Menorrhagia and abnormal bleeding before the menopause

Best Pract Res Clin Obstet Gynaecol. 2004 Feb;18(1):59-69. doi: 10.1016/j.bpobgyn.2003.10.003.


Abnormal uterine bleeding before the menopause accounts for 20% of visits to the gynaecology clinic and almost 25% of gynaecological operations. The patient who presents with such bleeding presents two distinct but important challenges for the clinician. The first is the exclusion of cancer or hyperplasia; the second is dealing with the annoyance as well as the fear that the bleeding engenders in the patient. Any attempt at appropriate therapy--whether surgical, hormonal or expectant--begins with an accurate diagnosis. Transvaginal ultrasound with saline infusion sonohysterography for selective patients has emerged as a safe, non-invasive and, inexpensive method of triaging patients with abnormal uterine bleeding in order to determine which patients require no further evaluation, blind endometrial sampling for a global endometrial process or visually directed endometrial sampling when pathology is thought to be focal.

Publication types

  • Review

MeSH terms

  • Biopsy
  • Endometrium / pathology
  • Female
  • Humans
  • Menorrhagia / diagnostic imaging
  • Menorrhagia / etiology
  • Premenopause
  • Ultrasonography
  • Uterine Hemorrhage / diagnostic imaging*
  • Uterine Hemorrhage / etiology*