A 48-year-old woman presents with an episode of heavy menstrual bleeding. She reports that her periods have been irregular for the past year, and she occasionally experiences hot flashes. What could be the potential causes and next steps?
The patient is likely in perimenopause, which can cause irregular menstrual cycles and heavy bleeding. However, other causes such as fibroids or endometrial hyperplasia should be ruled out. The next step would be to conduct a pelvic ultrasound and possibly an endometrial biopsy depending on the results.