Abstract: The main cause of perimenopausal abnormal uterine bleeding (AUB) is the decline of ovarian function resulting in anovulatory status, which may lead to menstrual abnormalities and act as a predisposing factor for benign and malignant endometrial lesions. In most cases, AUB is disquieting and significantly affecting the quality of life. With abundant and standardized diagnostic methods, more and more AUB could be rapidly diagnosed in clinics. It is of vital importance to perform a standardized and individualized diagnosis and treatment procedure. Structural and nonstructural changes are two categories of perimenopausal AUB, which need completely different methods of treatment. Nonstructural diseases commonly require non-surgical interventions, for instance, cyclic progestogens, oral contraceptives (especially short-acting oral contraceptives), the levonorgestrel intraute-rine system, antifibrinolytic medicines, and minimally invasive treatments such as hysteroscopy and endometrial ablation, which may avoid or delay hysterectomy.