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Menstruation is taken into consideration normal once uterine bleeding occurs eextremely 21 to 35 days and is not excessive. The normal duration of menstrual bleeding is between two and also seven days. Abnormal uterine bleeding occurs when either the frequency or amount of uterine bleeding differs from that stated above or the woman has actually spotting or bleeding in between her menstrual durations. Abnormal uterine bleeding may be brought about by a range of factors. The 2 most common causes are structural abnormalities of the reabundant system and also ovulation disorders. Women who are postmenopausal must look for prompt treatment from a doctor for any bleeding, as the reasons of bleeding and concerns are various from those in woguys of refertile age.

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In women of refertile age, the odiffer secretes estrogen and progesterone into the bloodstream. These 2 hormones prepare the endometrium (the lining of the uterus) for implantation of a fertilized egg. The pituitary gland also, located at the base of the brain, impacts ovarian hormone manufacturing and ovulation by secreting 2 hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Following stimulation by FSH and also LH, a follicle containing an immature egg begins to build within the odiffer. As the follicle enlarges, it secretes boosting amounts of estrogen. When a enough amount of estrogen is secreted, the pituitary gland releases a large amount of LH, which reasons the follicle to release its egg (ovulation). If the egg does not come to be fertilized or does not implant in the endometrium, the secretion of estrogen and also progesterone starts to decrease approximately seven days after ovulation. With declining levels of estrogen and also progesterone, the lining of the uterus is shed as the menstrual period (around 12-16 days after ovulation).

The cyclical release of FSH and also LH from the pituitary gland also is tightly regulated and quickly disrupted. When the pituitary gland does not release proper quantities of FSH or LH, ovulation might not take place and the cycle may be disrupted. In some women that do not ovulate, the endometrium is stimulated by constant exposure to estrogen without sufficient levels of progesterone to permit for finish shedding of the endometrial lining. This eventually might lead to irregular or hefty bleeding. If estrogen expocertain is constant, cells within the endometrium also might come to be overcreated and also ultimately construct right into endometrial cancer.


Abnormal uterine bleeding (AUB) may be due to structural abnormalities of the uterus. Some of the more common structural causes of abnormal uterine bleeding encompass benign (non-cancerous) lesions of the uterus such as polyps, fibroids (myomas), and also adenomyosis (uterine thickening resulted in by endometrial tworry moving into the outer walls of the uterus) (Figure 1). Other causes include bleeding associated via beforehand pregnancy, including miscarriage and ectopic pregnancy, and bleeding disorders that affect the capacity of the blood to clot typically. Lesions of the cervix or vagina (benign and cancerous), chronic infections of the endometrial lining (endometritis), scar tissue (adhesions) in the endometrium, and the usage of an intrauterine device (IUD) also might be associated through abnormal uterine bleeding. Additional causes of abnormal bleeding incorporate medications that can influence the normal release of estrogen and also progesterone; chronic clinical difficulties such as diabetes mellitus or disorders of the liver, kidney, thyroid gland also, or adrenal glands; or various other clinical problems that deserve to influence the production and metabolism of estrogen and also progesterone. Emotional or physical stress and also considerable transforms in body weight might disrupt the pituitary’s release of FSH and LH and also proccasion ovulation.

Anovulatory or Dysuseful Uterine Bleeding (DUB)

Dysfunctional uterine bleeding is the event of uterine bleeding unregarded structural abnormalities of the uterus or the endometrial lining. It is a diagnosis of exemption made after structural causes of bleeding and chronic medical diseases have been ruled out. Other causes of abnormal bleeding need to additionally be ruled out, consisting of pregnancy complications and also drugs that influence hormonal activity or affect clotting. Dyssensible bleeding occurs more commonly in the first five years after a woman starts menstruating and also as she viewpoints menopausage, yet it deserve to happen at any kind of time duration. The reason of DUB is anovulation, the absence of ovulation and the orderly secretion of estrogen and progesterone, and also may alert the woguy and also her physician to the reality that she is no longer ovulating usually.



Women that experience abnormal uterine bleeding need to be evaluated by a physician. A clinical history, discussion of possible contributing factors, and a thorough physical exam are shown. A range of diagnostic methods are available for determining the reason of abnormal uterine bleeding.

