Diagnostic Tests and Interpretation
ImagingInitial Imaging Approach
- Pregnancy test: Exclude pregnancy first.
- CBC to assess severity of blood loss and to rule out thrombocytopenia and leukemia (2)
- In selected cases:
- TSH test
- Coagulation screen, with follow-up testing if screen is abnormal
- Creatinine, BUN
- Serum progesterone: 5–20 ng/mL (15.9–63.6 nmol/L) in luteal phase, <1 ng/mL (<3.18 nmol/L) in follicular phase or anovulatory cycle
- Transvaginal ultrasonography can help distinguish bleeding due to atrophy from bleeding caused by hyperplasia, polyps, or myomas.
- Ultrasonography to evaluate adnexal masses or myomas suspected from pelvic exam.
- A CT is used to investigate potentially malignant pelvic masses.
- An MRI is not recommended as a first-line procedure (3).
- Endometrial biopsy detects hyperplasia, dysplasia, or atrophy. If done before expected menses, it may also help confirm the diagnosis of anovulation or luteal phase defect.
- After age 35–40, endometrial carcinoma is a significant cause of bleeding. Obtain endometrial sampling before attempting hormonal treatment (4)[C].
- Vary with etiology. In ~50% of cases, no uterine pathology is found (1).
- Progestins used before endometrial biopsy may cause decidualization and obscure correct diagnosis.
Menorrhagia is a sample topic found in
5-Minute Clinical Consult .
To find other 5-Minute Clinical Consult topics
please login or purchase a subscription.