Menometrorrhagia during the premenopause: an overview

Menometrorrhagia, defined as excessive and prolonged uterine bleeding occurring at irregular and/or frequent intervals, occurs in up to 24% of women aged 40-50 years. There are a wide range of causes of menometrorrhagia, although histological differences in endometrium between women aged <45 years compared with those aged 48-50 years indicate a much higher prevalence of myomas, adenomyosis, and dysfunctional endometrium (dysfunctional uterine bleeding, hyperplasia, neoplasia) around the time of the premenopause, emphasizing the importance of accurate diagnosis and appropriate management in women of this age group. In women presenting with menometrorrhagia, it is imperative to recognize that underlying lesions and diagnosis are frequently missed due to multiple causes. Primary diagnosis needs to exclude pregnancy and cancer, whereas secondary investigations (including ultrasound with instillation of saline solution, hysteroscopy and biopsy, and magnetic resonance imaging) can assist in accurately diagnosing the underlying cause of menometrorrhagia.