Massive painless vaginal bleeding after a 6-8 week period of amenorrhoea, in a premenopausal woman, is suggestive of ?

Metropathia haemorrhagical, a specialised form of anovulatory DUB, is seen in women aged 40 to 45 years. Typical symptoms are continuous painless vaginal bleeding at the onset of mensus, or preceeded by a 6-8 week period of amenorrhoea. Occasionally the woman gives a history of menorrhagia prior to this. The uterus is slightly bulky, uniformly enlarged and the uterine wall shows a mild degree of myohyperplasia, measuring upto 2.5 cm. The endometrium is thick, polypoidal and thin slender poplyps project into the uterine cavity. The endometrium shows characteristic cystic glandular hyperplasia, which appears as a swiss cheese pattern. The second feature is the absence of secretory endometrium i.e., absence of cork screw glands (as the bleeding is anovulatory,, there is no progesterone and hence no secretory changes in the endometrium) Corpus luteum is absent and one or both ovaries may contain a cyst, not larger than 5 cm. Ref: Shaw&;s textbook of Gynaecology 17th edition Pgno: 133