**4. Anovulatory cycles**

Female genital hormone equilibrium disorders observed either in cases of hyperestrogenism (estrogen escape bleeding) or in cases of sudden subestrogenism (interruption of exogenous administration – bilateral ovariectomy), or, finally, in cases of progesteronism (progesterone bleeding bleeding-progesterone withdrawal contraceptive). Diagnosis is often raised by exclusions (malignant diseases, genital tract, PCO, and hypothyroidism liver cirrhosis). The mechanisms involved in the pathophysiology of the above-mentioned bleeding cases are systemic in their nature, although it is possible to observe inadequacy of local hemostatic mechanisms resulting from the absence of cyclic production of progesterone and related endothelin-1, prostaglandins and other substances that contribute positively to local hemostasis of the endometrium [9]. Additionally, lack of ovulation causes unexpected bleeding, which adversely affects the quality of life of the patient. Functional hypothalamic or pituitary disorders that cause suppression of gonadotropin production, anovulation, and the approach to perimenopausal age cause typical changes in the genital cycle.

Progressively shorter cycles due to a gradual decrease in follicles and a corresponding fall in ovarian function lead to metrorrhagia [9].