Diagnostic Procedures

After perdeveloping a physical exam and ordering blood tests, a medical professional may recommfinish an imaging research in order to better evaluate the appearance of the uterus, including the form, size, and existence of any type of evident structural abnormality. A variety of methods are available to visualize the uterus and pelvic organs.

Ultrasound (sonogram) is a procedure which uses high-frequency sound waves to create a snapshot of the pelvic structures. This is the a lot of frequently used imaging technique for the pelvic organs and also does not involve the usage of radiation. The ultrasound is generally performed both on optimal of the abdomen and pelvis and from within the vagina. A sonohysterogram might be perdeveloped in the office or in a radiology unit. Throughout this procedure, a small catheter is first inserted right into the cervix via which a sterile solution (such as saline or water) might be injected under ultrasound guidance. The water allows the medical professional to see inside the uterine cavity to look for polyps, fibroids, or svehicle tconcern. Abnormalities of the endometrium may likewise be detected by a hysterosalpingogram (HSG). This requires the sluggish injection of an iodine-containing solution into the uterine cavity under x-ray guidance so that the contours of the endometrium and also fallopian tubes deserve to be seen. Less frequently, computerized tomography (CT) and magnetic resonance imaging (MRI) have the right to be offered to depict a three-dimensional image of interior organs consisting of the uterus. MRI is regularly even more beneficial than CT in visualizing pelvic frameworks and also may be especially beneficial in patients where adenomyosis is suspected. The physician may recommend an endometrial biopsy, an office procedure, to examine a sample of the uterine lining to rule out cancerous and noncancerous abnormalities.

Hysteroscopy is a helpful procedure in which a thin telescope-prefer instrument is placed through the cervix into the uterus which enables visual inspection of the whole uterine cavity (Figure 2). It might permit the physician to identify particular locations of the endometrium that may be biopsied or removed with distinct tools. Hysteroscopy might be performed under basic anesthesia or as an office procedure. For even more indevelopment on hysteroscopy, refer to the Amerideserve to Society for Reproductive Medicine (ASRM) patient indevelopment booklet titled, Laparoscopy and also Hysteroscopy. In some situations, a dilation and also curettage (D&C) may be recommended to further assess the endometrial tconcern. This can be percreated at the exact same time as hysteroscopy in many type of scenarios. D&C may additionally be recommfinished for regulate of persistent or heavy bleeding in woguys for whom various other approaches have actually been ineffective. Normally, yet, hysteroscopy is perdeveloped at the exact same time as the D&C, and D&C is only efficient in dealing with abnormal bleeding in that certain menstrual cycle.


Laboratory Studies

Laboratory research studies additionally help in diagnosing abnormal uterine bleeding. A pregnancy test is constantly percreated because abnormal bleeding in the reabundant years is commonly due to abnormalities linked with pregnancy. Often a blood test will certainly be derived to check for anemia (low blood count) or a blood clotting disorder. When structural disturbances of the refertile tract have actually been ruled out, a blood test to measure pituitary hormones, such as prolactin, FSH, and thyroid hormones, may be performed. If tbelow is proof of abnormal hair growth on the face or dvery own the middle of the body, the reason might be polycystic ovary syndrome (PCOS). PCOS regularly is connected with irregular or heavy menstruation. For more information on PCOS, describe the ASRM patient indevelopment booklet titled Hirsutism and Polycystic Odiffer Syndrome. Increased body hair may lead the medical professional to meacertain the androgens (hormones) testosterone and also dehydroepiandrosterone sulfate (DHEAS). Additional tests of the liver, kidney, pancreas, and also various other significant organs might be beneficial, depending on each woman’s medical history. Laboratory research studies for abnormal uterine bleeding will certainly be based on the physician’s clinical judgment as to the underlying reason of the bleeding.


The individual treatment recommended to you by your doctor will certainly be tailored to the certain cause of abnormal bleeding. Structural abnormalities of the refertile tract such as fibroids, polyps, or scar tconcern regularly deserve to be treated during hysteroscopy. Surgical instruments have the right to be put through the hysteroscope to rerelocate or correct structural abnormalities within the uterine cavity. Generally, patients have the right to go back to normal activities within 24 hrs after hysteroscopy. Serious complications are rare.

