Hickey Martha
School of Women's and Infants' Health, King Edward Memorial Hospital, University of Western Australia.
Menopause Int. 2007 Dec;13(4):188-90. doi: 10.1258/175404507783004005.
Abnormal bleeding is a common reason for discontinuation of hormone replacement therapy. There is little consensus regarding when to investigate abnormal bleeding, what to do about persistent bleeding or when reinvestigation is indicated. Transvaginal ultrasound, endometrial biopsy and hysteroscopy are discussed. The mechanisms of this bleeding are poorly understood and do not correlate well with endometrial histology or the type or dose of hormone therapy used. Endometrial bleeding requires breakdown of endometrial vessels and their overlying epithelium. Endometrial vascular breakdown appears to be largely locally regulated. Potential mechanisms involved in endometrial bleeding include: changes in the ratio of vascular endothelial growth factor (pro-angiogenic) to thrombospondin-1 (anti-angiogenic); alterations in matrix metalloproteinases and their tissue inhibitors; changes in endometrial haemostasis due to tissue factor; and increased endometrial leucocytes.
异常出血是停止激素替代疗法的常见原因。对于何时调查异常出血、如何处理持续性出血或何时需要再次调查，几乎没有共识。文中讨论了经阴道超声、子宫内膜活检和宫腔镜检查。这种出血的机制尚不清楚，与子宫内膜组织学或所用激素治疗的类型或剂量相关性不佳。子宫内膜出血需要子宫内膜血管及其上皮的破裂。子宫内膜血管破裂似乎主要受局部调节。子宫内膜出血涉及的潜在机制包括：血管内皮生长因子（促血管生成）与血小板反应蛋白-1（抗血管生成）的比例变化；基质金属蛋白酶及其组织抑制剂的改变；组织因子导致的子宫内膜止血变化；以及子宫内膜白细胞增多。
