If the patient has already given birth to a daughter, endometrial resection can be performed if medication is not effective. There are two types of endometrial resection: hysteroscopic and non-hysteroscopic. Hysteroscopy includes mainly high-temperature liquid endometrial resection; non-hysteroscopy includes thermal bulb, radiofrequency thermal bulb, three-dimensional bidirectional, microwave, laser, and frozen endometrial resection. Endometrial resection began in 1970. Early endometrial resections were performed hysteroscopically, using an auxiliary tool to destroy the endometrium, requiring specialized training and a high level of operator demand. Traditional endometrial resection uses laser or electronic techniques to remove the endometrium, restoring it in 80% to 90% of cases of excessive menstruation. Another technique called hyperthermic fluid resection, in which hot saline is introduced into the uterine cavity and left for 10 minutes to destroy the endometrium, was approved for use in the United States in 1997 as a non-hysteroscopic endometrial balloon device, in which a catheter attached to a balloon is inserted into the uterine cavity and the balloon is filled with a small amount of sterile fluid and heated for 8 minutes to destroy the endometrium, At the end of the treatment, the fluid is drained from the catheter and the catheter is removed. The endometrium is shed over the next 7 to 10 days. The procedure can be performed under local anesthesia, without general anesthesia, and is simple, with few complications, short duration, and low technical requirements. In a 3-year follow-up study, the results of endo-lobe resection were the same as those of the conventional method. After endorectomy, menstruation was reduced by 45% and patient satisfaction was 90%. After 3 years, 8.5% of endometriosis patients underwent repeat endometrial resection and 8.5% underwent hysterectomy. 34% of hysteroscopic endometrial resection patients underwent repeat hysterectomy after 5 years, while some studies showed that 5%-20% of endometrial resection patients underwent repeat hysterectomy. Because the remaining endometrium is active after endometrial resection, these women should receive estrogen along with progestin when using hormone replacement therapy. Numerous studies comparing the costs and outcomes of endometrial resection and hysterectomy have found that endometrial resection is less expensive, has a faster recovery, is more effective, and has high patient satisfaction. Compared to oral GnRHa and danazol, endometrial resection has fewer side effects, is more effective, and is less expensive. Therefore, the American Society for Reproductive Medicine, ASRM, recommends endometrial resection as an effective treatment for menorrhagia, more effective in patients with thin endometrium, simpler to perform with non-hysterectomy, and shorter operative time. However, endometrial resection is not indicated in postmenopausal women, in women with endometrial cancer or proliferation, or in premenopausal women who wish to preserve their fertility. Hysterectomy should be chosen after all of the above treatment options. Some studies have shown that hysterectomy has a complication rate of 7% to 15% and a long and costly recovery time, but can be a permanent treatment. The ASRM Society defines the menopausal transition as the period from the beginning of the change in the female menstrual cycle to the end of the last menstrual FMP. It should be recognized 1 year after the last bleeding from the uterus. The general age of onset of the menopausal transition is 47 years and the duration is approximately 4 years. As women age, the incidence of anovulatory dysfunction gradually increases. Irregular uterine bleeding is more frequent in the first 3 years of menopause. During the menopausal transition, ovarian function continues to decline, the ovaries become less responsive to pituitary gonadotropins, and follicles fail to ovulate due to degenerative changes during development. The elevated FSH levels that occur both in the early menopausal transition may be due to increased negative feedback to the hypothalamus and pituitary gland. During the menopausal transition, there is no cyclic stimulation of ovarian sex hormones, but only acyclic stimulation of estrogen, resulting in continuous endothelial growth without cyclic shedding, leading to endothelial growth beyond the functional range of the blood vessels that supply blood, resulting in ischemia and necrotic shedding of tissue. However, the shedding is irregular, the endothelium is not repaired on time, and the chronic and prolonged estrogen stimulation causes irregular, frequent and heavy bleeding, prolonging the menstrual period for more than 7 days, with a bleeding volume of more than 60-80 ml. However, this anovulatory cycle has a good prognosis and is easily recovered. Long-term recurrent anovulatory cycles or even anovulatory gonorrhea may lead to a series of complications such as anemia. Unlike adolescent anovulation, perimenopausal anovulation indicates the decline of ovarian function. Clinical manifestations Irregular menstruation: shortened menstrual cycle, prolonged menstrual period, increased menstrual flow: no abdominal pain or other discomfort during the menstrual period, accompanied by anemia when the bleeding volume is high, acute heavy bleeding may also lead to shock. The change in menstruation is accompanied by perimenopausal symptoms such as hot flashes, decreased libido, sleep disturbances, depression, or mood disorders, migraines, etc. The FSH level is measured on the 3rd and 5th day of menstruation and is considered to be perimenopausal if it is above 30MIU/ml. The diagnosis of perimenopausal dysfunction is based on the exclusion of organic lesions, as the incidence of endometrial cancer in women aged 40-49 years is 36.2/100,000. Therefore, endometrial examination is required in women over 40 years of age who present with anovulatory dysfunction, after excluding pregnancy. For other tests and differential diagnosis with other systems, see Meritorious Blood of Reproductive Age. Treatment The ACOG recommends that in women in the menopausal transition, attention should be paid to the prevention of pathological conditions associated with reduced hormone levels, such as osteoporosis. Hormone replacement therapy and cycle adjustment should be accompanied by a healthy lifestyle, such as increased exercise, diet modification, and cessation of smoking. Unlike adolescent hemorrhage, these women do not have large amounts of estrogen in their bodies and will experience relief of menopausal symptoms such as hot flashes when treated with a combination of estrogen and continuous or cyclic progestin. more than 90% of women in the menopausal transition will experience More than 90% of women in the menopausal transition experience progestogen withdrawal bleeding after combination therapy. Other non-steroidal anti-inflammatory drugs, antifibrinolytic drugs, and antianemia drugs are used as adjunctive therapy for the same menopausal symptoms, and will not be discussed further. Surgical treatment is the same as for women of childbearing age. The aim of treatment is to stop bleeding, correct anemia, maintain normal quality of life, and enter menopause peacefully.