Dysfunctional uterine bleeding : Investigation

A complete history taking and thorough physical examination usually enable us to establish few possible causes for the abnormal uterine bleeding (AUB) and direct us with further investigations. 

Common lab tests done in the assessment of abnormal uterine bleeding (AUB) include: 1) Full blood count (for heavy or prolonged bleeding), 2) Serum ferritin (to diagnose iron deficiency anemia), 3) Coagulation tests (if there is bleeding tendency or family history of bleeding disorders), 4)Thyroid function tests (if there is signs and symptoms of thyroid problems), and 5) Urine pregnancy test (to rule out pregnancy).

Other than that, investigations include imaging , hysteroscopy and biopsy.

Transvaginal sonography should be considered as the 1^st line imaging modality in the assessment of abnormal uterine bleeding (AUB). It allows detailed assessment of the uterus, cervix, fallopian tubes and ovaries

.

Saline infusion sonohysterography is done by introducing 5 – 15 ml of saline into the uterine cavity during the transvaginal sonography. This procedure improves the image features where it allows greater discrimination of location and relationship of intrauterine pathologies to the uterine cavity. 

MRI is rarely indicated but may be useful in some conditions: 1) To map the exact location of fibroids in planned surgery and prior to embolization procedure. 2) To assess the endometrium when transvaginal sonohysterography could not be performed (e.g in case of uterus anomalies).

Hysteroscopy allows direct visualization of the endometrium and intrauterine cavity, and it allows directed biopsy to be done.

Directed biopsy under direct visualization provides more benefit compared to blind biopsy done during dilation and curettage.

See

Dysfunctional uterine bleeding