The causes and management of endometrial breakthrough bleeding

Published online by Cambridge University Press: 14 February 2002 The term breakthrough bleeding (BTB) is rather poorly defined, but essentially describes the symptom of vaginal bleeding occurring with scheduled periods of withdrawal bleeding, in the absence of pelvic pathology in women taking exogenous sex steroids, usually contraceptives or hormone-replacement therapy (HRT). It may also describe occasional bleeding in those who are predominantly experiencing amenorrhoea due to these preparations. Rather confusingly, the term is sometimes used to describe intermenstrual bleeding in women who are not taking sex steroids, when structural or other pathological causes are more likely. In the absence of such pathology intermenstrual bleeding in the normal menstrual cycle is relatively uncommon, suggesting that exogenous sex steroids can profoundly disrupt the tight regulation of endometrial vascular development, function and breakdown. Intermenstrual bleeding also occurs spontaneously in some women and it is possible that this phenomenon has similar mechanisms to that seen in sex-steroid-related breakthrough bleeding. - Type - Research Article - Information - Copyright - © 2001 Cambridge University Press - 4 - Cited by Cited by Crossref Citations Wahab, M. Taylor, A.H. Pringle, J.H. Thompson, J. and Al-Azzawi, F. 2006. Trimegestone differentially modulates the expression of matrix metalloproteinases in the endometrial stromal cell. MHR: Basic science of reproductive medicine, Vol. 12, Issue. 3, p. 157. Hammar, ML Van De Weijer, P Franke, HR Pornel, B Von Mauw, EMJ and Nijland, EA 2007. Tibolone and low‐dose continuous combined hormone treatment: vaginal bleeding pattern, efficacy and tolerability. BJOG: An International Journal of Obstetrics & Gynaecology, Vol. 114, Issue. 12, p. 1522. Mansour, Diana Bahamondes, Luis Critchley, Hilary Darney, Philip and Fraser, Ian S. 2011. The management of unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users. Contraception, Vol. 83, Issue. 3, p. 202. Di Carlo, Costantino Guida, Maurizio De Rosa, Nicoletta Sansone, Anna Gargano, Virginia Cagnacci, Angelo and Nappi, Carmine 2015. Bleeding profile in users of an etonogestrel sub-dermal implant: effects of anthropometric variables. An observational uncontrolled preliminary study in Italian population. Gynecological Endocrinology, Vol. 31, Issue. 6, p. 491.