Abnormal uterine bleeding physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S

Physical findings vary amongst patients but it is common to find pelvic and endocrine as well as skin changes. These include changes associated with underlying anemia such as pallor and a pale conjunctiva. Endocrine findings such as increased hair growth, clitoromegaly and acne may help diagnose underlying endocrine related causes of abnormal bleeding. In those experiencing uterine bleeding due to coagulopathies, signs of platelet deficiencies may be present, such as bruising and petechiae. An extensive physical examination may help in diagnosing the cause of abnormal uterine bleeding.

Patients often appear in no distress but may experience discomfort and pain during their menstrual cycle.

• Pulse: Often normal, between 60-100/minute
• Temperature: Often normal, 37 C/98 F
• Respiratory Rate: Often normal, 12-16 breaths/minute

• No significant findings

• Signs of anemia such as pallor and pale conjunctiva^[1]

• No significant findings

Patients should be assessed for endocrine-related causes of abnormal uterine bleeding. This includes an examination of:

• Thyroid gland: look for changes in size and tenderness to palpation
• Changes in hair growth patterns
• Clitoromegaly
• Acne

• No significant findings

• No significant findings

• No significant findings

• No significant findings

• No significant findings

• No significant findings

Palpation of the abdomen may assist in determining the underlying cause.

• Polyps can present with an irregularly enlarged uterus indicating the underlying polyps that vary in shape and size
• A ‘boggy’ uterus indicates adenomyosis^[2]
• Leiomyoma presents as a tender, irregularly enlarged uterus^[2]

• Signs of anemia; pallor, fatigue
• Signs of coagulopathies; bruising, petechiae, a history of uncontrolled bleeding following minor surgical procedures

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