From the Guidelines
The workup for dysfunctional uterine bleeding should include a thorough history and physical examination, as well as laboratory tests and imaging studies to assess for structural abnormalities.
Initial Evaluation
- A thorough history to identify potential causes of abnormal uterine bleeding, such as hormonal changes, uterine abnormalities, or other medical conditions 1
- A physical examination, including a pelvic exam, to evaluate for any abnormalities or signs of infection 1
Laboratory Tests
- Endometrial sampling may be considered in patients with abnormal uterine bleeding who have an increased risk for endometrial cancer, such as postmenopausal women or those with a family history of the disease 1
- Complete blood count (CBC) and coagulation studies to evaluate for any underlying bleeding disorders 1
Imaging Studies
- Transvaginal ultrasound is the most appropriate initial imaging study for patients with abnormal uterine bleeding, as it can help identify structural abnormalities such as polyps, fibroids, or endometrial hyperplasia 1
- MRI of the pelvis may be considered if the initial ultrasound is inconclusive or if further evaluation is needed 1
- Sonohysterography may be performed if a polyp is suspected on the original ultrasound 1
Special Considerations
- In postmenopausal women, the primary concern is endometrial cancer, and the workup should focus on evaluating for this condition 1
- Hysteroscopy with biopsy may be used as a final step in the diagnostic pathway if needed, as it is highly accurate and clinically useful in diagnosing endometrial cancer 1
From the Research
Diagnostic Approach
The workup for dysfunctional uterine bleeding (DUB) involves a combination of the following:
- History: A detailed clinical history to identify the severity and pattern of bleeding 2, 3
- Physical examination: A thorough physical and pelvic examination to rule out other pathologic causes of abnormal uterine bleeding 2, 3
- Laboratory evaluation: Coagulation profile, complete blood count with platelet evaluation, and sometimes a serum pregnancy test 2
- Endometrial sampling: To rule out other pathologic causes of abnormal uterine bleeding 4
- Uterine imaging: Sonographic techniques and/or hysteroscopy to evaluate the uterus and rule out structural abnormalities 4
Considerations
When evaluating patients with DUB, the following should be considered:
- Coagulopathies: As a potential cause of DUB 4, 2
- Anovulation: As a primary cause of DUB, particularly in adolescents and women at the extremes of their reproductive life 5, 2, 3
- Structural uterine abnormalities: Such as intramural and subserosal myomas, which are unlikely to contribute to abnormal uterine bleeding 4
Treatment
The treatment of DUB is determined by the needs of the patient and may include:
- Medical therapy: Such as oral contraceptives, cyclic progestins, and non-steroidal anti-inflammatory drugs 5, 2, 6
- Surgical options: Such as dilatation and curettage, endometrial ablation, and hysterectomy, which may be considered for patients who are intolerant of medical therapy or for whom fertility is no longer desired 4, 5