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Human Reproduction, Vol. 15, No. suppl_3, pp. 30-38, 2000
© 2000 European Society of Human Reproduction and Embryology

The role of selective oestrogen receptor modulators in the treatment of endometrial bleeding in women using long-acting progestin contraception

D.R. Grow1 and M.T. Reece

Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine Springfield, MA 01199, USA

Correspondence: 1To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA E-mail: daniel.grow{at}bhs.org

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 associatedwith 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. Oestrogenallows 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.

Key words: endometrial bleeding/mifepristone/progestin-only contraception/selective oestrogen receptor modulators


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