Which factor contributes to menorrhagia in patients with regular ovulatory cycles?

Menorrhagia, or heavy menstrual bleeding, in patients who have regular ovulatory cycles can be attributed to endometrial overgrowth. In this condition, the endometrium (the inner lining of the uterus) can become hyperplastic, meaning it thickens excessively due to prolonged stimulation from estrogen without sufficient progesterone to counterbalance its effects. This imbalance can lead to increased menstrual bleeding during the shedding of this thick endometrial lining.

In a regular ovulatory cycle, estrogen levels rise and fall throughout the menstrual cycle, leading to normal proliferation of the endometrial lining. However, if the influence of estrogen is sustained, it can lead to an overgrowth that ultimately causes heavier bleeding when menstruation occurs. Conditions such as endometrial hyperplasia may develop from this excessive growth, thus contributing to the presentation of menorrhagia.

The other factors listed play different roles in menstruation. Decreased estrogen levels would typically lead to lighter menstrual bleeding rather than menorrhagia. Excessive testosterone levels can affect menstruation and may lead to irregular cycles but not directly contribute to menorrhagia itself in the context of regular ovulation. Anovulatory cycles result in irregular bleeding patterns rather than heavy menstrual bleeding specifically. Therefore,