abnormal uterine bleeding

Perimenopause may contribute to mood vulnerability and poor concentration, particularly through sleep disturbance, but don't attribute severe depression, suicidality, mania, or neurological symptoms to hormones without appropriate assessment.

For our patient, treating night sweats may improve sleep and anxiety, but we first address the abnormal bleeding pathway.

We can discuss interim non-hormonal symptom management and return to MHT once the bleeding is appropriately evaluated.

When discussing MHT, explain the two main objectives.

Do not prescribe MHT and leave the patient uncertain about whether bleeding warrants review.

For our 48 year old, the uterus is intact and contraception remains relevant.

A 52 milligram LNG IUD could potentially address HMB, contraception and endometrial protection with systemic estrogen, but only after her abnormal bleeding and endometrial risk are appropriately assessed.

One of the most common counseling gaps is contraception.