Womales who have actually adequate levels of estrogen however who execute not ovulate have the right to be properly treated via artificial progestins such as medroxyprogesterone acetate making use of dosperiods of 5 to 10 mg each day orally for more than 10 days. Other progestins, consisting of herbal progesterone, are easily accessible as oral capsules, vaginal suppositories, or intramuscular injections and also also are efficient in fostering complete shedding of the endometrial lining. In many type of instances, patients can be treated via low-dose combination oral contraceptives (OCs), which carry out both estrogen and also progestins and also promote constant menstruation. This may be a specifically helpful choice for individuals who additionally desire birth regulate.


For women with menorrhagia (excessively extended or heavy menstruation), the management of an estrogen may be recommfinished to temporarily speak the bleeding and stabilize the endometrial lining. Often the doctor will certainly recommfinish an endometrial biopsy under such circumstances. Estrogens deserve to be administered orally, such as conjugated estrogens, making use of dosages of 1.25 to 5 mg eexceptionally six hrs for a 12- to 24-hour period. Conversely, intravenous estrogens at dosages of 20 to 25 mg have the right to be administered eincredibly four to six hours to regulate hefty bleeding. After numerous days of estrogen therapy, progestins have to be administered orally for 12 days to attempt to accomplish a managed bleeding episode.

Heavy uterine bleeding may be controlled through the use of low-dose OCs. A combicountry OC formulation may be administered as 2 to 4 tablets per day for up to seven days to manage significant menorrhagia. Thereafter, an interruption of OC use for five to seven days might be recommfinished, and a regulated withdrawal flow generally adheres to. Subsequently, low dose OCs may be supplied in a typical fashion to facilitate orderly menstrual bleeding. If OC therapy is used in women over the age of 40, reabundant tract abnormalities, malignancies, and clinical problems which may prevent the usage of these medications need to first be excluded. For more indevelopment on the use of OCs to control bleeding, refer to the ASRM patient reality sheet titled Noncontraceptive Benefits of Birth Control Pills.

Tranexamic acid can be supplied for heavy bleeding episodes. This orally administered medication is used twice per day and also has actually been displayed to cause a major reduction in menstrual blood flow.

Levonorgestrel-containing IUDs are valuable in treating DUB hefty menstrual bleeding and also might be the the majority of effective treatment. Prostaglandin synthesis inhibitors, consisting of ibuprofen and also related compounds, additionally have been displayed to mitigate extreme menstrual bleeding in some womales. This might be useful especially in womales through menorrhagia adhering to the insertion of an IUD.

Occasionally, the physician might recommfinish the use of gonadotropinreleasing hormone (GnRH) analogs to temporarily manage extreme uterine bleeding, particularly for the therapy of severe menorrhagia, which may cause anemia. These compounds temporarily speak the release of FSH and LH from the pituitary gland also and also reason ovarian estrogen production to loss to menopausal levels. Short-term use of GnRH analogs in combination through iron supplementation may improve or correct the anemia.

Surgical ideologies encompass removal of any kind of uterine abnormalities via the use of the hysteroscope. Surgical removal of fibroids (myomectomy) may be recommended for woguys with menorrhagia who fail to respond to hormonal therapy. The kind of surgical approach will depfinish upon both the size and also area of the fibroids. Myomectomy might be performed through hysteroscopy, laparoscopy (typical or robotic), and also by an abdominal incision (laparotomy). Some womales might pick to have actually their uterus removed (hysterectomy) by one of numerous different paths (vaginal, laparoscopy, laparotomy). For even more indevelopment on fibroids, describe the ASRM patient information factsheet Treatment of Uterine Fibroids.

Furthermore, endometrial ablation might be recommfinished for woguys that no much longer desire fertility. This procedure, which is performed under general anesthesia, uses thermal radiofrequency, cryosurgical treatment (freezing), or a laser beam to remove the endometrial lining and also generally corrects hefty menstrual flow. It is necessary to exclude significant endometrial lesions before perdeveloping this procedure. Although the goal is to soptimal menstrual bleeding completely, most often menstrual periods simply become lighter following this procedure. Ablation must not be percreated if a woman still desires future fertility. For more indevelopment on endometrial ablation, refer to the ASRM patient indevelopment factsheet Endometrial Ablation.

Only hardly ever will certainly a hysterectomy be recommended for heavy menstrual bleeding. This only must be taken into consideration for patients who no longer desire childbearing and also who have actually failed other hormonal and/or surgical therapies and that have actually been thoabout evaluated.

