The pathogenesis of abnormal uterine bleeding in myopathic uteri

Abnormal Uterine Involution May Lead to Atony and Postpartum Hemorrhage: A Hypothesis, With Review of the Evidence

“…Our experience confirms the observation of Shahid et al (Figure 1(b)); however, our studies of developing uteri and nonpregnant hysterectomies for bleeding suggest that this outer wall edema and vascular ectasia (outer pressure effects) is secondary to increased intramural pressure, as first suggested by Farrer-Brown and co-workers in the 1970s. 5,10,16,18,20,27 We believe this pressure-induced This has been seen previously in nonpregnant uteri, and is interpreted as minor tissue damage secondary to increased intramural pressure. 5,13,16 (C) (400×)-Elastic van Gieson stain of postpartum hysterectomy shows numerous apoptotic globules (arrows), consistent with single cell death of myocytes.…”

“…Our experience confirms the observation of Shahid et al (Figure 1(b)); however, our studies of developing uteri and nonpregnant hysterectomies for bleeding suggest that this outer wall edema and vascular ectasia (outer pressure effects) is secondary to increased intramural pressure, as first suggested by Farrer-Brown and co-workers in the 1970s. 5,10,16,18,20,27 We believe this pressure-induced outer wall edema has nothing to do with myometrial involution. However, increased intramural pressure in the growing myometrium of early pregnancy—associated with the palpable bump in the abdomen that is a sign of early pregnancy—may lead to venous obstruction, with endometrial vascular ectasia, fibrin thrombi, and stromal breakdown, causing early pregnancy bleeding.…”

“…The theory of metropathy, still neither proven nor disproven, persists to the present era. 5,16,18,20 It is ironic that in the 19th century, knowledge of uterine atony led to the hypothesis that myometrial histopathology (metropathy) could cause serious abnormal bleeding, and that we now suggest the pathophysiology of myometrial involution may lead to uterine atony.…”

Possible association between adenomyosis and disseminated intravascular coagulation and thromboembolism: A systematic review

“…Immature and fragile blood vessels penetrate the endometrial-myometrial barrier in type I adenomyosis (17). Moreover, Turner et al (43) suggested that 'impaired venous drainage and endometrial vascular ectasia, secondary to increased intramural pressure' can cause AUB in diffuse adenomyosis. Therefore, adenomyosis-specific angiogenesis, increased MVD and morphologically abnormal blood vessels with leaky and fragile features are considered to cause vascular damage, leading to the extravasation of blood, damage to surrounding tissue, and subsequently, to thrombo-hemorrhagic events (43).…”

“…Moreover, Turner et al (43) suggested that 'impaired venous drainage and endometrial vascular ectasia, secondary to increased intramural pressure' can cause AUB in diffuse adenomyosis. Therefore, adenomyosis-specific angiogenesis, increased MVD and morphologically abnormal blood vessels with leaky and fragile features are considered to cause vascular damage, leading to the extravasation of blood, damage to surrounding tissue, and subsequently, to thrombo-hemorrhagic events (43). In patients with diffuse or type I adenomyosis, surgical procedures, such as dilatation and curettage for abortion and pharmacological interventions, such as gonadotropins and progestin-only pill, may be a potential risk factor for massive hemorrhage and life-threatening DIC.…”