Endometria from long term progestin only contraceptive-treated patients display abnormally enlarged blood vessels that are prone to bleeding as well as inflammation and possibly local diminution in blood flow. Such bleeding is also characterized by focal reductions in the expression of angiopoietin-1, a vessel stabilization and maturation agent, and excess production of the potent angiogenic agents, vascular endothelial growth factor and angiopoietin-2. In addition, tissue factor, the key initiator of hemostasis may play an angiogenic role either directly or via the activation of thrombin. This review article summarizes current findings related to the endometrial dysregulation of angiogenic/hemostatic agents following treatment with long term progestin only contraception. Studies in this area offer a promising avenue to alleviate abnormal uterine bleeding associated with this otherwise highly effective form of contraception