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Human Reproduction, Vol. 15, No. suppl_3, pp. 1-6, 2000
© 2000 European Society of Human Reproduction and Embryology

A functional model for progestogen-induced breakthrough bleeding

M. Hickey1,3 and I.S. Fraser2

1 Department of Obstetrics and Gynaecology, Imperial College School of Medicine at St Mary's Norfolk Place, London W2 1PG, UK 2 Sydney Centre for Reproductive Health Research, Department of Obstetrics and Gynaecology, University of Sydney NSW 2006, Australia

Correspondence: 3 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, Imperial College School of Medicine at St Mary's, Norfolk Place, London W2 1PG, UK. E-mail: m.hickey{at}ic.ac.uk

During the past 5 years, a number of important advances have been made in our understanding of the mechanisms of sex steroid-induced breakthrough bleeding (BTB). These observations suggest that superficial endometrial vascular fragility may be the mechanism underlying BTB, and molecular changes in the microvasculature as well as hysteroscopic observations have supported this hypothesis. This paper aims to present a unified picture of our current understanding of BTB, particularly that associated with progestogens, to indicate current gaps in our knowledge and possible directions for future research.

Key words: breakthrough bleeding/endometrium/microvasculature/progestogens


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