Abnormal Uterine Bleeding: Postmenopausal and Menopausal Transition

Catherine A. Gill, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Menopausal transition (MT)

    • Commonly referred to as “perimenopause”

    • Begins with onset of cycle irregularity

    • Ends at 1 year from last menstruation

  • Menopause

    • Absence of menstruation for 1 ye...

DIAGNOSIS

HISTORY

  • Date of last menstruation

  • Bleeding patterns

    • Menses length/frequency

    • Volume of menstrual bleeding

    • Presence of midcycle bleeding

    • Postcoital bleeding

  • History of abnormal cervical lesions

  • Sexual...

TREATMENT

GENERAL MEASURES

  • Endometrial cancer, atypia, and hyperplasia must be ruled out prior to proceeding with treatment. Recommendations vary for reasonable exclusion of possible endometrial cancer...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Routine well woman care

  • Should be followed by gynecologic oncology if indicated for premalignant or malignant diagnosis and treatment

  • Consider referral to reproduct...

REFERENCES

Breijer MC, Timmermans A, van Doorn HC, et al. Diagnostic strategies for postmenopausal bleeding. Obstet Gynecol Int.  2010;2010:850812.  [View Abstract]
Null DB, Weiland CM, Camlibel...

CODES

ICD10

  • N93.9 Abnormal uterine and vaginal bleeding, unspecified

  • N95.0 Postmenopausal bleeding

  • N92.4 Excessive bleeding in the premenopausal period

ICD9

  • 626.9 Unspecified disorders of menstruation and ...

CLINICAL PEARLS

  • Endometrial cancer must be reasonably ruled out in patients with AUB in MT or menopause.

  • Medical management should be first line for patients in MT, once endometrial cancer and hyperpla...

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