{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T04:22:34Z","timestamp":1792297354367,"version":"4.4.0"},"reference-count":83,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2016,1,1]],"date-time":"2016-01-01T00:00:00Z","timestamp":1451606400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:p> Heavy menstrual bleeding (HMB) is a common gynecological complaint with multiple etiologies and diverse pathophysiological origins. This review discusses HMB with reference to the recently proposed PALM-COEIN classification system for abnormal uterine bleeding, initially describing the endometrial events in normal menstruation followed by discussion of the perturbations of normal endometrial shedding that can result in HMB. Our present understanding of the mechanisms of menstrual bleeding as well as many of the pathological aberrations of HMB is incomplete. Further research into the pathophysiology of HMB is urgently needed, as clear knowledge of the mechanisms of this disorder will provide new therapeutic targets to formulate more effective treatments. <\/jats:p>","DOI":"10.2217\/whe.15.81","type":"journal-article","created":{"date-parts":[[2015,12,23]],"date-time":"2015-12-23T08:49:32Z","timestamp":1450860572000},"page":"3-13","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":72,"title":["Pathophysiology of Heavy Menstrual Bleeding"],"prefix":"10.1177","volume":"12","author":[{"given":"Dharani K","family":"Hapangama","sequence":"first","affiliation":[{"name":"Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith N","family":"Bulmer","sequence":"additional","affiliation":[{"name":"Reproductive & Vascular Biology Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2016,1,1]]},"reference":[{"key":"bibr1-whe.15.81","volume-title":"National menstrual heavy bleeding audit. Second Annual Report","author":"Royal College of Obstetricians and Gynaecologists","year":"2012"},{"key":"bibr2-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2000.tb13226.x"},{"key":"bibr3-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2010.11.011"},{"key":"bibr4-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1210\/er.2004-0021"},{"key":"bibr5-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmu053"},{"key":"bibr6-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/det285"},{"key":"bibr7-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-012-9223-7"},{"key":"bibr8-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1189\/jlb.0712327"},{"key":"bibr9-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1097\/MOH.0b013e32830a4ed4"},{"key":"bibr10-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2013.96"},{"key":"bibr11-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmq016"},{"key":"bibr12-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmg011"},{"key":"bibr13-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/S1521-6934(03)00071-3"},{"key":"bibr14-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.K08E-067"},{"key":"bibr15-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-012-9221-9"},{"key":"bibr16-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1095\/biolreprod.108.075226"},{"key":"bibr17-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2003.11.015"},{"key":"bibr18-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2003.11.016"},{"key":"bibr19-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12292"},{"issue":"1","key":"bibr20-whe.15.81","first-page":"77","volume":"12","author":"Treloar AE","year":"1967","journal-title":"Int. J. Fertil."},{"issue":"5","key":"bibr21-whe.15.81","first-page":"771","volume":"71","author":"Van Bogaert LJ","year":"1988","journal-title":"Obstet. Gynecol."},{"issue":"1","key":"bibr22-whe.15.81","first-page":"5","volume":"34","author":"Indraccolo U","year":"2013","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"bibr23-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181f74864"},{"key":"bibr24-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2008.02.007"},{"key":"bibr25-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1097\/PGP.0b013e318187033b"},{"key":"bibr26-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2004.03.048"},{"key":"bibr27-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1186\/2162-3619-2-3"},{"key":"bibr28-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/94.4.435"},{"key":"bibr29-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/hmg\/ddm043"},{"key":"bibr30-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2008.04.002"},{"key":"bibr31-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/0020-7292(95)02533-I"},{"key":"bibr32-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2008.791"},{"key":"bibr33-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2008.01.008"},{"key":"bibr34-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1097\/00003081-200106000-00022"},{"issue":"4","key":"bibr35-whe.15.81","first-page":"516","volume":"94","author":"Clevenger-Hoeft M","year":"1999","journal-title":"Obstet. Gynecol."},{"issue":"3","key":"bibr36-whe.15.81","first-page":"431","volume":"101","author":"Wegienka G","year":"2003","journal-title":"Obstet. Gynecol."},{"key":"bibr37-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1002\/jemt.10276"},{"key":"bibr38-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2007.01.093"},{"key":"bibr39-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/2.4.295"},{"key":"bibr40-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/molehr\/gag066"},{"key":"bibr41-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1177\/1933719112459233"},{"key":"bibr42-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.humimm.2009.11.014"},{"key":"bibr43-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1189\/jlb.0406250"},{"key":"bibr44-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/det233"},{"key":"bibr45-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2006.01.010"},{"key":"bibr46-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2006.01.006"},{"key":"bibr47-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2006.01.017"},{"key":"bibr48-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/des332"},{"key":"bibr49-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1159\/000068385"},{"key":"bibr50-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(72)90781-8"},{"key":"bibr51-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2006.01.016"},{"issue":"5","key":"bibr52-whe.15.81","first-page":"688","volume":"95","author":"Levgur M","year":"2000","journal-title":"Obstet. Gynecol."},{"issue":"6","key":"bibr53-whe.15.81","first-page":"366","volume":"54","author":"Ferrero S","year":"2009","journal-title":"J. Reprod. Med."},{"key":"bibr54-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00970.x"},{"key":"bibr55-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.jri.2011.12.001"},{"key":"bibr56-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.124285"},{"key":"bibr57-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(16)43935-X"},{"key":"bibr58-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2011.04.004"},{"key":"bibr59-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1434.014"},{"key":"bibr60-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/179515"},{"key":"bibr61-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2012.06.044"},{"key":"bibr62-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2011.03.003"},{"key":"bibr63-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2010.04.016"},{"key":"bibr64-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1111\/his.12249"},{"key":"bibr65-whe.15.81","first-page":"125","volume-title":"WHO Classification of Tumours of Female Reproductive Organs.","author":"Zaino R","year":"2014"},{"key":"bibr66-whe.15.81","doi-asserted-by":"publisher","DOI":"10.5653\/cerm.2011.38.1.42"},{"key":"bibr67-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdt353"},{"key":"bibr68-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70591-6"},{"key":"bibr69-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.2010.085951"},{"key":"bibr70-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.48.2596"},{"key":"bibr71-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.humrep.a137430"},{"key":"bibr72-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00176.x"},{"key":"bibr73-whe.15.81","doi-asserted-by":"publisher","DOI":"10.3109\/09513590.2011.588848"},{"key":"bibr74-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2013.10.003"},{"key":"bibr75-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/132.11.3451S"},{"key":"bibr76-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dep036"},{"key":"bibr77-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1530\/rep.0.1210181"},{"key":"bibr78-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/14.1.186"},{"key":"bibr79-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/14.4.1072"},{"key":"bibr80-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/14.12.3095"},{"key":"bibr81-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deu164"},{"key":"bibr82-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dem026"},{"key":"bibr83-whe.15.81","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcmd.2009.04.003"}],"container-title":["Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.2217\/whe.15.81","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.2217\/whe.15.81","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.2217\/whe.15.81","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T05:51:18Z","timestamp":1741672278000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.2217\/whe.15.81"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1]]},"references-count":83,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2016,1]]}},"alternative-id":["10.2217\/whe.15.81"],"URL":"https:\/\/doi.org\/10.2217\/whe.15.81","relation":{},"ISSN":["1745-5057","1745-5065"],"issn-type":[{"value":"1745-5057","type":"print"},{"value":"1745-5065","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1]]}}}