Abnormal uterine bleeding in peri/menopause may be a sign of what?

• A. Ovarian cyst
• B. UTI
• C. Prolapse
• D. Endometrial hyperplasia or cancer

Answer: (D)

Abnormal uterine bleeding during the peri/menopause is a warning sign for endometrial pathology. As ovulation becomes irregular or stops, the endometrium is exposed to estrogen without the balancing effect of progesterone. This unopposed estrogen drives endometrial proliferation, leading to hyperplasia, and the risk of progression to cancer increases with age and factors like obesity. So new or changed bleeding in this stage of life most strongly points to endometrial hyperplasia or cancer, making it a priority to evaluate endometrial thickness with ultrasound and obtain an endometrial sample if indicated. Other listed conditions can cause pelvic symptoms, but they don’t explain the typical bleeding pattern seen with endometrial overgrowth or malignancy in this age group.