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Abnormal Uterine Bleeding - Exams and Tests

Your doctor looks for a number of possible causes of your bleeding.

First tests

First, your doctor will:

  • Review your history of symptoms and menstrual periods. (If possible, bring with you a record of the days you had your period, how heavy or light the flow was, and how you felt each day.)
  • Conduct a routine pelvic exam.
  • Find out whether you are ovulating regularly. This is done using one or more of the following:
    • A daily record of your symptoms (menstrual calendar)
    • A daily basal body temperature chart, if you have been keeping track at home. This charts your at-rest temperature.
    • A progesterone test, because low levels during the third week of a menstrual cycle suggest an ovulation problem
    • An endometrial biopsy for perimenopausal women, because abnormal endometrial tissue is common in this age group. The endometrial tissue is the lining of the uterus.

Other tests

If your symptoms are severe, your doctor suspects a serious medical problem, or you are considering a certain treatment, you may also have one or more other tests, such as:

  • Blood tests, which may include:
  • Pap smear and cultures to check for infection or abnormal cervical cells.
  • Urine test to screen for infection, disease, and other signs of poor health.
  • Transvaginal pelvic ultrasound, to check for any abnormalities in the pelvic area. After the pelvic exam, a transvaginal ultrasound is often the next step in diagnosing a vaginal bleeding problem. If a pelvic mass is found, ultrasound results are useful for making further testing and treatment decisions.
  • Sonohysterogram, which uses ultrasound to monitor the movement of a salt solution (saline), which is injected into the uterus. This test may be done to look for uterine polyps or fibroids.
  • Endometrial biopsy, usually for women older than 35 or who are postmenopausal, to learn whether the lining of the uterus (endometrium) is healthy and functioning normally.
  • Hysteroscopy, if no cause is apparent but a problem condition is suspected; to check for and treat a suspected condition, such as uterine fibroids; or if bleeding continues despite treatment.
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