Pituitary and also Glandular Dysfunction

Disorders of the pituitary and thyroid glands deserve to cause anovulation and menstrual irregularity. Individuals with insufficient manufacturing of thyroid hormone (hypothyroidism) have the right to be treated through day-to-day dental replacement of thyroid hormone. Excess thyroid hormone production (hyperthyroidism) may be treated with dental medicines, radioactive iodine, or surgical removal of all or component of the thyroid gland also. The treatment of hyperprolactinemia (extreme release of prolactin from the pituitary) is generally treated via the dental medication cabergoline or bromocriptine. Individuals through elevated levels of prolactin may be advised to have actually an imaging examine, such as a CT sdeserve to or MRI, of the pituitary gland also to determine if tright here is proof of a pituitary lesion. Pituitary adenomas are the the majority of widespread benign tumors of the pituitary gland also and are often associated through excessive release of prolactin. If pituitary adenomas are huge, they may be treated surgically. Sometimes transforms in exercise and/or dietary actions (to decreased calorie intake or a vegetarian diet) have the right to cause changes in many type of of these hormones and bring about irregular bleeding. Such way of living alters cause FSH and also LH to be incredibly low or cshed to undetectable and this may imply a proper evaluation. An elevated FSH level might indicate impfinishing ovarian faiattract, either because of menopausage or to beforehand menopause, also recognized as premature ovarian faitempt (POF). For even more information on POF, describe the ASRM patient information factsheet titled Premature Ovarian Failure.

Polycystic Ovary Syndrome (PCOS)

Patients through PCOS should have their therapy individualized depending upon whether their goal is restoration of fertility or constant menstruation. For people through ircontinual uterine bleeding that are not currently attempting to obtain pregnant, intermittent progestin therapy (medroxyprogesterone acetate 5 to 10 mg orally for 12 to 14 days a month) or dental contraceptives may be recommended to establish continual bleeding episodes and to alleviate the hazard of hyperplasia and cancer. Estrogen and progestin together, as in OCs, may be more reliable than progestin treatment alone. Woguys through PCOS who are attempting to get pregnant are generally treated via clomiphene citrate. If clomiphene is inreliable, alternative treatment programs have the right to be recommfinished. PCOS have the right to be connected via high blood press, heart illness, acne, excess body hair (hirsutism), obesity, and diabetes mellitus, so correct medical attention and treatment are necessary. For better indevelopment on PCOS and also fertility treatment for patients through PCOS, refer to the ASRM patient indevelopment bookallows and also fact sheets on PCOS and also hirsutism.


Abnormal uterine bleeding is a common problem in women of refertile age that typically can be corrected with surgical treatment or medication. Surgery may be able to correct structural causes of abnormal bleeding. If tbelow are no structural causes, clinical treatment frequently have the right to restore consistent menstrual cycles. Whatever before the reason of abnormal uterine bleeding, the many treatments accessible now generally have the right to settle the problem. Patients must soptimal to their doctors around which medical or surgical alternatives may be finest for them.


Adenoma. A benign (non-cancerous) growth of cells that commonly does not invade adjacent tconcern. A pituitary adenoma deserve to disrupt ovulation and menstruation and also frequently is associated via extreme prolactin production.

Adenomyosis. A benign (non-cancerous) invasion of endometrial tconcern into the muscular wall (myometrium) of the uterus; is linked with painful or heavy menstrual durations.

Adhesions (scar tissue). Bands of fibrous sautomobile tworry that might bind the pelvic organs and/or loops of bowel together. Adhesions can outcome from previous infections, endometriosis, or previous surgeries.

Adrenal glands. Glands located above each kidney that secrete a large variety of hormones (cortisol, adrenaline, and also others) that aid the body withstand stress and anxiety and control metabolism. Altered feature of these glands have the right to disrupt menstruation, reason inappropriate hair expansion, and affect blood push.

Androgen. In guys, androgens are the “male” hormones developed by the testes which are responsible for encouraging masculine qualities. In women, androgens are developed in small quantities by both the adrenal glands and ovaries. In woguys, excess amounts of androgens can result in irconsistent menstrual periods, obesity, extreme growth of body hair (hirsutism), and infertility.

Anemia. A reduction in the variety of red blood cells, which bring oxygen in the body. Anemia is defined by weakness or listlessness. It deserve to be a repercussion of abnormal bleeding.

