breakthrough bleeding (btb) is the cause of 50% of discontinuations of use by long-acting progestogen-only contraceptive users. btb appears to be associated with capillaries of abnormal morphology and fragility. disturbances in vessels integrity, intercellular junctions or alteration of the basement membrane (bm) composition has been proposed to contribute toward the fragility of these capillar...

I n 1982, more than 20% of women surveyed in a nationally representative sample had discontinued oral contraceptives (OCs) on their own or at the recommendation of their physician due to bleeding or spotting. Sadly, the percentage today has not decreased much. Understandable concern, embarrassment, and annoyance lead these women to abandon OCs. What they often don’t know, though, is that breakt...

This review focuses on the complex events that occur in the endometrium after progesterone is withdrawn (or blocked) and menstrual bleeding ensues. A detailed understanding of these local mechanisms will enhance our knowledge of disturbed endometrial/uterine function--including problems with excessively heavy menstrual bleeding, endometriosis and breakthrough bleeding with progestin only contra...

Women using the progestin-only contraceptive Norplant often suffer from unpredictable bouts of breakthrough bleeding, which usually occurs from a thin atrophic endometrium. The role of cellular apoptosis in the endometrial response to Norplant has not been investigated. The aim of the present study was to use immunohistochemistry to produce semi-quantitative scores for expression of the apoptos...