ABSTRACT
Endometrial disease in the later reproductive years is relatively common. Dilatation and curettage procedures have been reported to occur at a rate of about 15% per annum in one population based sample of women in their forties (Crawford, personal communication). Hysterectomy utilization peaks in the 5th decade of life (Wilcox et al., 1994). Data from the UK suggests that the primary reason for hysterectomy of women in this age group is menorrhagia (Bonnar and Sheppard, 1996). Newer procedures to reduce menorrhagia, such as endometrial ablation (O’Connor and Magos, 1996) may offer minimally invasive techniques to relieve this widespread clinical complaint. Although hysterectomy may be thought of as a drastic solution to menorrhagia, women often express very high rates of satisfaction when surgical therapy has been undertaken (Carlson et al., 1994a) or when aggressive medical management is employed (Carlson et al., 1994b). The bleeding problems that plague women in the post-reproductive and premenopausal years have been incompletely characterized and appear to arise from anatomic, hormonal, and functional alterations in the endometrium’ sability to perform organized, monthly shedding and/or support the growth of a conceptus. This chapter will attempt to integrate the current state of knowledge regarding possible clues to the common problem of unwanted, irregular and excessively heavy bleeding in mid-life women.
