From the Guidelines
Laboratory evaluation of menometrorrhagia should include a comprehensive set of tests to identify the underlying cause of abnormal uterine bleeding, including a complete blood count (CBC), pregnancy test, coagulation studies, thyroid function tests, and hormone levels, as well as additional tests such as a Pap smear, endometrial biopsy, and pelvic ultrasound, tailored to the patient's age, risk factors, and clinical presentation 1.
Key Components of Laboratory Evaluation
- Complete blood count (CBC) to assess for anemia
- Pregnancy test to rule out pregnancy-related bleeding
- Coagulation studies (PT, PTT, INR) to identify bleeding disorders
- Thyroid function tests (TSH, free T4) to detect thyroid dysfunction
- Hormone levels (FSH, LH, estradiol, progesterone) to evaluate ovarian function
Additional Tests
- Pap smear to screen for cervical abnormalities
- Endometrial biopsy for women over 35 or with risk factors for endometrial cancer
- Pelvic ultrasound to evaluate uterine anatomy and identify structural causes like fibroids or polyps
- Specific testing for von Willebrand disease, including von Willebrand factor antigen, ristocetin cofactor activity, and factor VIII levels, if suspected
Importance of Timely Evaluation
Timely laboratory evaluation is crucial as menometrorrhagia can lead to iron deficiency anemia and significantly impact quality of life 1. The evaluation should be tailored based on the patient's age, risk factors, and clinical presentation, taking into account the potential causes of abnormal uterine bleeding, including structural and nonstructural etiologies 1.
From the Research
Lab Evaluation of Menometrorrhagia
The lab evaluation of menometrorrhagia involves several steps to determine the underlying cause of the condition.
- The first step is to exclude pregnancy, which is a common cause of abnormal uterine bleeding 2, 3, 4.
- A clinical examination is necessary to provide an accurate diagnosis and find complications such as anaemia 2.
- Pelvic ultrasound examination and endometrial biopsy are required to eliminate endometrial cancer 2, 3, 5, 4.
- The treatment of menometrorrhagia consists of symptomatic treatment (tranexamic acid, levonorgestrel intrauterine device) and specific treatment of its cause (hysteroscopic resection of myom, polyp, endometrectomy, hysterectomy) 2, 5, 4.
Diagnostic Tests
Several diagnostic tests can be used to evaluate menometrorrhagia, including:
- Pelvic ultrasound examination to evaluate the uterus and ovaries 2, 3, 5, 4.
- Endometrial biopsy to evaluate the endometrium for cancer or hyperplasia 2, 3, 5, 4.
- Hysteroscopy to evaluate the uterine cavity for polyps, fibroids, or other abnormalities 3, 5, 4.
- Magnetic resonance imaging (MRI) to evaluate the uterus and ovaries in more detail 3.
Treatment Options
The treatment of menometrorrhagia depends on the underlying cause and may include:
- Symptomatic treatment with tranexamic acid or levonorgestrel intrauterine device 2, 5, 4.
- Specific treatment of the underlying cause, such as hysteroscopic resection of myom or polyp, endometrectomy, or hysterectomy 2, 5, 4.
- Medical treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or hormonal contraceptives 5, 4, 6.