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Menorrhagia (Heavy Bleeding)

Initial Evaluation

You will be asked about:

  • Your family and medical history
  • Your lifestyle, eating, and exercise habits
  • Stress
  • Changes in body weight
  • Your menstrual periods
  • Birth control

Your doctor will also do a physical exam, including a pelvic exam.

Tests

You may have one or more of the following tests:

  • Blood tests—Your doctor will measure levels of hormones and other factors in the blood, as well as to check for pregnancy.
  • Endometrial biopsy—A small amount of tissue is scraped from the lining of your uterus and examined under a microscope.
  • Ultrasound—A device that uses sound waves to create an image of your pelvic organ is placed on your abdomen or inside of your vagina.
  • Laparoscopy—A thin tube with a tiny camera attached is inserted through a small incision below or through your navel, allowing the doctor to look inside your abdomen.
  • Hysteroscopy—A thin tube with a tiny camera attached is inserted into your vagina and up through your cervix, allowing your doctor to see inside your uterus.

Amenorrhea (Lack of Menstruation)

It may be difficult for your doctor to diagnose the cause of your amenorrhea. Evaluation usually includes the following:

Initial Evaluation

You will be asked about:

  • Your family and medical history
  • Your lifestyle, eating, and exercise habits
  • Stress
  • Changes in body weight
  • Your menstrual periods
  • Birth control

Your doctor will also perform a physical exam, including a pelvic exam.

Tests

The most common cause of secondary amenorrhea is pregnancy. If your menstrual period is at least 2-3 weeks overdue and you are sexually active, the first consideration is pregnancy.

Your doctor may recommend testing your blood for hormone levels:

  • Androgen excess
  • Estrogen deficiency
  • Problems with the endocrine system (hormone production)
  • Prolactin in the blood
  • Thyroid hormone

Further Testing

Other tests that may be done include:

  • Imaging of the brain to evaluate the pituitary gland—Sometimes a small, noncancerous growth can produce excess hormones that interfere with the normal menstrual cycle.
  • Ultrasound scans of your abdomen and pelvis
  • Chromosome studies

Revision Information

  • American Congress of Obstetricians and Gynecologists. Premenstrual syndrome. ACOG Practice Bulletin. 2000.

  • Menstruation and the menstrual cycle fact sheet. Womens Health.gov website. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/menstruation.cfm. Updated October 21, 2009. Accessed August 20, 2012.