ABSTRACT
Ovarian steroid hormones orchestrate the cyclical remodeling of the endometrium that occurs during reproductive life and after the menopause. When ovarian follicular activity ceases, endometrial remodeling also ceases and the endometrium enters a phase of quiescence which remains for the rest of a woman’s life. As the menopause approaches, the hormonal milieu becomes unpredictable and liable to large fluctuations, and considerable disturbances in patterns of menstrual bleeding occur. Similar disturbances of uterine bleeding are also experienced by women using progestagenic steroids as contraceptives (particularly the long-acting progestins), or hormone replacement therapy: such disturbances occur predominantly during the first year of use.
