LabInitial Labs

• 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.