The management of perimenopausal abnormal uterine bleeding

Abnormal uterine bleeding around the time of the menopause is common and may be a sign of premalignancy such as endometrial hyperplasia or even endometrial carcinoma. All such women therefore need uterine assessment, which may include transvaginal scan combined with endometrial biopsy, hysteroscopy or a sonohysterogram. Having excluded (pre) cancer, treatment can then be offered. Medical treatment options include tranexamic acid to reduce blood loss, low-dose contraceptive pills, the levonorgestrel intra-uterine device and cyclic progestins. Surgical options include resecting sub-mucus fibroids hysteroscopically, endometrial ablation and hysterectomy.