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Old 07-09-2011
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ObGyn Postmenopausal Bleeding in Endometrial Hyperplasia

hi there,

can some1 please explain why would you have postmenopausal bleeding because of endometrial hyperplasia? in menopause, don't you have decreased estrogen? if thats the case, then how do you have endometrial hyperplasia postmenopausal? is it just because of HRT? how can it be due to anovulatory cycles? this is in FA page 487.

i'm very confused on this concept. if some1 can explain it to me that would be appreciated.

thanks
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Originally Posted by star123 View Post
hi there,

can some1 please explain why would you have postmenopausal bleeding because of endometrial hyperplasia? in menopause, don't you have decreased estrogen? if thats the case, then how do you have endometrial hyperplasia postmenopausal? is it just because of HRT? how can it be due to anovulatory cycles? this is in FA page 487.

i'm very confused on this concept. if some1 can explain it to me that would be appreciated.

thanks
There should be no bleeding in post menopausal period. Even if u have spotting need to be check up. In normal cycle..estrogen causes increased proliferation of stroma and cells lining endometrium. In post menopausal women this harmone should be low. But if she is taking exogenous ,estrogen therapy, HRT, estrogen secreting tumor..etc may increase estogen level in body...so endometrial hyperplasia....and once this harmone fall resulting in postmenopausal bleeding.
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Endometrium can bleed when exposed to estrogen whether its a newborn, an old woman, etc. When endometrium is exposed to high amounts of estrogen with unopposed progesterone it can cause endometrial hyperplasia and that is a precursor of endometrial cancer which u should suspect in a women with postmenopausal bleeding.. Women with anovulatory cycles have a longer follicular phase which is estrogen dependent so they have a risk of getting endometrial hyperplasia.
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ooooo ok... that makes sense.. thanks confident and mashee

nnn 1 more question in polycystic ovarian syndrome how do you get increased levels of estrogen? i know you have high levels of androgens because of the high LH but if you have low FSH how are you converting it to estrogen?
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ooooo ok... that makes sense.. thanks confident and mashee

nnn 1 more question in polycystic ovarian syndrome how do you get increased levels of estrogen? i know you have high levels of androgens because of the high LH but if you have low FSH how are you converting it to estrogen?
You're welcum...women with PCOS convert those androgens into estrogens by the aromatase enzyme present in adipose tissue. These women tend to be obese...

oh n they also have anovulatory cycles

Last edited by Mashee; 07-09-2011 at 11:31 AM. Reason: added something
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Originally Posted by star123 View Post
ooooo ok... that makes sense.. thanks confident and mashee

nnn 1 more question in polycystic ovarian syndrome how do you get increased levels of estrogen? i know you have high levels of androgens because of the high LH but if you have low FSH how are you converting it to estrogen?
In PCOD there will be
High LH
LH>FSH
high androgen
Normal to low FSH
Low estrogen( not increased level of estogen)
low or absent progesterone since low or no ovulation occur
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You're welcum...women with PCOS convert those androgens into estrogens by the aromatase enzyme present in adipose tissue. These women tend to be obese...

oh n they also have anovulatory cycles
oo ok,,, so in the adipose tissue its a direct conversion into estrogen? because in the ovary we have the granulosa cells right, which r stimulated by FSH n convert androstenedione to estrogen.
so in the adipose tissue this conversion is happening directly?
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In PCOD there will be
High LH
LH>FSH
high androgen
Normal to low FSH
Low estrogen( not increased level of estogen)
low or absent progesterone since low or no ovulation occur
i thought it would b low estrogen too but then i heard in DIT that estrogen was increased. so thats what got me very confused.
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Originally Posted by star123 View Post
oo ok,,, so in the adipose tissue its a direct conversion into estrogen? because in the ovary we have the granulosa cells right, which r stimulated by FSH n convert androstenedione to estrogen.
so in the adipose tissue this conversion is happening directly?
Yes i think that's right. I don't think that the adipose tissue aromatase is under the same regulation as the ovary...not sure though
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Yes i think that's right. I don't think that the adipose tissue aromatase is under the same regulation as the ovary...not sure though

