The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
Menopause. 2011 Apr;18(4):416-20. doi: 10.1097/gme.0b013e31820ca808.
The aim of this study was to present a review of the potential mechanisms involved in the occurrence of endometrial bleeding in postmenopausal women using hormone therapy. Selected literature on the incidence of bleeding in postmenopausal women using estrogen progestogen therapy was reviewed. The incidence of spotting and bleeding in women using continuous-combined hormone therapy was presented. Relevant articles related to the role of angiogenic factors and vasculogenesis in the endometrium, endometrial leukocytes, and endometrial metalloproteinases were used for the review. The cause or etiology of endometrial bleeding with hormone therapy is unknown. Several options are known to alter angiogenesis or be involved in tissue remodeling during normal menstruation. Vascular endothelial growth factor and thrombospondin-1 are proangiogenic and antiangiogenic factors that could cause dysfunction in vasculogenesis that could result in blood vessel fragility and bleeding. The role of pericytes in maintaining vessel morphology and integrity is discussed. Endometrial leukocytes and metalloproteinases are involved in normal menstruation, but their role in postmenopausal bleeding is not clear suggesting involvement of mechanisms in the bleeding. There is limited information on clinical investigation into the etiology of postmenopausal bleeding associated with hormone therapy. The major cause of hormone therapy-related bleeding is unknown. Alterations in angiogenic factors that could result in vascular dysfunction and vessel breakdown provide a working hypothesis as to the potential cause of vessel breakdown.
本研究旨在综述激素治疗引起绝经后妇女子宫内膜出血的潜在机制。对雌孕激素联合治疗绝经后妇女出血的发生率进行了文献回顾。阐述了连续联合激素治疗妇女点状出血和出血的发生率。综述了与血管生成因子和血管发生、子宫内膜白细胞和子宫内膜金属蛋白酶在子宫内膜中的作用相关的文章。激素治疗引起的子宫内膜出血的原因或病因尚不清楚。已知有几种方法可以改变血管生成或参与正常月经期间的组织重塑。血管内皮生长因子和血栓素-1是促血管生成和抗血管生成因子，可能导致血管发生功能障碍，导致血管脆弱和出血。还讨论了周细胞在维持血管形态和完整性中的作用。子宫内膜白细胞和金属蛋白酶参与正常月经，但它们在绝经后出血中的作用尚不清楚，提示可能涉及出血机制。关于激素治疗相关绝经后出血的病因的临床研究信息有限。激素治疗相关出血的主要原因尚不清楚。血管生成因子的改变可能导致血管功能障碍和血管破裂，为血管破裂的潜在原因提供了一个工作假说。
