How might a clinician distinguish abnormal bleeding from a chronic condition, such as hypothyroidism, diabetes, or PCOs?
Dr. Bradley: The best first step is for the physician to ask the patient what has changed or is different about her physically. The physician can look for a pattern of symptoms that will suggest a direction for evaluation. For example, about 1 in 100 women has an underactive thyroid, and its presence is marked by such distinguishing characteristics as unexplained weight gain, temperature sensitivity (always feeling cold), hair loss, easy bruising, brittle nails, depression, and constipation. Common symptoms of PCOS include skin changes (i.e., acne, hirsutism, oily skin, pigmentation or darkening of the face) and obesity/insulin sensitivity.
Dr. Schrager: Abnormal bleeding is commonly due to other causes. It is fairly simple to exclude thyroid disease, diabetes, and PCOS as causes using laboratory tests. Most women who experience abnormal bleeding should have a thyroid-stimulating hormone (TSH) test and a fasting glucose test. Testing for elevated levels of androgens sometimes is indicated. These results as well as data from the medical history will help to narrow the diagnosis.
Dr. Bradley: Some patients may experience abnormal bleeding, but usually the chief complaint for endometriosis is severe pain or cramping.
Dr. Schrager: A bleeding peptic ulcer will cause rectal bleeding or black tarry stools. Physicians should be able to help women distinguish rectal bleeding from vaginal bleeding.
© 2004 Mary Ann Liebert, Inc.
Cite this: Toward Optimal Health: The Experts Discuss Abnormal Uterine Bleeding - Medscape - Apr 01, 2004.