Diagnosis of Menorrhagia
Diagnostic Test list for Menorrhagia:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Menorrhagia
includes:
Menorrhagia Diagnosis: Book Excerpts
Diagnosis of Menorrhagia: medical news summaries:
The following medical news items
are relevant to diagnosis and misdiagnosis issues for Menorrhagia:
Diagnostic Tests for Menorrhagia: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about diagnostis of Menorrhagia.
DYSMENORRHEA:
Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Are there abnormalities on pelvic examination? A tubo-ovarian mass on pelvic examination should suggest salpingo-oophoritis, endometriosis with a chocolate cyst, or ectopic pregnancy. Perhaps the uterus is abnormal, in which case one should suspect fibroids, endometrial carcinoma, uterine pregnancy, retroverted uterus, endometrial cast, or cervical polyp. A normal examination should suggest ovarian dysfunction, endocrine imbalance, and psychogenic causes.
- What is the age of the patient? If the patient is young, she probably has a virginal uterus and may be considered to have primary dysmenorrhea. These cases are usually due to uterine hypoplasia, congenital malformations, ovarian dysfunction, or psychogenic causes.
DIAGNOSTIC WORKUP
Routine studies should include a CBC, sedimentation rate, chemistry panel, and thyroid profile. If there is vaginal discharge, a smear and culture should be done for gonorrhea and chlamydia. A cervical and rectal culture for these organisms may also be necessary. If there is a tubo-ovarian mass or enlarged uterus, abdominal ultrasound may help in differentiating the cause. A pregnancy test should be done. The pregnancy test of choice is
radioimmunoassay
for the beta subunit of human chorionic gonadotropin (HCG), which will be positive within a week of fertilization. If a ruptured ectopic pregnancy is expected, a peritoneal tap or culdocentesis may help if abdominal ultrasound is not conclusive. Laparoscopy may also be helpful in the diagnosis. A fern test and basal body temperature may help diagnose endometriosis. An exploratory laparotomy may be the only way to make a diagnosis in cases of a pelvic mass. If the pelvic examination is perfectly normal, sometimes a course of progesterone hormones is useful in alleviating the problem. A dilation and curettage may also be done to address the problem. Referral to a gynecologist is usually made before doing expensive diagnostic tests.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
METRORRHAGIA:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Are there abnormalities found on the vaginal examination? An enlarged uterus suggests pregnancy, fibroids, retained secundina, hydatiform mole, choriocarcinoma, endometrial carcinoma, or endometrial polyp. An adnexal mass suggests a granulosa cell tumor, salpingitis, or ectopic pregnancy. Cervical lesions that cause metrorrhagia are cervicitis, carcinoma of the cervix, and cervical polyp. Vaginal lesions include vaginal carcinoma and senile vaginitis.
- Is there a history of hormone therapy? If the patient has been taking estrogen or progesterone, withdrawal or breakthrough bleeding should be considered.
- Is there pallor or other signs of anemia? Most types of anemia, but particularly iron deficiency anemia, are associated with metrorrhagia.
- Is there a history of tremor, tachycardia, or edema? Both hyperthyroidism and hypothyroidism may be associated with metrorrhagia.
- Is there hirsutism or virilism? Look for an adrenal or ovarian neoplasm in these cases.
If all of these questions fail to turn up any positive answers, then dysfunctional uterine bleeding, collagen disease, or a coagulation disorder should be strongly considered.
DIAGNOSTIC WORKUP
Routine studies include a CBC, sedimentation rate, urinalysis, pregnancy test, chemistry panel, ANA test, coagulation profile, thyroid profile, and flat plate of the abdomen. A Pap smear and vaginal smear and culture should also be done.
