Vascular dysfunction as a cause of endometrial bleeding

Gynecol Endocrinol. 2012 Sep;28(9):688-93. doi: 10.3109/09513590.2011.588848. Epub 2012 Jun 12.


Introduction: Heavy menstrual bleeding (HMB) and the spotting and bleeding (S/B) associated with the use of hormonal contraceptives are distinct entities affecting endometrial vasculature and hemostasis.

Materials and methods: An overview of the major etiologies and potential treatments for each condition is provided.

Results: HMB is potentially caused by several different hemostatic dysfunctions. Combination oral contraceptives, levonorgestrel-releasing intrauterine system, non-steroidal anti-inflammatory drugs, and anti-fibrinolytics all have been shown to have some degree of efficacy in treating HMB. The basic cause of HMB is unknown in the majority of cases. Endometrial S/B related to hormonal contraceptives is a common occurrence and may well have a common etiology in altered angiogenesis resulting in abnormal blood vessels with fragile vessel walls. There is no effective treatment for this problem.

Conclusions: Medical therapy for HMB is limited and effective for reducing blood loss during menstruation. There is no effective treatment for the S/B associated with hormonal contraceptives.

Publication types

  • Review

MeSH terms

  • Contraceptives, Oral, Synthetic / therapeutic use*
  • Endometrium / blood supply*
  • Endometrium / physiopathology
  • Female
  • Humans
  • Levonorgestrel / therapeutic use*
  • Menorrhagia / drug therapy
  • Menorrhagia / physiopathology*
  • Metrorrhagia / drug therapy
  • Metrorrhagia / physiopathology*


  • Contraceptives, Oral, Synthetic
  • Levonorgestrel