Vascular dysfunction as a cause of endometrial bleeding

Abstract

Introduction. Heavy menstrual bleeding (HMB) and the spotting and bleeding (S/B) associated with the use of hormonal contraceptives are distinct entities affecting endometrial vasculature and hemostasis.

Materials and methods. An overview of the major etiologies and potential treatments for each condition is provided.

Results. HMB is potentially caused by several different hemostatic dysfunctions. Combination oral contraceptives, levonorgestrel-releasing intrauterine system, non-steroidal anti-inflammatory drugs, and anti-fibrinolytics all have been shown to have some degree of efficacy in treating HMB. The basic cause of HMB is unknown in the majority of cases. Endometrial S/B related to hormonal contraceptives is a common occurrence and may well have a common etiology in altered angiogenesis resulting in abnormal blood vessels with fragile vessel walls. There is no effective treatment for this problem.

Conclusions. Medical therapy for HMB is limited and effective for reducing blood loss during menstruation. There is no effective treatment for the S/B associated with hormonal contraceptives.

Keywords:

• Heavy menstrual bleeding
• hormonal contraceptives
• endometrial spotting and bleeding
• medical therapy

Declaration of Interest: Dr. Archer is a consultant to Agile Pharmaceutics, Bayer, CHEMO, Merck, Pfizer, and Warner Chilcott and has received grant support from Bayer, Merck, Pfizer, TEVA, and Watson Pharmaceuticals.