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


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.



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