АBNORMAL UTERINE BLEEDING DURING МENOPAUSAL HORMONAL THERAPY

Abstract

Postmenopausal women using continuous combined estrogen/progestin therapy are likely to have irregular bleedings or spotting. Up to now, their causes remain unclear. Most investigators believe that a potential mechanism of abnormal bleedings during menopausal hormonal therapy could be a change in the ratio of pro- and anti-angiogenic factors, namely, of vascular endothelial growth factor to thrombospondin-1; alterations in metalloproteinases and their tissue inhibitors; changes in a tissue factor that is a mediator of endometrial hemostasis; as well as an increased number of endometrial leukocytes with predominance of uterine natural killer cells. As long as no link between bleeding discharge during continuous combined hormonal treatment and any of these actors has been established, each and every of them is the subject of in vivo and in vitro investigations. At present, there are no herapeutic methods to correct this complication of hormonal treatment. Patient monitoring to exclude neoplastic abnormalities in endometrium are of paramount importance.

Keywords

• climacterium
• postmenopause
• menopausal hormonal therapy
• endometrium
• progestogens
• angiogenesis
• abnormal uterine bleedings