If these are negative, referral to a gynecologist should be made before undertaking expensive diagnostic tests such as ultrasound or CT scans of the abdomen and pelvis. Alternatively, a trial of cyclical estrogen and progesterone hormones may be done if dysfunctional bleeding is suspected before referral is made. A gynecologist may be able to resolve the diagnostic dilemma with a good pelvic examination or, if that is unsuccessful, may perform laparoscopy or culdocentesis. A dilation and curettage or office endometrial biopsy are among the additional procedures at the gynecologist's disposal. An endocrinologist may be of help in deciding whether pituitary or ovarian dysfunction is responsible. An FSH of greater than 40 ml suggests ovarian failure. The endocrinologist may note hirsutism and order a free testosterone and 17-hydroxy progesterone to rule out adrenal or ovarian neoplasm.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
MENORRHAGIA:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there persistent or recurring abdominal or pelvic pain? The presence of pain with menorrhagia should make one suspect PID, endometriosis, and ectopic pregnancy.
- Are there abnormalities on the pelvic examination? The pelvic examination will usually be positive in cases of uterine fibroid, pregnancy, cervical polyp, pelvic inflammatory disease, and ectopic pregnancy. Endometriosis may not always be detected on pelvic examination.
- Is there anemia or other systemic symptoms or signs? The clinician should remember that iron deficiency anemia, hypothyroidism, lupus erythematosus, and cirrhosis of the liver are just a few of the systemic conditions that may present with menorrhagia.
DIAGNOSTIC WORKUP
Routine studies include a CBC, sedimentation rate, urinalysis, pregnancy test, chemistry panel, ANA titer, VDRL test, coagulation profile, thyroid profile, and flat plate of the abdomen. A Pap smear and vaginal smear and culture should be done.
If these tests are negative, referral to a gynecologist should be made before undertaking expensive tests such as pelvic ultrasound or CT scan of the abdomen and pelvis. Some clinicians will probably ignore this advice. A gynecologist will often be able to resolve the diagnostic dilemma with a good pelvic examination. Laparoscopy, culdocentesis, endometrial biopsy, and dilation and curettage are just a few of the diagnostic tools at his disposal.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Dysmenorrhea:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Primary dysmenorrhea
–Symptoms develop before age 25
–Pain occurs with onset of bleeding, then gradually diminishes
- Secondary dysmenorrhea
–Endometriosis (uterosacral ligament nodules, severe dysmenorrhea)
–Adenomyosis (enlarged uterus, menorrhagia, age 40–50, parous)
–Acute PID (acute adnexal and cervical motion tenderness, fever, discharge, and/or new-onset dysmenorrhea)
–Chronic PID (due to scarring)
–Uterine leiomyoma/fibroids (enlarged, mobile uterus, menorrhagia)
–Ovarian cysts (new dysmenorrhea, unilateral fullness)
-
Mental health issues
–Somatization
–Substance abuse
–Depression
–Sexual abuse
-
Extrapelvic disorders
–Irritable bowel syndrome
–Appendicitis
–Urinary tract infection
–Inflammatory bowel disease
–Diverticulitis
–Cholecystitis
-
Fibromyalgia
-
Malformations of the müllerian ducts
-
Interstitial cystitis
-
Intestinal or uteropelvic junction obstruction
-
Malignancy (e.g., uterine, ovarian)
-
Ectopic pregnancy
Workup and Diagnosis
-
History, physical, pelvic, and rectal examination will often identify the diagnosis
-
Patients unresponsive to an initial trial of NSAIDs and oral contraceptives may have pelvic pathology (secondary dysmenorrhea)
-
- Initial labs include CBC, urinalysis, β-hCG, wet mount, KOH prep, and gonorrhea and Chlamydia cultures, which may uncover pathology associated with secondary dysmenorrhea
-
Abdominal and/or vaginal (with vaginal probe) ultrasound may be used to detect pelvic masses (e.g., ovarian cysts, uterine leiomyoma)
-
Hysterosonogram if intrauterine pathology is suspected
-
Hysteroscopy should follow abnormal hysterosonogram
-
Abdominal and/or pelvic CT scan will evaluate gynecologic and abdominal pathology
-
Laparoscopy may be both diagnostic and therapeutic
-
Culdocentesis may be indicated if ruptured ectopic pregnancy is suspected; however, rarely used today, because of the advent of ultrasound
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
DYSMENORRHEA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The clinical approach to dysmenorrhea is simply to rule out significant organic disease by a thorough pelvic and rectal examination. A smear and culture for gonococcus and Chlamydia should be done. A course of contraceptives or progesterone in adequate doses may then be tried. Diuretics may be indicated if examination suggests pelvic congestion. When the aforementioned measures fail, a dilatation and curettage (D & C) may be indicated. A gynecologist may decide to do a culdoscopy, a peritoneoscopy, or an exploratory laparotomy.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Dysmenorrhea:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient complains of dysmenorrhea, have her describe it fully. Is it intermittent or continuous? Sharp, cramping, or aching? Ask where the pain is located and whether it's bilateral. When does the pain begin and end, and when is it severe? Does it radiate to the back? How long has she been experiencing the pain? If it's a recent complaint, obtain a human chorionic gonadotropin level to determine if the patient is or was pregnant, because miscarriage can cause painful bleeding. Explore associated signs and symptoms, such as nausea and vomiting, altered bowel or urinary habits, bloating, water retention, pelvic or rectal pressure, and unusual fatigue, irritability, or depression.
