634 EMIL NOVAK 



Functional Uterine Bleeding 



"Idiopafhic" or Essential Uterine Hemorrhage. Another gynecologi- 

 cal complaint, the endocrine origin of which permits of very little doubt, 

 is the so-called functional, "idiopathic," or essential uterine hemorrhage. 

 .This symptom is of very frequent occurrence, especially at the two ex- 

 tremes of menstrual life, puberty and the menopause. It may, however, 

 occur at any age. In these cases the most careful examination may 

 show perfectly normal pelvic organs, and yet bleeding may be persistent 

 and perhaps very profuse. Most commonly it takes the form of menor- 

 rhagia rather than metrorrhagia. Cases of this type usually come to 

 curettage sooner or later, and indeed, in the case of climacteric hemor- 

 rhage, the indication for this procedure is urgent, owing to the importance 

 of excluding carcinoma. In the non-malignant climacteric cases and in 

 those of puberty the pathological report on the curettings has usually 

 been some such designation as "Normal endometrium, hypertrophic glan- 

 dular endometritis, chronic endometritis," etc. It has seemed difficult 

 to incriminate the endometrium as the cause of bleeding of this type. 

 Equally unsatisfactory have been the efforts to explain this form of 

 bleeding by such factors as arteriosclerosis of the uterus, the "insuffi- 

 cientia uteri" of Theilhaber, etc. 



The point which I should like to emphasize is that the endometrium in 

 a very large proportion of these cases I am not prepared to put it in 

 percentage figures conforms to the type described by Cullen (&) as hyper- 

 pi a si a of the endcmetrium. The histological picture presented by this 

 condition is extremely characteristic. As the term indicates, there is 

 a genuine hyperplasia of the uterine mucosa, with an increase of both 

 the epithelial and stromal elements. The histological characteristics of 

 this condition are fully discussed in a recent paper by the author. 



Secondary Nature of Endometrial Change. An endometrium of this 

 type is never observed except in association with the symptom of uterine 

 bleeding. The reverse is, of course, not true, for uterine hemorrhage 

 may be due to many anatomic causes. Most frequently the endometrium 

 is perfectly normal. It is of interest, however, to note that with certain 

 pelvic lesions, especially myoma and adenomyoma, the endometrium may 

 exhibit the condition of hyperplasia, as above described. There is some 

 evidence to believe that both myoma and adenomyoma are due to some 

 as yet unknown aberration of ovarian function and, as we shall see, 

 there is little doubt that the same factor is responsible for hyperplasia of 

 the endometrium. 



The finding in a case of uterine bleeding of such a definite struc- 

 tural alteration as hyperplasia of the endometrium would seem at 

 once to take such a case out of the category of functional hemorrhage. 



