Menstrual Disorders - Diagnosis

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 cycle patterns -- 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 drugs)
• Diet history, including caffeine and alcohol intake
• Past or present contraceptive use
• Any recent stressful events
• Sexual history (it is very important that patients trust their doctor 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 function to make sure that low thyroid (hypothyroidism) is not present. Blood tests can also check follicle-stimulating hormone, estrogen, and prolactin levels. 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):