Professional Documents
Culture Documents
6067, 2002
Department of Reproductive Endocrinology, King George V and Royal Prince Alfred Hospitals, Camperdown, NSW and
Department of Obstetrics and Gynaecology, University of Sydney, NSW 2006, Australia
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Over the past 10 years there has been an upsurge of interest in the mechanisms underlying normal and disturbed
menstrual bleeding. These studies have particularly focused on the mechanisms underlying the common problems of
menorrhagia associated with ovulatory and anovulatory dysfunctional uterine bleeding (DUB) and of unpredictable
breakthrough bleeding during hormonal contraceptive use. A wide range of abnormalities of endometrial
morphology and function have been demonstrated, but it is still not clear how all the pieces of this complex jigsaw
puzzle t together. Ovulatory DUB is predominantly associated with decreased endometrial vasoconstriction and
vascular haemostatic plug formation, leading to defective control of the volume of blood which is lost during
menstruation. By contrast, breakthrough bleeding is associated with a wide range of molecular disturbances which
appear to result in unpredictable vessel breakdown through disturbed endometrial angiogenesis, increased vascular
fragility and loss of the integrity of the endothelial, epithelial and stromal supporting structures. Anovulatory DUB is
very poorly understood, but may be associated with disturbed angiogenesis, fragile vessels and defective haemostatic
processes. Little is known about the actual mechanisms of the common problem of abnormal bleeding associated with
specic genital tract pathologies such as uterine myomata.
Key words: endometrium/menorrhagia/menstrual bleeding/progestogens
TABLE OF CONTENTS
Introduction
The nature of abnormal uterine bleeding
Mechanism of abnormal menstruation
Mechanisms involved in abnormal uterine bleeding
Abnormalities of regularity and frequency
Conclusion
References
Introduction
The spectrum of abnormal uterine bleeding affects up to one-third
of women of child bearing age and is therefore one of the
commonest complaints seen by family doctors and gynaecologists. These disturbances lead to considerable social and physical
morbidity in all societies, and may also be a reection of serious
underlying pathology. Menorrhagia affects 1030% of menstruating women at any one time, and may occur at some time during
the perimenopause in up to 50% of women (Ballinger et al., 1987;
Prentice, 1999). Disturbance of the menstrual pattern is almost
universal with long-acting methods of hormonal contraception,
although the patterns usually improve with time and most women
tolerate the changes well (Odlind and Fraser, 1990). Nevertheless,
>50% of women who prematurely discontinue use of these
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Conclusion
Abnormal uterine bleeding is a very common gynaecological
problem, with varied presentations and multiple causes. Over the
past 1015 years there has been a major escalation in the scientic
effort aimed at elucidating the underlying mechanisms. It is now
clear that these mechanisms are complex and involve a number of
different molecular systems. This review has attempted to pull
together the evidence from different disciplines to provide a
picture of the way in which these systems interact to cause
different symptoms.
References
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