Perimenopausal Women

Abnormal bleeding in the 5 to 10 years before menopause is very common. The most common pathology is anovula-tion caused by declining numbers of ovarian follicles and decreasing inhibin B levels (Jain and Santoro, 2005). Peri-menopausal women may also bleed from structural lesions (most often uterine fibroid tumors) or bleeding disorders. Evaluation of a perimenopausal woman with abnormal

KEY TREATMENT

Unstable women with acute heavy vaginal bleeding should be admitted to hospital for IV estrogen therapy or surgical intervention.

Treatment of abnormal bleeding includes ovulation induction if a woman desires pregnancy and hormonal cycle control if she does not.

To protect against the development of endometrial hyperplasia, a precursor to endometrial cancer, all women with chronic anovulation should have a progesterone-induced withdrawal bleed at least four times a year (Albers et al., 2004). If hemoglobin and hematocrit are near normal, outpatient treatment with high-dose oral contraceptives, estrogen, or progesterone may be attempted (Ely et al., 2006). SOR: C.

bleeding should include an endometrial biopsy to exclude endometrial hyperplasia or cancer. The risk of endometrial cancer increases in women who are nulliparous, diabetic, or obese (Espindola et al., 2007). Nonsmoking women in this age group can be effectively managed with hormonal contraception for cycle control. Smokers can use cyclic progestin to provide a monthly withdrawal bleed.

Natural Cures For Menopause

Natural Cures For Menopause

Are Menopause Symptoms Playing Havoc With Your Health and Relationships? Are you tired of the mood swings, dryness, hair loss and wrinkles that come with the change of life? Do you want to do something about it but are wary of taking the estrogen or antidepressants usually prescribed for menopause symptoms?

Get My Free Ebook


Post a comment