Vascular dysfunction as a cause of endometrial bleeding

Archer, David F.

doi:10.3109/09513590.2011.588848

Cited by 5 publications

(4 citation statements)

References 66 publications

(87 reference statements)

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“…Regulation of menstrual shedding and cessation of menstrual bleeding is not fully understood. The previously proposed theory that re-epithelialization of the luminal epithelial surface is the primary factor in cessation of bleeding [73] is not supported by the histological observations that complete re-epithelialization is frequently seen on days 1 and 2 of the menses, despite continued menstrual bleeding. The stratum basalis of the endometrium maintains tissue integrity during menstrual breakdown of the stratum functionalis [5].…”

Section: Mechanisms Of Hmbmentioning

confidence: 95%

“…A decrease in clot strength and integrity due to the breakdown of fibrin results in an increased blood loss during menstruation. Plasminogen activators are fibrinolytic in that they induce lysis or dissolution of blood clots and endometrial and menstrual effluent levels of plasminogen activators are increased in women with excessive menstrual blood loss [73].…”

Section: Mechanisms Of Hmbmentioning

confidence: 99%

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Pathophysiology of Heavy Menstrual Bleeding

Hapangama

Bulmer

2016

Womens Health (Lond Engl)

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Heavy menstrual bleeding (HMB) is a common gynecological complaint with multiple etiologies and diverse pathophysiological origins. This review discusses HMB with reference to the recently proposed PALM-COEIN classification system for abnormal uterine bleeding, initially describing the endometrial events in normal menstruation followed by discussion of the perturbations of normal endometrial shedding that can result in HMB. Our present understanding of the mechanisms of menstrual bleeding as well as many of the pathological aberrations of HMB is incomplete. Further research into the pathophysiology of HMB is urgently needed, as clear knowledge of the mechanisms of this disorder will provide new therapeutic targets to formulate more effective treatments. Keywords: endometrial cancer • endometrial hyperplasia • heavy menstrual bleeding • leiomyoma/fibroid • polycystic ovarian syndromeIn the developed world an average woman undergoes ∼400 repetitive cycles of monthly menstrual bleeding with shedding of her superficial endometrial functional layer. In as many as 20-30% of women, this bleeding is excessive and is termed heavy menstrual bleeding (HMB) [1]. Apart from the physical symptoms of anemia (fatigue, lethargy and exertional dyspnea), HMB can interfere with normal daily life and may affect the social and emotional well being of women, reducing their productivity in society. HMB commonly presents to primary and secondary healthcare providers, with over 1.5 million women suffering from this problem in England and Wales alone [1]. It is the fourth most common reason for secondary gynecological referrals and each year over 30,000 women in England and Wales undergo surgical treatment for HMB [1]. The annual cost to the National Health Service in 2000 was estimated to be over GB£65 million [2] and with the spiraling cost of healthcare provision, it is clear that the current cost of HMB to women, society and the National Health Service is huge.In this review HMB will be discussed with reference to the recently proposed polyps; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic and not yet classified (PALM-COEIN) classification system for abnormal uterine bleeding (AUB), approved by the International Federation of Gynecology and Obstetrics [3]. HMB can present as a chronic disorder of over 12 months duration or as an acute increase in bleeding over a short time period. The age at presentation can range from adolescence to the perimenopausal phase and HMB may occur in the context of either ovulatory or anovulatory cycles. This review will briefly describe the endometrial events in normal menstruation followed by discussion of the perturbations of normal endometrial shedding that can result in HMB. Normal menstruationThe purpose of menstruation is unknown but it is a phenomenon confined mainly to the upper order primates and humans [4], suggesting an associated evolutionary advan- tage. The morphology of human endometrium, relatively greater quantity of menstr...

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Section: Mechanisms Of Hmbmentioning

confidence: 95%

Section: Mechanisms Of Hmbmentioning

confidence: 99%

Pathophysiology of Heavy Menstrual Bleeding

Hapangama

Bulmer

2016

Womens Health (Lond Engl)

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“…Several different pathways that result or cause hemostatic dysfunctions have been implicated in increased menstrual blood loss [ 30 ]. The multiple pathways include the fibrinolytic system represented by plasminogen activator and its inhibitor, increased prostaglandinE2, local cytokines, and the influx of leukocytes into the endometrial stroma.…”

Section: Clinical Findingsmentioning

confidence: 99%

“…Endometrial cytokines and metalloproteinases (MMPs) have been reported to be involved in HMB as they are initial mediators of the dissolution of endometrial collagen [ 30 ]. The proinflammatory cytokine tumor necrosis factor alpha (TNF-alpha) was significantly elevated and MMP-2 and MMP-9 were reduced in the menstrual effluent of heavy menstrual bleeders compared to women with normal bleeding [ 43 ].…”

Section: Clinical Findingsmentioning

confidence: 99%

Heavy menstrual bleeding diagnosis and medical management

Sriprasert

Pakrashi

Kimble

et al. 2017

Contracept Reprod Med

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Heavy menstrual bleeding (HMB) is a common gynecological problem that has a significant impact on a woman’s quality of life and the activities of daily living. Due to the difficulty in accurately describing menstrual bleeding abnormalities using older terminology, the PALM-COEIN classification system of the Federation Internationale de Gynecologie et d’Obstetrique was proposed to describe and identify the etiology of abnormal endometrial bleeding. As there is no single pathway that is associated with HMB, there are several therapeutic interventions involving different molecular pathways to reduce HMB. This article will highlight the current evidence as it relates to the etiology of HMB as well as medical modalities of treatment.

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