural contributors are ovulatory dysfunction and coagulopathy. Ovulatory dysfunction causes irregular or absent ovulation. Without regular progesterone withdrawal after a dominant corpus luteum, the endometrium may proliferate under estrogen and then bleed irregularly or heavily. This pattern is common when the hypothalamic-pituitary-ovarian axis is immature (adolescence) or fluctuating (perimenopause). The bleeding is often irregular in timing and amount, not due to a focal uterine mass. Coagulopathy leads to heavier or longer-than-normal menstrual bleeding because the blood’s ability to clot is impaired. Bleeding disorders, such as von Willebrand disease or platelet function issues, produce menorrhagia that is disproportionate to uterine size or structure. Evaluation typically includes a bleeding history and targeted coagulation testing, with treatment focusing on hemostasis and, when appropriate, hormonal or antifibrinolytic therapies. In contrast, the other conditions are structural causes, involving physical lesions or changes within the uterus (such as adenomyosis, endometrial hyperplasia or cancer, and leiomyomas).

AUB from non-structural causes refers to bleeding driven by systemic or hormonal factors rather than a lesion in the uterine lining. Two classic non-structural contributors are ovulatory dysfunction and coagulopathy.

Ovulatory dysfunction causes irregular or absent ovulation. Without regular progesterone withdrawal after a dominant corpus luteum, the endometrium may proliferate under estrogen and then bleed irregularly or heavily. This pattern is common when the hypothalamic-pituitary-ovarian axis is immature (adolescence) or fluctuating (perimenopause). The bleeding is often irregular in timing and amount, not due to a focal uterine mass.

Coagulopathy leads to heavier or longer-than-normal menstrual bleeding because the blood’s ability to clot is impaired. Bleeding disorders, such as von Willebrand disease or platelet function issues, produce menorrhagia that is disproportionate to uterine size or structure. Evaluation typically includes a bleeding history and targeted coagulation testing, with treatment focusing on hemostasis and, when appropriate, hormonal or antifibrinolytic therapies.

In contrast, the other conditions are structural causes, involving physical lesions or changes within the uterus (such as adenomyosis, endometrial hyperplasia or cancer, and leiomyomas).