What laboratory tests are indicated for menorrhagia (heavy menstrual bleeding) and oligomenorrhea (irregular menses)?

From the Guidelines

Laboratory tests for heavy and irregular menstrual bleeding should include a complete blood count, thyroid function tests, coagulation studies, pregnancy test, hormonal evaluations (follicle-stimulating hormone, luteinizing hormone, estradiol, and progesterone levels), and prolactin levels, as recommended by the most recent guidelines 1. When evaluating heavy and irregular menstrual bleeding, it is essential to consider the potential underlying causes, which can range from hormonal imbalances to structural abnormalities.

• The initial laboratory tests should include: + Complete blood count to assess for anemia + Thyroid function tests to rule out thyroid disorders + Coagulation studies to check for bleeding disorders + Pregnancy test to exclude pregnancy-related bleeding
• Hormonal evaluations should include: + Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels to identify hormonal imbalances, with abnormal findings indicating an LH/FSH ratio >2, FSH >35 IU/l, or LH >11 IU/l 2 + Estradiol and progesterone levels to assess ovarian function + Prolactin levels to rule out hyperprolactinemia, with levels >20 μg/l indicating potential hyperprolactinemia 2
• Additional tests may include: + Ferritin to assess iron stores + Endometrial biopsy or transvaginal ultrasound to evaluate the uterine lining and structure, with findings such as polycystic ovaries or thickening of ovarian stroma indicating potential polycystic ovary syndrome (PCOS) 2 The specific combination of tests will depend on the patient's age, medical history, and clinical presentation, as outlined in the guidelines for management of abnormal uterine bleeding associated with ovulatory dysfunction 1.
• The PALM-COEIN classification system can be used to describe uterine bleeding abnormalities, including structural and nonstructural causes 1. Early diagnosis and appropriate treatment can significantly improve patient outcomes, reducing morbidity, mortality, and improving quality of life, as supported by the most recent study on the management of abnormal uterine bleeding associated with ovulatory dysfunction 1.

From the Research

Labs for Heavy and Irregular Menses

Some potential lab tests for heavy and irregular menses include:

• Complete Blood Count (CBC) to check for anemia or other blood disorders 3
• Blood tests to check hormone levels, such as testosterone and insulin 3
• Tests to check for polycystic ovary syndrome (PCOS), such as ultrasound and hormone level tests 3
• Liver function tests, such as those that measure sulphatase activity, although the relevance of this to heavy and irregular menses is not clear 4

Potential Biomarkers

Some potential biomarkers for heavy and irregular menses include:

• Hemoglobin levels, which have been linked to PCOS and metabolic disorders 3
• Testosterone levels, which can be elevated in women with PCOS 3
• Insulin levels, which can be affected by PCOS and other hormonal disorders 3
• Arylsulphatase activity, although the relevance of this to heavy and irregular menses is not clear 4

Limitations

It is worth noting that the evidence for lab tests for heavy and irregular menses is limited, and more research is needed to determine the most effective tests and biomarkers for diagnosing and managing these conditions. Additionally, the relevance of some lab tests, such as those that measure sulphatase activity, to heavy and irregular menses is not clear 4.