Your history and examination will give a clue as to the cause of your abnormal bleeding. A history of infrequent periods and signs of male hormone excess (such as excess facial hair growth) would point to PCOS with anovulation as the cause. Use of the anticoagulant, warfarin, may cause heavy bleeding. Examination of the pelvis may identify an enlarged womb in cases of adenomyosis or fibroids. Swabs should be obtained to screen for infection. It is important to check that Pap smears are up to date and whether they have been normal.
Ultrasound scanning is an extremely important tool during the workup for abnormal bleeding since it will identify polyps, adenomyosis and fibroids. It will also determine whether the womb lining is excessively thickened.
Obtaining a sample of the lining of the womb (endometrial biopsy) may be indicated if there is a suspicion of cancer. Sampling can be undertaken in the clinic using a fine biopsy tube (known as a Pipelle sampler) or by means of a hysteroscopy.
Blood tests are also important. A full blood count should be done to determine whether there is anaemia or low iron stores as a result of abnormal bleeding. Blood tests will also identify other conditions such as problems with clotting; high male hormone levels as seen in PCOS and high prolactin levels (with hyperprolactinaemia). For more information, see my section on Anovulation and Ovulation Induction.