What is the workup for polymenorrhea?

From the Guidelines

The workup for polymenorrhea, characterized by frequent menstrual periods, should begin with a thorough history, physical examination, and appropriate laboratory tests, including a complete blood count to assess for anemia and thyroid function tests to rule out thyroid disorders 1. The evaluation process aims to identify underlying structural or non-structural causes of abnormal uterine bleeding. Key considerations include:

• Assessing menstrual regularity and identifying symptoms of endocrine disorders, such as thyroid dysfunction or polycystic ovary syndrome (PCOS) 1
• Conducting a pelvic ultrasound to identify structural abnormalities like fibroids, polyps, or adenomyosis 1
• Considering endometrial sampling for women with risk factors for endometrial cancer or those over 35 years old 1
• Evaluating for other symptoms such as hirsutism, galactorrhea, or infertility, which may indicate underlying endocrine disorders 1 The goal of the workup is to determine the underlying cause of polymenorrhea and guide appropriate management, which may include hormonal medications, non-hormonal options, or surgical interventions to address structural abnormalities or reduce menstrual bleeding.

From the Research

Workup for Polymenorrhea

The workup for polymenorrhea, which is characterized by frequent menstrual bleeding, involves a thorough evaluation to determine the underlying cause. The following steps are recommended:

• A thorough history and physical examination to identify any underlying medical conditions or structural causes of abnormal uterine bleeding 2
• Laboratory tests, such as:
  • Hematocrit or hemoglobin to detect and evaluate anemia 3
  • Thyroid stimulating hormone (TSH) level to evaluate thyroid function as a possible cause 3
  • Pregnancy test to rule out an incomplete, spontaneous abortion as a cause 3
  • Pap test to screen for dysplasia that can suggest a gynecologic cancer cause 3
• Additional screening for endocrine disorders that may be causing menorrhagia, including tests of thyroid, liver, and kidney function, and tests of follicle stimulating hormone (FSH), prolactin, and cortisol levels 3
• Imaging studies, such as ultrasound, to evaluate the uterus and ovaries for any structural abnormalities 2
• Evaluation for bleeding disorders, especially in adolescents with heavy menstrual bleeding, which may include referrals to a hematologist 4, 5

Special Considerations

• In adolescents with heavy menstrual bleeding, it is essential to consider the possibility of an underlying bleeding disorder, even in the absence of anemia 5
• Thyroid disease should be considered as a potential cause of abnormal uterine bleeding, and thyroid function tests should be performed as part of the evaluation 3, 6