What is included in the physical exam for menorrhagia?

Updated: Dec 20, 2018
  • Author: Julia A Shaw, MD, MBA, FACOG; Chief Editor: Michel E Rivlin, MD  more...
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The physical examination should be tailored to the differential diagnoses formulated by the results of the patient's history.

Initial inspection should include evaluation for the following:

  • Signs of severe volume depletion (eg, anemia): This may help confirm the patient's history of very heavy bleeding and/or prompt immediate inpatient care.

  • Obesity: This is an independent risk factor for endometrial cancer. Adipose tissue is a locale for estrogen conversion. Therefore, the larger the patient, the more increased the risk (and the higher the unopposed estrogen level on the endometrium).

  • Signs of androgen excess (eg, hirsutism): This usually points to polycystic ovarian syndrome (PCOS), leading to anovulatory bleeding (see Presence of hirsutism).

  • Ecchymosis: This usually is a sign of trauma or a bleeding disorder.

  • Purpura: This also is a sign of trauma or a possible bleeding disorder.

  • Pronounced acne: This is a sign of PCOS.

General examination should include evaluation of the following:

  • Visual fields

  • Bleeding gums

  • Thyroid evaluation

  • Galactorrhea

  • Enlarged liver or spleen

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