Your doctor looks for a number of possible causes of your bleeding.
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.
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:
- Pregnancy test (human chorionic gonadotropin, or hCG).
- Complete blood count (CBC), to check for signs of disease, infection, and anemia.
- Thyroid-stimulating hormone (TSH) to check for a thyroid gland problem, which can cause menstrual irregularity.
- Serum prolactin level, to check for a pituitary gland problem, which can interfere with or stop the menstrual cycle.
- Serum ferritin, to check for anemia, a symptom of heavy blood loss.
- 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.
Endometrial cancer risk increases with age. Also known as uterine cancer, it is most common in women over age 50, after menopause. But endometrial cancer can also develop earlier, during perimenopause or in women who have had abnormal bleeding for many years.
- If you have heavy or unusual vaginal bleeding after menopause, your doctor will do tests, usually either ultrasound or endometrial biopsy, to look for cancerous cell changes.
- If you are perimenopausal, have not responded to other treatment for uterine bleeding, or have things that increase your risk for endometrial cancer, your doctor may recommend an endometrial biopsy.