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Progestogen only contraception and endometrial break through bleeding

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Abstract

Progestogen only contraceptives (POC) provide a safe and effective method of fertility regulation. Unfortunately, they are commonly associated with the problem of endometrial break through bleeding (BTB), often leading to discontinuation of use. An increase in endometrial vascular fragility has been demonstrated as an important mechanism that contributes to BTB but our understanding of the interaction between exogenous steroid use and endometrial vasculature remains incomplete. This review sets out to describe a number of commonly used POC, their effects on endometrial morphology and possible molecular and cellular mechanisms that may lead to unscheduled bleeding.

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Abbreviations

Ang:

angiopoietin

BM:

basement membrane

BTB:

breakthrough bleeding

ER:

oestrogen receptor

HEEC:

human endometrial endothelial cells

HESC:

human endometrial stromal cells

HIF-1α:

hypoxia inducible factor-1α

IL-1β:

interleukin-1β

LNG:

levonorgestrel

LNG-IUS:

levonorgestrel intrauterine system

MMP:

matrix metalloproteinases

MPA:

medroxyprogesterone acetate

PD-ECGF:

platelet derived endothelial cell growth factor

POC:

progestogen only contraceptives

PR:

progesterone receptor

TF:

tissue factor

TGF-β1:

transforming growth factor β1

TIMP:

tissue inhibitor of matrix metalloproteinases

TP:

thymidine phosphorylase

VEGF:

vascular endothelial growth factor

VSMC:

vascular smooth muscle cells

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Acknowledgement

The authors would like to thank Kate Williams for her secretarial assistance.

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Authors and Affiliations

  1. Department of Reproductive and Developmental Sciences, The University of Edinburgh, Edinburgh, UK

    Oliver P. Milling Smith & Hilary O.D. Critchley

  2. Department of Reproductive and Developmental Sciences, The University of Edinburgh, Chancellor’s Building, 49 Little France, Edinburgh, EH16 4SB, UK

    Hilary O.D. Critchley

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Correspondence to Hilary O.D. Critchley.

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Smith, O.P.M., Critchley, H.O. Progestogen only contraception and endometrial break through bleeding. Angiogenesis 8, 117–126 (2005). https://doi.org/10.1007/s10456-005-9003-z

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