What Do We Know About Why Women Bleed and What Do We Not Know?

J Thromb Haemost. 2023 Sep 12:S1538-7836(23)00671-2. doi: 10.1016/j.jtha.2023.08.034. Online ahead of print.ABSTRACTWomen, or people with a uterus, are vulnerable to both normal and abnormal bleeding. During the reproductive years, the uterus is prepared physiologically to accept an embryo and support its growth and development during pregnancy, or in the absence of implantation of an embryo, recycle through the process of menstruation and accept an embryo a month or so later. If fertilization takes place and an embryo or embryos implant in the uterus, the fetal trophoblast, or outer cell layer of the embryo, invades and dilates the maternal spiral arteries and forms the placenta. No matter when in gestation a pregnancy ends, at the conclusion of pregnancy, the placenta should separate from the wall of the uterus and be expelled. Abnormal bleeding occurs during pregnancy or after delivery when the normal uteroplacental interface has not been established or is interrupted; during miscarriage; during ectopic pregnancy; during premature separation of the placenta; or during postpartum hemorrhage (PPH). Heavy menstrual bleeding (HMB), a subset of abnormal menstrual bleeding, can be quantitatively defined as greater than 80 mL of blood loss per cycle. Unlike PPH, HMB is significantly associated with an underlying bleeding disorder. While there is other reproductive tract bleeding in women, notably bleeding at the time of ovulation or with a life-threatening ruptured ectopic pregna...
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Source Type: research