Diagnosis of Abnormal Uterine Bleeding
Diagnosis of abnormal uterine bleeding should be sus-pected when vaginal bleeding is not regular, not pre-dictable, and not associated with premenstrual signs and symptoms that usually accompany ovulatory cycles. These signs and symptoms include breast fullness, abdominal bloating, mood changes, edema, weight gain, and uterine cramps.
Before anovulatory uterine bleeding can be diagnosed, anatomic causes including neoplasia should be excluded.
In a reproductive-aged woman, complications of pregnancy as a cause of irregular vaginal bleeding should be excluded. Other anatomic causes of irregular vaginal bleeding include uterine leiomyomata, inflammation or infection of the gen-ital tract, hyperplasia or carcinoma of the cervix or endo-metrium, cervical and endometrial polyps, and lesions of the vagina (Box 35.4). Pelvic ultrasonography or sonohysterog-raphy may assist in diagnosing these lesions. Women with organic causes for bleeding may have regular ovulatory cycles with superimposed irregular bleeding.
If the diagnosis is uncertain based on history and phys-ical examination alone, a woman may keep a basal body temperature chart for 6 to 8 weeks to look for the shift in the basal temperature that occurs with ovulation. An ovu-lation predictor kit may also be used. Luteal phase pro-gestin may also be measured. In cases of anovulation and abnormal bleeding, an endometrial biopsy may reveal endometrial hyperplasia. Because abnormal uterine bleed-ing results from chronic, unopposed estrogenic stimulation of the endometrium, the endometrium appears prolifera-tive or, with prolonged estrogenic stimulation, hyperplas-tic. Without treatment, these women are at increased risk for endometrial cancer.