Dysfunctional uterine bleeding is due to which hormonal pattern in young and perimenopausal women?

• A. Regular ovulation
• B. Anovulatory cycles
• C. Excess progesterone
• D. Hyperprolactinemia

Answer: (C)

Dysfunctional uterine bleeding in young and perimenopausal women is driven by anovulatory cycles, meaning the ovary does not release an egg during the cycle. When ovulation doesn’t occur, there’s no corpus luteum and progesterone is not produced. Estrogen still stimulates the endometrium to grow, but without progesterone to balance and stabilize it, the endometrium becomes proliferative and then sheds irregularly. This unopposed estrogen effect leads to unpredictable, often irregular and sometimes heavy bleeding—the pattern seen in these age groups.

Regular ovulation would bring a coordinated estrogen-progesterone cycle and predictable menses, not the irregular bleeding described here. Excess progesterone would push the endometrium toward a secretory state and typically results in more regulated shedding rather than the classic DUB pattern. Hyperprolactinemia can disrupt ovulation and menstruation, but the defining pattern for this question is the absence of ovulation with unopposed estrogen.