Final answer:
Women over 40 with irregular menstrual bleeding should undergo a comprehensive evaluation to determine the cause.
Step-by-step explanation:
Women over 40 years old with irregular menstrual bleeding should have a thorough evaluation to determine the cause of the irregular bleeding. This evaluation may include a pelvic exam, testing hormone levels, and imaging tests such as ultrasound. The most common cause of irregular menstrual bleeding in women over 40 is hormonal imbalance, such as the perimenopausal transition. However, other conditions like polycystic ovary syndrome (PCOS), uterine fibroids, and endometrial hyperplasia should also be considered.