title: The role of selective oestrogen receptor modulators in the treatment of endometrial bleeding in women using long-acting progestin contraception.
abstract: This paper explores the concept that endometrial breakthrough bleeding results from the stimulatory effects of oestrogen in the endometrium. Though 'progestin-only' contraceptive regimens have long been associated with user dissatisfaction because of unpredictable vaginal bleeding, it is likely that the substantial contribution of endogenous ovarian oestradiol during such treatments predisposes the bleeding problems. Oestrogen causes endometrial proliferation, hyperplasia and neoplasia if unopposed. Oestrogen allows production of growth factors supporting angiogenesis which results in an abundance of dilated or fragile endothelial surface blood vessels, predisposing this tissue to bleeding when these vessels lose competence.
authors.affiliation: Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA. daniel.grow@bhs.org
authors.forename: D R
authors.initials: DR
authors.lastname: Grow
authors.forename: M T
authors.initials: MT
authors.lastname: Reece
mesh_terms: D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D018919:Neovascularization, Physiologic / Q000187:drug effects; D011372:Progestins / Q000009:adverse effects*; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*; D013629:Tamoxifen / Q000627:therapeutic use; D014592:Uterine Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy*
chemical_list: D003271:Contraceptive Agents, Female; D004965:Estrogen Antagonists; D011372:Progestins; D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen; D020849:Raloxifene Hydrochloride