Bleeding arising from the use of exogenous steroids.

A range of hormonal contraceptives and hormone replacement therapies are widely and increasingly used in most societies. These preparations result in a wide variety of scheduled and unscheduled effects on uterine bleeding patterns, some of which may be quite disconcerting for the women who use them. There is now an extensive literature on the analysis of these bleeding patterns, the way in which different hormonal methods affect these patterns and the influence which they may have on women's choice to continue or discontinue use of a method. This review has concentrated particularly on the issues related to bleeding patterns with hormonal contraceptives, but many of the issues are also relevant to menopausal hormone replacement therapy. This is particularly the case with research into the complex vascular and molecular mechanisms underlying disturbances of bleeding, where there may well be substantial overlap. Perception and tolerance are important in determining a woman's approach to a change in her menstrual pattern, and her possible acceptance of counselling and treatment approaches which may improve her symptoms.