Menstrual Disorders - Diagnosis

Highlights	Risk Factors	Medications
Introduction	Complications	Surgery
Menstrual Disorders	Diagnosis	Resources
Causes	Treatment	References

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Diagnosis

A doctor needs to have a complete history of any medical or personal conditions that might be causing menstrual disorders. This information can help determine whether a menstrual problem is caused by another medical condition.For example, non-menstrual conditions that may cause abdominal pain include appendicitis, urinary tract infections, ectopic pregnancy, and irritable bowel syndrome. Endometriosis and fibroids may cause heavy bleeding and pain.Doctors may ask questions concerning:

Menstrual cyclepatterns -- length of time between periods, number of days that periods last, number of days of heavy or light bleeding.
The presence or history of any medical conditions that might be causing menstrual problems.
Any family history of menstrual problems.
History of pelvic pain.
Regular use of any medications (including vitamins and over-the-counter agents).
Diet history, including caffeine and alcohol intake.
Past or present contraceptive use.
Any recent stressful events.
Sexual history. (It is very important that the patient trust theirdoctor enough to describe any sexual activity that might be risky.)

Menstrual Diary. A menstrual diary is a helpful way to keep track of changes in menstrual cycles. Patients can record when their period starts, how long it lasts, and the amount of bleeding and pain that occurs during the course of menstruation.

Pelvic Examination. A pelvic exam is a standard part of diagnosis. A Pap test may be done during this exam.

Blood and Hormonal Tests

Blood tests can help rule out other conditions that cause menstrual disorders. For example, a doctor may test thyroid functionto make sure that low thyroid (hypothyroidism) is not present. Blood tests can also check follicle-stimulating hormone, estrogen, and prolactinlevels. Patients who have menorrhagia may get tests for bleeding disorders; if patients are losing a lot of blood they should also get tested for anemia.

Patients who have amenorrhea may need to receive special hormonal tests. The progestational challenge test uses oral or injected progesterone to test for a functional uterine lining (endometrium):

Bleeding that occurs up to three weeks after the progesterone dose suggests that the woman has normal estrogen levels but is not ovulating, particularly if thyroid and prolactin levels are normal. In such cases, thedoctor willcheck for stress, recent weight loss, and any medications. Such results could also suggest polycystic ovaries or stress.
A failure to bleed could indicate an abnormal uterus that prevents outflow or insufficient estrogen. In such cases, the next step may be to administer estrogen followed by progestin. If bleeding occurs after that, then the cause of amenorrhea is related to low estrogen levels. The physician will then check for ovarian failure, anorexia, or other causes of low estrogen. If bleeding does not occur, then the physician would check for obstructions that are preventing outflow of menstruation.