An alternative approach to surgery and hormonal therapy for the treatment of heavy menstrual bleeding is presented in a mouse model this week in Nature Communications. About one in five women will experience this condition at some point in their life, and either undergo surgery, which often precludes later pregnancy, or go under hormonal treatment, which is associated with a wide range of adverse effects. More research is therefore needed to identify alternative treatment options.

In the absence of pregnancy, the lining of the uterus breaks down, causing menstruation. Bleeding persists until the lining of the uterus is successfully repaired. In many women this process comes with severe pain and heavy bleeding, and the risk of developing severe anaemia.

Jackie Maybin, Hilary Critchley and colleagues show that the lining of the uterus needs to experience low levels of oxygen to successfully repair. They show that treatment with a pharmaceutical compound called a PHD inhibitor, which ‘tricks’ the uterus into thinking that oxygen levels are low, promotes repair of the uterus lining in a mouse model of menses. These experiments suggest that PHD inhibitors could be used in women to accelerate repair of the uterus lining and thus reduce bleeding and associated symptoms during menstruation, although further research is needed to confirm these results in humans.