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Perimenopausal abnormal uterine bleeding.

Eva Dreisler1, Christian Seerup Frandsen1, Lian Ulrich1

  • 1Department of Gynaecology, University of Copenhagen, Rigshospitalet, Blegdamsvej 3, DK-2200 Copenhagen O, Denmark.

Maturitas
|February 27, 2024
PubMed
Summary
This summary is machine-generated.

Perimenopausal abnormal uterine bleeding has many causes, including hormonal changes and structural issues. Diagnosis involves ultrasound and potentially biopsies, with treatment tailored to the cause and severity.

Keywords:
Abnormal uterine bleedingClimactericHeavy menstrual bleedingIrregular bleeding“Perimenopause”[MeSH Term]“Uterine hemorrhage”[MeSH Term]

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Area of Science:

  • Gynecology
  • Reproductive Endocrinology

Background:

  • Abnormal uterine bleeding (AUB) is a common perimenopausal symptom.
  • Causes range from hormonal fluctuations to premalignant/malignant conditions and benign findings like polyps and myomas.

Purpose of the Study:

  • To outline the diagnostic and management strategies for perimenopausal abnormal uterine bleeding.
  • To emphasize a systematic approach to exclude serious pathology and tailor treatment.

Main Methods:

  • Initial evaluation includes speculum examination, exclusion of pregnancy and STDs, and relevant blood tests.
  • Transvaginal ultrasound is the primary imaging modality, often enhanced by contrast sonohysterography.
  • Invasive procedures like endometrial biopsy or hysteroscopy are guided by ultrasound findings.

Main Results:

  • Benign conditions like polyps and myomas are prevalent and contribute to AUB.
  • Diagnostic accuracy is improved with contrast sonohysterography.
  • Treatment is individualized after excluding malignancy, ranging from watchful waiting to hormonal therapy or surgery.

Conclusions:

  • A stepwise diagnostic approach is crucial for managing perimenopausal AUB.
  • Treatment options are diverse, including hormonal management, medical therapy, minimally invasive procedures, and hysterectomy.
  • Excluding premalignant and malignant conditions is paramount before initiating treatment.