Abnormal uterine bleeding history and symptoms

Assessment of anovulatory DUB should always start with a good medical history and physical examination. Laboratory assessment of hemoglobin, luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, T₄, thyroid stimulating hormone (TSH), pregnancy (by βhCG), and androgen profile should also happen. More extensive testing might include an ultrasound and endometrial sampling. It is important to retrieve a complete history including menstrual history, sexual and reproductive history, drug history, family history, as well as social activities and hobbies. Assessment for symptoms of anemia should also be done as women can loose large volumes of blood often leading to iron deficiency anemia.

Obtaining a detailed history in cases of dysfunctional uterine bleeding can aide in diagnosis of the underlying cause. Patients should be asked about:^[1]

1. Menstrual History^[2]
   • Last Menstrual Period
   • Age at menarche
   • Frequency, duration and regularity of bleeding as well as the volume
     • Frequency can be described as:
       • Normal (24 to 38 days)
       • Frequent (less than 24 days)
       • Infrequent (greater than 38 days)
     • Duration can be described as:
       • Normal (approximately 4 to 8 days)
       • Prolonged (greater than 8 days)
       • Shortened (less than 4 days)
     • Regularity can be described as:
       • Regular (with a variation of +/- 2 to 7 days)
       • Absent
       • Irregular (variation greater than 20 days)
     • Volume can be described as:
     • Normal (5 to 80 mL)
     • Heavy (greater than 80 mL)
     • Light (less than 5 mL of blood loss)
     • Patients should be asked about frequent changes of sanitary products and passage of clots
   • Presence of inter menstrual and postcoital bleeding
2. Sexual and Reproductive History
   • Previous pregnancies and route of delivery
   • Fertility desire and difficulty achieving it
   • Contraceptive use
   • History of sexually transmitted diseases
   • Abnormal findings on previous pap smear
3. Systematic Changes
   • Changes in weight (especially weight loss indicating an underlying malignancy)
   • Pain
   • Bowel and bladder changes^[2]
   • Symptoms of endocrine disorders
4. Drug history that must be inquired about:
   • Anticoagulants
   • Hormonal medications such as Tamoxifen or hormonal replacement therapy
   • Hormonal contraceptives including intrauterine devices
   • Dopamine agonists
5. Family History
   • Coagulopathies
   • Malignancies
6. Social History^[2]
   • Tobacco
   • Alcohol
   • Recreational drug use
   • Occupation
7. Surgical History

Patients should be assessed for symptoms of anemia including pale discolouration of skin and conjunctiva, history of fatigue. As the most common type of anemia is iron deficiency anemia, spooning of the nails and pica may also be present.^[2]

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