Menstrual Complaints
A complete medical history is critical to the diagnosis of menstrual disorders and recognition of any underlying medical conditions. Doctors will ask about:
- Menstrual Cycle Patterns - Frequency of menstruation, duration, and heaviness or lightness of periods.
- Pre-existing Medical Conditions - Any prior or existing condition that can add to menstrual irregularities.
- Family History - Incidence of inherited menstrual disorders.
- Pelvic Pain History - Recurrence, severity, and frequency.
- Medication Use - Daily use of prescription medications, over-the-counter drugs, and supplements.
- Food Habits - Use of caffeine, alcohol, and any food factors that could influence hormonal balance.
- Contraceptive Use - Past or present use of birth control measures.
- Stressful Events - Any current psychological or physiological stressors.
- Sexual History - To determine possible reproductive health issues.
Menstrual Diary
Keeping a menstrual diary may yield useful information regarding cycle regularity, length, pain severity, and fluctuation in patterns of bleeding.
- Pelvic Examination- A pelvic exam is an essential diagnostic process that can encompass a Pap smear to evaluate cervical health.
- Blood and Hormonal Testing- Blood tests play a crucial role in diagnosing causes of menstrual disorders. The following are some of the possible assessments done by physicians.
- Thyroid Function – To eliminate hypothyroidism as an underlying cause.
- Follicle-Stimulating Hormone (FSH), Estrogen, and Prolactin Levels – To analyze ovarian function and hormonal balance.
- Bleeding Disorders – In cases of heavy menstrual bleeding (menorrhagia).
- Anemia Testing – If there is a suspected significant blood loss.
- Hormonal Challenges (Progestational Challenge Test) – To check whether the endometrium is functional or not and also to check for estrogen levels.
Bleeding within three weeks of progesterone intake indicates normal estrogen status but anovulation (inability to ovulate). Lack of bleeding can signal uterine pathology, estrogen deficiency, or ovarian failure.
Imaging Methods
High-level imaging is routinely used to identify structural pathology, fibroids, or endometriosis.
Ultrasound and Sonohysterography
- Ultrasound - A painless method that uses sound waves to view the ovaries and uterus, helping detect fibroids, ovarian cysts, and urinary tract blockage.
- Sonohysterography - A specific ultrasound method where saline is injected into the uterus to enhance clarity.
Other Diagnostic Procedures
Hysteroscopy
Hysteroscopy involves a minimally invasive approach with direct visualization of the uterine cavity to identify fibroids, polyps, or other abnormalities. Though helpful, it is not a diagnostic test for uterine cancer and other procedures like dilation and curettage (D&C) or an endometrial biopsy might be performed if malignancy is suspected.
The process consists of passing a hysteroscope (a thin, flexible or rigid instrument with a lens) through the cervix into the uterus.
- The uterus is filled with saline or carbon dioxide to allow for clearer viewing.
- Although not invasive, hysteroscopy can be painful and local anesthesia may be needed.
- Complications include fluid absorption problems, infection, and perforation of the uterus.
Laparoscopy
Laparoscopy is a diagnostic and therapeutic surgical procedure for endometriosis, which is a frequent cause of menstrual discomfort (dysmenorrhea).
- General anesthesia is needed but discharge is the same day.
- A small cut is made in the abdomen, through which a fiber-optic laparoscope is passed.
- The uterus, ovaries, and pelvic organs are inspected for pathology.
Endometrial Biopsy
For women with heavy or abnormal bleeding, an endometrial biopsy can determine unusual cellular alterations that could suggest cancer or direct hormonal therapy choices.
- The test is generally done in a medical office with or without anesthesia.
- A few millimeters of uterine lining is taken with a suction device for microscopic analysis by a pathologist.
Dilation and Curettage (D&C)
D&C is a more invasive therapeutic and diagnostic procedure utilized for the assessment of abnormal uterine bleeding.
- The cervix is dilated to permit the removal of tissue of the uterine lining.
- It can be done under general anesthesia in an outpatient department.
D&C is a more invasive therapeutic and diagnostic procedure utilized for the assessment of abnormal uterine bleeding.
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