women s health issues
Abnormal Uterine Bleeding (AUB)
Diagnosis of Abnormal Uterine Bleeding
Description of the pattern of bleeding (menstrual history) A pregnancy test A complete blood count Measurement of hormone levels Sometimes procedures such as an endometrial biopsy or hysteroscopy Abnormal uterine bleeding is suspected when bleeding occurs at irregular times or in excessive amounts. To establish that bleeding is abnormal, doctors ask questions about the pattern of bleeding ( What the doctor does ). To determine the cause, doctors ask about other symptoms and possible causes (such as use of medications, the presence of other disorders, fibroids, and complications during pregnancies). A physical examination is also done. Doctors do a pregnancy test, even in adolescent girls and women who are going through menopause. Other tests to check for possible causes of vaginal bleeding may be done based on the findings during the interview and physical examination. For example, doctors usually do a complete blood count to estimate how much blood has been lost and whether Iron Deficiency Anemia (including Doctors typically do blood tests to measure hormone levels (to check for polycystic ovary syndrome, thyroid disorders, pituitary disorders, or other disorders that are common causes of vaginal bleeding). Hormones that may be measured include female hormones such asestrogenorprogesterone(which helps control the menstrual cycle), thyroid hormones, and prolactin. Doctors may do a cervical cancer screening test, such as a Papanicolaou (Pap) test and/or human papillomavirus (HPV) test, if women have not been tested recently. Doctors may also do an imaging test or a procedure. For example, they may do a biopsy if results of blood tests or a Pap test are abnormal or do not identify the cause of the bleeding. Transvaginal ultrasonography(using a small handheld device inserted through the vagina to view the interior of the uterus) is usually used to check for growths in the uterus and to determine whether the uterine lining is thickened. Thickening of the uterine lining may result from noncancerous conditions such as polyps or fibroids or hormonal changes. (The hormonal changes that cause abnormal uterine bleeding can result in such thickening, which may cause precancerous cells to develop and increase the risk of endometrial cancer.) Transvaginal ultrasonography is done if women have any of the following (which includes most women with abnormal uterine bleeding): Causes , such as obesity, diabetes, high blood pressure, polycystic ovary syndrome, and excess body hair (hirsutism), regardless of age Age 45 or older (younger if they have risk factors) Bleeding that continues despite treatment with hormones Pelvic or reproductive organs that cannot be examined adequately during the physical examination Findings suggesting abnormalities in the ovaries or uterus based on the physical examination Transvaginal ultrasonography can detect most polyps, fibroids, abnormalities in the ovaries, and areas of thickening in the lining of the uterus (which may be precancerous). If transvaginal ultrasonography detects areas of thickening, other tests may be done to check for small polyps or other masses. One or both of the following tests may be done: Sonohysterography (ultrasonography after saline is infused into the uterus) Hysteroscopy (insertion of a viewing tube through the vagina to view the uterus) Both tests may be done in the doctor's office. If the doctor's office cannot provide hysteroscopy, the procedure can be done in a hospital as an outpatient procedure. Anendometrial biopsyis usually also done to check for precancerous changes and for cancer in women with any of the following: Age 45 or older plus one or more risk factors for endometrial cancer (see above) Age under 45 plus several risk factors for endometrial cancer Bleeding that is persistent or recurs despite treatment Thickening of the uterine lining (detected by transvaginal ultrasonography) Inconclusive findings during transvaginal ultrasonography 