Which women with intermenstrual bleeding need investigation with endometrial sampling or measurement of endometrial thickness?
Ovarian dysfunction is the most likely cause of abnormal bleeding in women pre-menopausally, but pelvic pathology is also common. The likelihood of finding particular pathology would depend on the bleeding disturbance. In one study, out of 500 perimenopausal women attending a clinic only nine (1.8%) had intermenstrual bleeding. Of these, two had endometrial hyperplasia and four a malignancy. Intermenstrual bleeding with or without postcoital bleeding is usually associated with surface pathology; endometrial disease (polyps, fibroids, endometritis and cancer); and cervical disease (polyps, cervicitis, ectropion and carcinoma). Intermenstrual bleeding in younger women can be managed expectantly unless symptoms are persistent. Inherent irregularity and variation in menses in peri-menopausal women makes detection more difficult unless a high index of suspicion is maintained. Endometrial sampling and measurement of endometrial thickness is mandatory in perimenopausal women with intermenstru
