Endometrial bleeding

Raloxifene is well tolerated overall. Hot flushes occur more frequently in women recently finishing menopause or discontinuing estrogen therapy (ET). Endometrial bleeding occurs rarely. Raloxifene is contraindicated in women with an active or past history of venous thromboembolism. Therapy should be stopped if a patient anticipates extended immobility. 

Androgens are sometimes given in combination with estrogens for replacement therapy in the postmenopausal period in an attempt to eliminate the endometrial bleeding that may occur when only estrogens are used and to enhance libido. They have been used for chemotherapy of breast tumors in premenopausal women. 

Hickey M, Higham J, Sullivan M, Miles L, Fraser IS. Endometrial bleeding in hormone replacement therapy users preliminary findings regarding the role of matrix metalloproteinase 9 (MMP-9) and tissue inhibitors of MMPs. Fertil Steril 2001 75(2) 288-96. 

Archer DE, Dorin M, Lewis V, et al. Effects of lower doses of conjugated equine estrogens and medroxyprogesterone acetate on endometrial bleeding. Eertil Steril 2001 75 1080-1087. 

I Administration. Overall, raloxifene therapy is well tolerated, but hot flushes occasionally cause women to discontinue therapy (see Table 88-6). Raloxifene use is associated with a threefold increased risk of venous thromboembolism, similar to the increased risk seen in women taking estrogens. Raloxifene is contraindicated for those with active thromboembolic disease. Therapy should be stopped if a patient anticipates a signiflcant period (several hours or more) of immobility. Raloxifene does not induce endometrial bleeding. 

Estrogen is the recommended treatment for managing acute bleeding episodes because it promotes endometrial growth and stabilization.11 Following its initial use for controlling acute bleeding episodes, it is necessary to continue therapy to prevent future occurrences. The use of OCs fulfills this role. 

Endometrial studies in women with undiagnosed vaginal bleeding... 

SUI. Systemic estrogen therapy also carries numerous short- and long-term side effect risks (mastodynia, uterine bleeding, nausea, thromboembolism, cardiac and cerebrovascular ischemic events, and enhanced breast and endometrial cancer risks). If estrogens are to be used in SUI management, only locally-administered products should be used (Table 50-4). 

Tamoxifen -nonsteroidal antiestrogen -nausea and vomiting -bowel changes (diarrhea or constipation) -headache -peripheral edema -hot flashes -endometrial carcinoma -vaginal bleeding -venous thrombosis... 

Tamoxifen is usually well tolerated. Symptoms of estrogen withdrawal (hot flashes and vaginal bleeding) may occur but decrease in frequency and intensity over time. Tamoxifen increases the risks of stroke, pulmonary embolism, deep vein thrombosis, and endometrial cancer, particularly in women age 50 years or older. 

Elimination of uterine bleeding. Reduced endometrial cancer risk... 

No significant effect was observed on endometrial thickness or on the length and severity of uterine bleedings after raloxifene treatment at doses of 60 and 180 mg/d in premenopausal women (Palomba et al. 2002a). Unfortunately,... 

Minipill. Continuous low-dose administration of progestin alone can prevent conception. Ovulations are not suppressed regularly the effect is then due to progestin-induced alterations in cervical and endometrial function. Because of the need for constant intake at the same time of day, a lower success rate, and relatively frequent bleeding anomalies, these preparations are now rarely employed. 

Progestins are nsed for varions menstmal cycle disorders, for functional uterine bleeding of various origins, and as a contraceptive. Progestin therapy is also used to treat endometriosis and endometrial carcinomas. Progesterone is not effective when taken orally due to intensive metabolism, and therefore it is used by either parenteral or transvaginal introduction. 

This drug can be used as a carboxylic acid ester, in particular, as an acetate. It causes the mucous membranes of the uterus to move into the secretory phase, which facilitates development of impregnated oocytes. It reduces the excitability and contractility of uterine musculature. It is used for amenorrhea, uterine bleeding, infertility, miscarriage, myoma, mastopathy, endometrial cancer, and other pathologies. Synonyms of this drug are conce-plan, norfor, brevinor, and many others. 

Female hypogonadism - Cyclically, administer 2.5 to 7.5 mg/day in divided doses for 20 days followed by a 10-day rest period. If bleeding does not occur by the end of this period, repeat the same dosage schedule. The number of courses of estrogen therapy necessary to produce bleeding varies depending on endometrial responsiveness. 

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