Name three risk factors for AUB in midlife women.

Name three risk factors for AUB in midlife women.

• A. Perimenopausal status, obesity, thyroid dysfunction
• B. Age < 35, obesity, smoking
• C. Regular menses, normal thyroid
• D. High activity, low BMI

Answer: (A)

In midlife, abnormal uterine bleeding is most often driven by perimenopausal changes, where ovarian function becomes irregular and ovulation may be missed. That leads to cycles with uneven estrogen exposure and insufficient progesterone support, so the endometrium can proliferate irregularly and shed unpredictably, producing heavy, irregular bleeding. Obesity compounds this by increasing estrogen production from adipose tissue, raising circulating estrogen without adequate progesterone, which promotes ongoing endometrial growth and heavier or longer bleeding and raises the risk of endometrial hyperplasia over time. Thyroid dysfunction disrupts the hypothalamic–pituitary–ovarian axis, altering cycle regularity and ovulatory patterns, which can manifest as irregular or heavy bleeding as well. Conversely, being under 35, having regular menses, or having very high activity with low BMI are not typical risk factors for AUB in this midlife context.

In midlife, abnormal uterine bleeding is most often driven by perimenopausal changes, where ovarian function becomes irregular and ovulation may be missed. That leads to cycles with uneven estrogen exposure and insufficient progesterone support, so the endometrium can proliferate irregularly and shed unpredictably, producing heavy, irregular bleeding. Obesity compounds this by increasing estrogen production from adipose tissue, raising circulating estrogen without adequate progesterone, which promotes ongoing endometrial growth and heavier or longer bleeding and raises the risk of endometrial hyperplasia over time. Thyroid dysfunction disrupts the hypothalamic–pituitary–ovarian axis, altering cycle regularity and ovulatory patterns, which can manifest as irregular or heavy bleeding as well. Conversely, being under 35, having regular menses, or having very high activity with low BMI are not typical risk factors for AUB in this midlife context.