Endometrial bleeding

D. Apter, D. T. Baird, J. Collins, H. O D Critchley, J. L H Evers, A. Glasier, P. Vercellini, K. Vogelsong, G. Benagiano, Pier Giorgio Crosignani, E. Diczfalusy, C. La Vecchia, A. Lanzone, S. O. Skouby, A. Volpe

Research output: Contribution to journalArticlepeer-review


Abnormal bleeding is a significant health problem, especially during adolescence and before menopause when anovulatory cycles are common. Curettage is rarely necessary to investigate or treat menstrual problems in adolescents, and its use should also be minimized in women younger than 40 years. In every age group, medical treatment is the initial choice, but surgical treatment by endometrial destruction or hysterectomy is sometimes required. Benign causes of bleeding include fibroids and possibly adenomyosis, but the indications for treatment in each case depend upon the extent of bleeding, not the extent of the lesion. Breakthrough bleeding (BTB) with combined oral contraceptives commonly leads to discontinuation of the method. As BTB tends to improve with time, in the first 3 months of pill use, unless there are obvious underlying causes, women should be reassured that it will likely settle. BTB is often the reason for discontinuing progestogen-only contraception, and there is a need for effective means of treating unscheduled bleeding. Bleeding occurs in ∼3% of post-menopausal women, and the use of hormones increases the likelihood of bleeding by >5-fold. Knowledge of the underlying mechanisms of bleeding is essential to the development of effective treatment.

Original languageEnglish
Pages (from-to)421-431
Number of pages11
JournalHuman Reproduction Update
Issue number5
Publication statusPublished - Sep 2007


  • Endometrial bleeding
  • Heavy menstrual bleeding
  • Menstruation

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Reproductive Medicine


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