Diagnosis and management of perimenopausal and postmenopausal bleeding.

The menopausal years are characterized by a deficiency of progesterone and relative hyperestrogenism. This hormonal imbalance creates an environment favorable for the development of endometrial hyperplasia. The pathologic progression of hyperplasia to endometrial carcinoma can be arrested with progestogen therapy. A simple diagnostic approach for peri- and postmenopausal bleeding disorders is presented, along with a rational treatment regimen. Some of the risks and benefits of hormonal replacement therapy are discussed.