The material on this page is supplemental to the discussion in Step 1 of the “5 Simple Steps” in my book “Dr. Liz’s Easy Guide to Menopause” on whether or not the menstrual changes in perimenopause are normal.
There are two procedures that evaluate abnormal bleeding. Either or both of these may be done after a pelvic ultrasound measures the thickness of the lining of the endometrium (lining of the uterus).
The first is hysteroscopy. The cervix is gently dilated and an instrument is passed through, with a camera on the end of this instrument visualizing the inside of the uterine cavity. This allows the doctor to see if there are structural problems such as fibroids or polyps causing abnormal bleeding.
The second is endometrial biopsy (EMB). Either in the doctor’s office or as an outpatient procedure, an EMB gives a sample of cells from the endometrium to look at under the microscope to make sure there is no cancer or pre-cancer causing the abnormal bleeding. Five percent of uterine cancers occur in women under age 50.