The management of perimenopausal menstrual symptoms

Abnormal bleeding around the time of the menopause is common and usually due to fluctuating sex-hormone levels. However, it may be a sign of premalignancy such as endometrial hyperplasia or even endometrial carcinoma. As such all will need uterine assessment which may include transvaginal scan combined with endometrial biopsy, and hysteroscopy. 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.