Exams and tests for vaginal bleeding

1.Your health care provider will take a careful medical history. You will be asked questions about the following issues and other general questions regarding your health:

oThis episode of vaginal bleeding oYour last known normal menstrual cycle oPrevious episodes of abnormal bleeding oCurrently pregnant oPrevious pregnancies oOutcomes of previous pregnancies

oPresent sexual activity oNumber of sexual partners oUse of any form of birth control oAny medications, over-the-counter, or illicit drugs you are taking

2.The doctor will also perform a complete physical, including a thorough pelvic exam. A woman who has irregular menstrual periods requires a physical examination with a special emphasis on the thyroid, breast, and pelvic area.

oThe exam includes careful inspection of your external genitalia, urethra, anal area, the vaginal walls and cervix or birth canal. They are inspected for the presence of any lesions or retained foreign objects. Sometimes a tampon or other object is left in the vagina and can cause bleeding. The physician attempts to detect cervical polyps or any unusual masses.

oWhile the doctor is examining your vagina and cervix, the doctor may take cultures (fluid samples)from the vagina to test for the diseases such as gonorrhea and chlamydia. oThe doctor may also take cells from the cervix that will be examined for the cervical cancer. This is a Pap smear.

o It is also important for the doctor to place his or her hand into your vagina and sometimes your rectum to detect the shape of your uterus and ovaries as well as to feel for any masses that may be present.

3.Tests that may be performed with abnormal vaginal bleeding. (1)A pregnancy test needs to be done to make sure that pregnancy is not the cause of bleeding.

(2)A blood count will be taken to see if you are anemic or have a low platelet count. (3) A clotting series that includes a prothrombin time (PT) and an activated partial thromboplastin time (APTT) gives information about your ability to form clots in your body to stop bleeding. Abnormal vaginal bleeding may be the first sign that you may have of a bleeding disorder.

(4)Sometimes, a blood sample will be tested for thyroid function, liver function, or kidney function abnormalities. (5) The vaginascopy and hysteroscopy. They are very directly.

(6) A blood hormone test for progesterone levels or daily body temperature charting may be recommended to verify that the woman ovulates. If the doctor suspects that the ovaries are failing, such as with menopause, blood levels of follicle-stimulating hormone (FSH) may be tested. Additional blood hormone tests are done if the doctor suspects PCOS or if excessive hair growth is present.

(7) An ultrasound of the abdomen and pelvis may be ordered if the doctor may have felt a mass during the examination. (8) If a woman does not adequately respond to medical treatment, if she is over age 40, or if she has persistent bleeding between her periods, a sampling of the lining of her uterus (endometrial biopsy) is analyzed.

An endometrial biopsy may be performed to take tissue from your uterus. This is performed in the doctor’s office and is a little more invasive than a Pap smear. Endometrial sampling helps to rule out cancer or precancer in the uterus, or it can confirm a suspicion that a woman is not ovulating.

First: get the history carefully. Second: do the physical examination. Third: choose the necessary tests.

Thank you!