A GP guide to perimenopausal bleeding

Abnormal uterine bleeding is a common presentation in primary healthcare, and for perimenopausal women in particular there can be significant changes in menstruation that can be highly distressing for some.1
These include heavy menstrual bleeding, irregular menses, intermenstrual bleeding and post-coital bleeding.2
Although these symptoms may arise from expected hormonal fluctuations due to approaching menopause, it is important for healthcare providers to understand the range of potential pathologies behind perimenopausal bleeding in order to arrange appropriate workup and treatment.
The perimenopausal phase is characterised by hormonal imbalances and unpredictable ovulation patterns. This often underpins the physiological menstrual irregularities experienced at this time.3,4