Future directions for research on endometrial bleeding

Disturbances in endometrial bleeding remain a major problem, and the primary reason for discontinuation of progestin-only methods of contraception. However, some interesting leads were uncovered in the course of this meeting on 'Current research on progestin-only contraceptives and endometrial bleeding', and a number of suggestions made about techniques and research topics. This paper attempts to summarize these suggestions, with a view to stimulating further research. Topics identified included the development of objective tests for vessel fragility, identification and properties of vessels likely to bleed, the location of bleeding vessels, the basis of the increased microvascular density, the integrity of the surface epithelium, the state of the stroma, the function of steroid receptors, and the properties of progestins and oestrogens. Several animal models are discussed, including monkeys, SCID mice and steroid-treated ovariectomized mice, and potential therapeutic agents suitable for human use are identified.