Guest Author - Denise Howard, M.D., M.P.H.

As mentioned in a previous article, abnormal uterine bleeding is the most common reason for gynecologic surgery in premenopausal women. Women typically present for medical care once the bleeding begins to interfere with the quality of her life, causes severe pain or other bothersome symptoms or has resulted in anemia.

The first step in the evaluation of abnormal uterine bleeding is a history of the problem. Your provider will ask questions related to the timing and duration of the bleeding. She will also inquire about the onset and frequency of menses. Information on the number of sanitary pads or tampons used is also helpful. She will ask about other symptoms such as fatigue, dizziness, and pain. All of this information will help determine if this problem is posing an immediate threat to your health or if it is disrupting your social or economic well being.

The next step in the process will include simple in office test and a physical examination. Checking the blood pressure and pulse may provide clues to other health problems that might be worsened by the bleeding. In addition a fast heart rate maybe an indication of severe anemia. A physical examination can provide clues to other possible medical problems that again maybe exacerbated by the bleeding. A pelvic examination is a targeted evaluation of the uterus. A Gynecologist can assess the size of the uterus and the presence of fibroid tumors or other pelvic abnormalities. Other test taken may include a blood draw to assess the degree of anemia with a hemoglobin or hematocrit. An assessment of thyroid function can also be performed with blood work. Thyroid dysfunction can sometimes present with abnormal uterine bleeding. Finally, the Gynecologist may request permission to perform an endometrial biopsy. This is a simple procedure designed to obtain a sample of tissue from the lining of the uterus. This tissue is sent to a Pathologist who can exam it under a microscope to look for evidence of endometrial cancer or other precancerous changes.

Your physician may recommended further evaluation with imaging test or outpatient procedures designed to evaluate the uterus further. These tests may include a pelvic ultrasound which can measure the size of the uterus and ovaries. Abnormalities such as fibroid tumors, ovarian cyst and an abnormally thickened uterine lining can be determined. A hysterosonogram is a more specialized evaluation of the lining of the uterus. It is essentially the same as a pelvic ultrasound except a saline solution is injected into the lining of the uterus to produce a better picture. An endometrial polyp or submucosal fibroid can be diagnosed with this procedure. A MRI (magnetic resonance imaging) is another way to image the uterus. It can give a more detailed assessment of pelvic structures. Fibroids can be seen in greater detail. Location and size of these fibroids are more specific. In some cases this test will be used when the ultrasound images are unhelpful. A hysteroscopy is an operative procedure that can be performed in the office or in the operating room. This procedure is performed by dilating the cervix and passing a rigid scope with attached camera into the uterine cavity. The cavity is distended with a solution to aide with visualization. This procedure allows the Gynecologist to inspect the lining of the uterus. A scraping procedure called curettage can be performed at the same time to obtain a sample of the endometrium for pathologic evaluation.

The test results can provide the information needed for your doctor to make appropriate treatment recommendations. A future article will describe options for managing abnormal uterine bleeding.