Abnormal uterine bleeding

The most probable etiology of abnormal uterine bleeding relates to the pati ent's reproductive age, as does the likelihood of serious endometrial patho logy. The specific diagnostic approach depends on whether the patient is pr emenopausal, peri-menopausal or postmenopausal. In premenopausal women with normal findings on physical examination, the most likely diagnosis is dysf unctional uterine bleeding (DUB) secondary to anovulation, In perimenopausa l patients, endometrial biopsy and other methods of detecting endometrial h yperplasia or carcinoma must be considered early in the investigation. Uter ine pathology, particularly endometrial carcinoma, is common in postmenopau sal women with abnormal uterine bleeding. Thus, in this age group, endometr ial biopsy or transvaginal ultrasonography is included in the initial inves tigation. Premenopausal women with DUE may respond to oral contraceptives, cyclic medroxyprogesterone therapy or cyclic clomiphene. Perimenopausal wom en may also be treated with low-dose oral contraceptives or medroxyprogeste rone. Erratic bleeding during hormone replacement therapy in postmenopausal women with no demonstrable pathology may respond to manipulation of the ho rmone regimen.