Anovulation. Absent out ovulation. Failure of the ovary to ovulate on a regular basis.

Cervix. The reduced, narrow end of the uterus that connects the uterine cavity to the vagina.

Computerized tomography (CT). An x-ray imaging technique that creates a three-dimensional picture of inner organs.

Diabetes mellitus. A condition due to abnormal manufacturing of insulin causing abcommonly elevated blood glucose (sugar) levels.

Dilation and also curettage (D&C). An outpatient surgical procedure in the time of which the cervix is dilated and also the lining of the uterus is scraped out. The tissue frequently is provided for microscopic examicountry for the presence of abnormality or pregnancy tissue.

Dysfunctional uterine bleeding (DUB). Abnormal uterine bleeding via no proof of mechanical or structural cause. The a lot of prevalent reason of DUB is deficient or excessive production of estrogen and/or progesterone.

Ectopic pregnancy. A pregnancy that implants external of the uterus, generally in the fallopian tube. The tube might rupture or bleed as the pregnancy grows and also produce or result in a significant medical situation.

Endometrial ablation. A hysteroscopic or non-hysteroscopic procedure provided to remove, burn, or freeze a lot of of the endometrium (uterine lining); periodically used to treat abnormal uterine bleeding.

Endometrial biopsy. Removal of a little item of tproblem from the endometrium (lining of the uterus) for microscopic examicountry. The outcomes might suggest whether or not the endometrium is at the appropriate stage for successful implantation of a fertilized egg (embryo) and/or if it is inflamed or diseased.

Endometritis. An inflammation of the endometrium brought about by bacterial invasion.

Endometrium. The lining of the uterus that is shed each month as the menstrual duration. As the monthly cycle progresses, the endometrium thickens and also hence provides a nourishing website for the implantation of a fertilized egg.

Estrogens. The female sex hormones produced by the ovaries that are responsible for the breakthrough of female sex attributes. Estrogens largely are responsible for stimulating the uterine lining to thicken during the first half of the menstrual cycle in preparation for ovulation and feasible pregnancy. They additionally are essential for healthy bones and also all at once wellness. A small amount of these hormones additionally is produced in the male when testosterone is converted to estrogen.

Fallopian tubes. A pair of hollow tubes attached one on each side of the uterus with which the egg travels from the odiffer to the uterus. Fertilization usually occurs in the fallopian tube. The fallopian tube is the a lot of widespread site of ectopic pregnancy.

Fibroids. Benign (non-cancerous) tumors of the uterine muscle wall that can reason abnormal uterine bleeding. Also recognized as leiomyomas or myomas.

Follicle. A fluid-filled sac situated just beneath the surface of the odiffer that includes an egg (oocyte) and cells that create hormones. The follicle rises in size and also volume during the first fifty percent of the menstrual cycle. At ovulation, the follicle matures and ruptures, releasing the egg. As the follicle matures, it can be visualized by ultrasound.

Follicle-stimulating hormone (FSH). In woguys, FSH is the pituitary hormone responsible for stimulating follicular cells in the ovary to prosper, stimulating egg advancement, and the production of the female hormone estrogen. In the male, FSH is the pituitary hormone that travels through the bloodstream to the testes and helps stimulate them to manufacture sperm.

Hysterectomy. The surgical removal of the uterus. Hysterectomy might be performed with an abdominal incision (laparotomy), via the vagina (vaginal hysterectomy), through laparoscopy or robotic aided laparoscopy, or by laparoscopic aided vaginal hysterectomy (LAVH). Sometimes the ovaries and fallopian tubes likewise are rerelocated.

Hysterosalpingogram (HSG). An x-ray procedure in which a distinct iodine-containing dye is injected via the cervix right into the uterine cavity to illustrate the inner shape of the uterus and also degree of openness (patency) of the fallopian tubes.

Hysteroscope. A thin, lighted telescope-choose instrument that is inserted through the vagina and cervix right into the uterine cavity to allow viewing of the inside of the uterus.

Hysteroscopy. The insertion of a lengthy, thin, lighted telescope-like instrument, dubbed a hysteroscope, with the cervix and also right into the uterus to research the inside of the uterus. Hysteroscopy can be supplied to both diagnose and surgically treat uterine conditions.

