From the Guidelines
For a patient presenting with abnormal uterine bleeding, initial laboratory tests should include a complete blood count (CBC), pregnancy test, thyroid-stimulating hormone (TSH), and coagulation studies (PT/PTT) as recommended by the most recent guidelines 1. The CBC helps assess for anemia from blood loss and can indicate infection. A pregnancy test is essential to rule out pregnancy-related bleeding or complications like ectopic pregnancy or miscarriage. TSH evaluates thyroid function since thyroid disorders can cause menstrual irregularities. Coagulation studies help identify bleeding disorders, which may be particularly relevant in adolescents with heavy menstrual bleeding. Additional tests to consider include:
- Prolactin levels to check for hyperprolactinemia
- Liver function tests to assess liver disease that may affect hormone metabolism
- Endocrine testing (FSH, LH, estradiol) if hormonal imbalances are suspected In patients over 45 or with risk factors for endometrial cancer, endometrial sampling should be considered, as suggested by guidelines for the evaluation of abnormal uterine bleeding 1. Iron studies may be appropriate if anemia is detected. These tests help identify the underlying cause of abnormal uterine bleeding, which is essential for determining appropriate treatment, and are in line with the recommendations for the initial evaluation of such patients 1.
From the Research
Labs to Draw for Abnormal Uterine Bleeding
The following labs and tests can be drawn for a patient presenting with abnormal uterine bleeding:
- Complete blood cell count (CBC) to rule out anemia or bleeding disorders 2
- Pregnancy test to rule out pregnancy or pregnancy-related disorders 2, 3
- Hormone levels, including:
- Estradiol
- Progesterone
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Prolactin
- Testosterone
- Dehydroepiandrosterone sulfate (DHEA-S) 2
- Thyroid function tests to rule out thyroid disorders 2
- Liver function tests to rule out liver disease 2
- Coagulation profile to rule out bleeding disorders 2
- Endometrial biopsy to rule out endometrial cancer or hyperplasia 2, 4, 3
- Transvaginal ultrasonography to evaluate the uterus and ovaries 2, 4, 3
- Hysteroscopy to evaluate the uterine cavity 2, 4
- Saline infusion sonohysterography to evaluate the uterine cavity 4, 3
Additional Tests
Additional tests may be ordered based on the patient's presentation and medical history, such as:
- Dilatation and curettage (D&C) to rule out endometrial cancer or hyperplasia 3
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to treat heavy menstrual bleeding 5, 3
- Tranexamic acid to treat heavy menstrual bleeding 5, 4
- Gonadotropin-releasing hormone (GnRH) agonists to treat leiomyoma or endometriosis 5, 4
- Antifibrinolytic agents to treat heavy menstrual bleeding 4