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Vaginal Bleeding (cont.)

How is the cause of abnormal vaginal bleeding diagnosed?

The health-care professional will take a careful medical history. The woman will be asked questions about the following issues and other general questions regarding her health:

  • This episode of vaginal bleeding
  • Last known normal menstrual cycle
  • Previous episodes of abnormal bleeding
  • If she may be currently pregnant
  • Previous pregnancies
  • Outcomes of previous pregnancies
  • Present sexual activity
  • Use of any form of birth control
  • Number of sexual partners
  • Any medications, over-the-counter, or illicit drugs she is taking
  • History of problems with clotting or bleeding disorders
  • History of recent surgeries or gynecological procedures

The doctor also will perform a complete physical examination, including a thorough pelvic exam.

  • The exam includes careful inspection of the external genitalia, urethra, and anal area.
  • The vaginal walls and cervix or birth canal are inspected for the presence of any abnormalities or retained foreign objects. Sometimes a tampon or other object is left in the vagina, which can cause bleeding.
  • While the doctor is examining the vagina and cervix, the doctor may take cultures (fluid samples) to test for sexually transmitted diseases (STDs) such as gonorrhea and Chlamydia.
  • The doctor may also take cells from the cervix that will be examined for cancer. This is known as a Pap smear.
  • It is also important for the doctor to place his or her hand into the vagina and sometimes the rectum to detect the shape of the uterus and ovaries as well as to feel for any masses that may be present.

Diagnostic tests that may be performed to help ascertain the cause of abnormal bleeding include the following:

  • A pregnancy test needs to be done to make sure that pregnancy or a related complication is not the cause of the woman's bleeding.
  • Blood will be taken to check for anemia (low red blood cell counts) or low platelet count.
  • A clotting series that includes a prothrombin time (PT) and an activated partial thromboplastin time (PTT) gives information about the ability to form clots in the body to stop bleeding. Abnormal vaginal bleeding may be the first sign that a woman may have of bleeding disorder.
  • Your doctor may also order thyroid tests, which are blood tests that examine the thyroid gland (a gland in the neck responsible for many complex functions of the body).
  • An ultrasound of the abdomen and pelvis may be performed. This is an imaging test, much like an X-ray.
  • An endometrial biopsy may be performed to take a sample of tissue from the lining of the uterus.

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