Bleeding pattern during the menopause transition

Uterine bleeding during the perimenopausal period can be highly irregular due to fluctuations in sex hormones.

Irregular menstrual bleeding is commonly seen during the menopausal transition or perimenopause due to hormonal fluctuations. Anovulation and/or irregular maturation of follicles leads to irregularity in menstrual cycle during the perimenopausal period.1,2 Irregular bleeding and postmenopausal bleeding could also be due to endometrial hyperplasia or a gynaecological malignancy.2

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Postmenopausal bleeding (PMB)

Postmenopausal bleeding (PMB) is defined for practical purposes as vaginal bleeding, occurring after twelve months of amenorrhoea, in a woman of the age where the menopause can be expected.3

There are several different aetiologies of PMB, including malignant and many non-malignant causes.4

History and examination may possibly indicate cause, but it is generally accepted that PMB should be treated as malignant, until proven otherwise.3

NICE guidelines and pathways are available to guide management of these patients, including direction on when to refer using a suspected cancer pathway referral (for an appointment within 2 weeks):4,5

Symptom and specific features Possible cancer Recommendation
Post‑menopausal bleeding  in women 55 and over Endometrial Refer women using a suspected cancer pathway referral (for an appointment within 2 weeks)
Post‑menopausal bleeding in women under 55 Endometrial Consider a suspected cancer pathway referral (for an appointment within 2 weeks)


Zumenon® is indicated for estrogen deficiency symptoms in postmenopausal women at least 6 months since last menses.


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Date of preparation: November 2021

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