ok cool... thanks again!
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ok cool... thanks again!
You're welcum
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@mashee and confident good job u r right ... and plz tell me one more thing that in normal womens estrogen increses during follicular phase and this increase inhibits LH release negative feedback but when estrogen levels increases above certain limit so its negative feedback will change into positive feedback and causes LH release and this LH surge causes ovulation so in anovulatory cycle what will happen to this relation of LH and estrogen ??????
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@mashee and confident good job u r right ... and plz tell me one more thing that in normal womens estrogen increses during follicular phase and this increase inhibits LH release negative feedback but when estrogen levels increases above certain limit so its negative feedback will change into positive feedback and causes LH release and this LH surge causes ovulation so in anovulatory cycle what will happen to this relation of LH and estrogen ??????
In anovulatory cycle as well as in PCOD due to failure to ovulate -->and imbalance in harmone level there will be disruption to the mechanism to LH surge-->there will be persistent LH surge and low estrogen-->failure of follicle to enter ovulatry stage they may persist in pre-ovulatry stage.
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[QUOTE=confident;52473]In anovulatory cycle as well as in PCOD due to failure to ovulate -->and imbalance in harmone level there will be disruption to the mechanism to LH surge-->there will be persistent LH surge and low estrogen-->failure of follicle to enter ovulatry stage they may persist in pre-ovulatry stage.[/QUOTE
yup u r right so it mean persistent LH surge in PCOD alongwith decreased levels of FSH .. and as we know FSH stimulates follicular cells and collicular cells form estrogens and now this decreased fSH also results in decreased estrogen but the main physiolgy of this decreased estrogen is due to NEGATIVE FEEDBACK mechanism of LH on estrogen .. increased Lh decreased estrogen .. hope am right ...
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Anovulation -->decreased progesterone-->decreased cycle in pcod-->due to lack of ovulation-->persistent LH surge-->increase in androgen(mainly by adrenal and ovary), ovary also with cholesterol produce estrogen(estrone), this estrogen also remain persistent i,e neither rise or fall...In normal cycle rise and fall are necessary to maintain normal cycle...But here estrogen level does not varies...so LH and estrogen surge remain persistent...insulin level rises and resistence also increases so DM also occur in PCOD...hope this explains......
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Quote:
Originally Posted by yasirsattar75 View Post
@mashee and confident good job u r right ... and plz tell me one more thing that in normal womens estrogen increses during follicular phase and this increase inhibits LH release negative feedback but when estrogen levels increases above certain limit so its negative feedback will change into positive feedback and causes LH release and this LH surge causes ovulation so in anovulatory cycle what will happen to this relation of LH and estrogen ??????
Hey i think it goes like this...
the follicular/proliferative phase of the menstrual cycle is variable and dependent on estrogen whereas the luteal phase is constant and dependent on progesterone. Normally, there is a mid-cyle LH surge and then ovulation occurs, then progesterone/secretory/luteal phase and then there is menstruation after that....but in anouvulatory cycle estrogen is continuously causing the endometrium to proliferate and then eventually there is bleeding but that is not normal it is called breakthrough bleeding which is because the endometrium builds up so much that it eventually just starts to break down...i'm not sure but i think there is no LH surge in anovulatory cycle...
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Originally Posted by confident View Post
Anovulation -->decreased progesterone-->decreased cycle in pcod-->due to lack of ovulation-->persistent LH surge-->increase in androgen(mainly by adrenal and ovary), ovary also with cholesterol produce estrogen(estrone), this estrogen also remain persistent i,e neither rise or fall...In normal cycle rise and fall are necessary to maintain normal cycle...But here estrogen level does not varies...so LH and estrogen surge remain persistent...insulin level rises and resistence also increases so DM also occur in PCOD...hope this explains......
Yes this is true i think maybe the persistent LH surge is there. Because the body is trying to promote ovulation!
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