Monika Sojáková
For women in their 40s or 50s, changes in intervals of menstrual bleeding, duration or amount signify the beginning of perimenopause caused by diminished function of ovaries. Anovulatory bleeding is associated with irregular intervals and prolongation of the number of days of bleeding. Excessive endometrial bleeding in perimenopausal women may by caused by systemic disease or structural abnormality. Dysfunctional uterine bleeding is evaluated by using transvaginal ultrasonography to assess the endometrial thickness; hysteroscopy and target endometrial biopsy is indicated in suspicious findings. The management of bleeding during sequential or continuous therapy is essential for the compliance of patients on hormone replacement therapy.