Abnormal Uterine Bleeding
To diagnose your abnormal uterine bleeding (AUB) condition, your health care professional first will assess whether its primary cause is anatomic (there is something structurally wrong that a health care professional can see with the help of a hysteroscope or a transvaginal ultrasound) or hormonal (usually a problem with ovulation).
Think about any major physical changes you've experienced recently, such as a change in your weight, eating habits or exercise regimen, and whether you've been undergoing more stress than usual. Make sure you share these details with your health care professional, as they could provide clues behind what's causing your AUB. There are many potential causes for this disorder (both anatomic and structural) so you and your health care professional may have to spend some time narrowing the field of potential causes through the uses of lab tests, personal and family health histories and physical examinations.
Your health care professional will no doubt ask about the regularity of your menstrual cycle, so it's a good idea to take notes on the dates and length of your periods. You can do this by marking your calendar or appointment book. You might also be asked to keep a daily track record of your temperature to determine when you are ovulating. Ovulation kits are available without a prescription and are easy to use.
During your initial evaluation with your health care professional, you should also discuss the following information:
- current medications
- details about menstrual flow and cycle length
- any gynecologic surgery or gynecologic disorders
- sexual activity and history of sexually transmitted diseases
- contraceptive use and history
- family history of fibroids or other conditions associated with AUB
- a history of a breast discharge
PMS and PMDD
A complete physical exam will be an essential part of your preliminary diagnosis. You can expect a blood test to check your blood count and a urine test to see if you're pregnant and possibly for other laboratory tests. Depending on your particular symptoms, these other tests may be performed during a follow-up visit:
- Endometrial biopsy: some tissue is removed from the lining of your uterus by a gentle scraping method. The tissue will be analyzed under a microscope to identify a potential problem.
- Ultrasound (sonohysterography): high frequency sound waves are reflected off of pelvic structures to provide an image without the use of x-ray. Your uterus may be filled with a saline solution to perform this test. No anesthesia is necessary.
- Diagnostic hysteroscopy: in this diagnostic procedure, your health care professional will look into your uterine cavity through a miniature telescope-like instrument called a hysteroscope. Either general or local anesthesia will be used.
- Hysterosalpingogram (HSG): a visualization test that uses dye and an x-ray to provide a picture of the reproductive tract, including the uterus. HSG is typically performed in a radiology suite with no anesthesia. However, because the picture in this test is not very clear, many health care practitioners are using sonohysterography instead.
There is no specific diagnostic test for PMS and PMDD. If you're looking for relief from these menstrual cycle disorders, you and your health care professional will work together to confirm that your symptoms match the criteria for diagnosing PMS and PMDD. To qualify as PMS or PMDD, your symptoms must follow a general pattern:
- symptoms tend to increase in severity as the menstrual cycle progresses
- symptoms tend to be relieved when menstrual flow begins or soon afterward
- symptoms must be present for at least three consecutive menstrual cycles
You'll probably be asked to keep track of your symptoms and write them down. A premenstrual symptom checklist is one of the most common methods currently used to evaluate symptoms. With this tool, a woman tracks the type and severity of her symptoms to help identify a pattern. The symptoms usually occur about seven to 10 days before your period and typically disappear once your period begins.