Intrauterine gadget (IUD). A contraceptive gadget inserted within the uterus; also may be used to prevent svehicle tproblem development adhering to uterine surgical procedure.

Laparotomy. Major abdominal surgical treatment with an incision in the abdominal wall.

Lesions. Growths or abnormalities of normal anatomy. Instances incorporate sauto tconcern, polyps, and uterine fibroids.

Luteinizing hormone (LH). In woguys, the pituitary hormone that triggers ovulation and stimulates the corpus luteum of the odiffer to secrete progesterone and also various other hormones during the second half of the menstrual cycle. In guys, LH is the pituitary hormone that stimulates the testes to create the male hormone testosterone.

Magnetic resonance imaging (MRI). A diagnostic procedure that absorbs power from particular high-frequency radio waves. The image produced by measurement of these waves deserve to be used to develop precise images of internal organs without the usage of x-ray methods. No radiation expocertain occurs.

Menopause. Cessation of ovarian function and menstruation that usually occurs normally yet also can be an outcome of surgical procedure. Menopause can occur between the ages of 42 and also 56 however generally occurs around the age of 51, once the ovaries stop producing eggs and estrogen levels decrease.

Menorrhagia. Regular yet hefty menstrual bleeding which is extreme in either amount (better than 80 cc – around five tablespoons) or duration (higher than seven days).

Myomas. Benign (non-cancerous) tumors of the uterine muscle wall that have the right to cause abnormal uterine bleeding and miscarriage. Also watch fibroids.

Myomectomy. The surgical removal of myomas (fibroids) from the uterus.

Ovaries. The two female sex glands in the pelvis, located one on each side of the uterus. The ovaries develop eggs and hormones consisting of estrogen, progesterone, and androgens.

Ovulation. The release of a mature egg from its occurring follicle in the external layer of the odiffer. This usually occurs about 14 days prior to the next menstrual period (the 1fourth day of a 28-day cycle).

Pituitary gland. A little hormone-creating gland located simply beneath the hypothalamus in the brain which controls the ovaries, thyroid, and adrenal glands. Ovarian attribute is managed via the secretion of follicle-stimulating hormone (FSH) and also luteinizing hormone (LH). Disorders of this gland might bring about irconsistent or missing ovulation in the female and abnormal or lacking sperm manufacturing in the male.

Polycystic ovary syndrome (PCOS). A condition in which the ovaries contain many kind of follicles that are linked via chronic anovulation and also overproduction of androgens (male hormones). The cystic follicles exist presumably bereason the eggs are not expelled at the moment of ovulation. Symptoms may incorporate ircontinual menstrual periods, obesity, extreme expansion of main body hair (hirsutism), and also infertility. PCOS deserve to also be connected with heart condition, hyperstress, or diabetes. Also called Stein-Leventhal syndrome.

Polyps. A basic term that explains any mass of tproblem which bulges or tasks external or upward from the normal surconfront level.

Progesterone. A female hormone usually secreted by the corpus luteum after ovulation throughout the second fifty percent of the menstrual cycle (luteal phase). It prepares the lining of the uterus (endometrium) for implantation of a fertilized egg and also enables for complete shedding of the endometrium at the moment of menstruation. In the occasion of pregnancy, the progesterone level remains steady beginning a week or so after conception.

Progestins. A man-made hormone that has an activity similar to progesterone. Synonymous via progestational hormones.

Prolactin. A hormone commonly secreted by the pituitary gland also into the bloodstream for the objective of preserving milk production during lactation. When secreted in extreme quantities, it might cause ircontinuous or missing menstrual periods and might create a milk-favor discharge from the breasts.

Thyroid gland. A huge, two-lobed, endocrine gland situated in front of and on either side of the trachea (windpipe) in the neck that secretes the hormone thyroxin into the bloodstream. Thyroxin maintains normal body development and also metabolism.

Ultrasound (sonogram). A photo of internal organs developed by high frequency sound waves perceived as a picture on a video screen; used to monitor growth of ovarian follicles or a fetus and to retrieve eggs. Ultrasound have the right to be either performed abdominally or vaginally.

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Uterus (womb). The hollow, muscular female reproductive body organ in the pelvis where an embryo implants and also grows during pregnancy. The lining of the uterus, referred to as the endometrium, produces the monthly menstrual blood circulation as soon as there is no pregnancy.