Final answer:
For heavy bleeding, suspect endometrial hyperplasia during peri-menopause due to hormonal changes, particularly a decrease in progesterone. Uterine fibroids can be suspected if symptoms of heavy bleeding persist over several years, possibly accompanied by pelvic discomfort.
Step-by-step explanation:
To distinguish between endometrial hyperplasia and uterine fibroids as causes of heavy bleeding, consider a woman's age, hormonal changes, and menstrual cycle irregularities. Endometrial hyperplasia typically occurs during peri-menopause when reduced progesterone can lead to abnormal endometrial growth, increasing the risk of endometrial cancer. On the other hand, uterine fibroids, benign masses of cells in the uterus, can cause heavy bleeding regardless of hormonal changes and are often associated with symptoms such as pelvic pressure or pain.
During the menopausal transition, as estrogen levels remain relatively stable and progesterone levels drop, there is a higher likelihood of endometrial hyperplasia due to unopposed estrogen stimulation. Other symptoms of the menopause transition include hot flashes, night sweats, and mood swings. Uterine fibroids may be considered when the heavy bleeding is recurrent over several years in a premenopausal woman, particularly if she exhibits symptoms like increased menstrual cramps or bulking of the lower abdomen, which could indicate the presence of fibroids.