Then obtain a menstrual and sexual history. Ask the patient if her menstrual flow is heavy or scant. Have her describe vaginal discharge between menses. Does she experience pain during sexual intercourse? Does it occur with menses? Find out what relieves her cramps. Does she take pain medication? Is it effective? Note her method of contraception, and ask about a history of pelvic infection. Does she have signs and symptoms of urinary system obstruction, such as pyuria, urine retention, or incontinence? Determine how she copes with stress. Determine her risk of sexually transmitted diseases.
Next, perform a focused physical examination. Take the patient's vital signs, noting fever and accompanying chills. Inspect the abdomen for distention, and palpate for tenderness and masses. Note costovertebral angle tenderness.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Metrorrhagia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin your evaluation by obtaining a thorough menstrual history. Ask the patient when she began menstruating and about the duration of menstrual periods, the interval between them, and the average number of tampons or pads she uses. When does metrorrhagia usually occur in relation to her period? Does she experience other signs or symptoms? Find out the date of her last menses, and ask about other recent changes in her normal menstrual pattern. Get details of previous gynecologic problems. If applicable, obtain a contraceptive and obstetric history. Record the dates of her last Papanicolaou smear and pelvic examination. Ask the patient when she last had sex and whether or not it was protected. Next, ask about her general health and any recent changes. Is she under emotional stress? If possible, obtain a pregnancy history of the patient’s mother. Was the patient exposed in utero to diethylstilbestrol? (This drug has been linked to vaginal adenosis.)
Perform a pelvic examination if indicated, and obtain blood and urine samples for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Menorrhagia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
When the patient’s condition permits, obtain a history. Determine her age at menarche, the duration of menstrual periods, and the interval between them. Establish the date of the patient’s last menses, and ask about recent changes in her normal menstrual pattern. Have the patient describe the character and amount of bleeding. For example, how many pads or tampons does the patient use? Has she noted clots or tissue in the blood? Also ask about the development of other signs and symptoms before and during her period.
Next, ask if the patient is sexually active. Does she use a method of birth control? If so, what kind? Could the patient be pregnant? Be sure to note the number of pregnancies, the outcome of each, and any pregnancy-related complications. Find out the dates of her most recent pelvic examination and Papanicolaou smear and the details of any previous gynecologic infections or neoplasms. Also, be sure to ask about previous episodes of abnormal bleeding and the outcome of treatment. If possible, obtain a pregnancy history of the patient’s mother, and determine if the patient was exposed in utero to diethylstilbestrol. (This drug has been linked to vaginal adenosis.)
Be sure to ask the patient about her general health and medical history. Note particularly if the patient or her family has a history of thyroid, adrenal, or hepatic disease; blood dyscrasias; or tuberculosis because these may predispose the patient to menorrhagia. Also, ask about the patient’s past surgical procedures and recent emotional stress. Find out if the patient has undergone X-ray or other radiation therapy, because this may indicate prior treatment for menorrhagia. Obtain a thorough drug and alcohol history, noting the use of anticoagulants or aspirin. Perform a pelvic examination, and obtain blood and urine samples for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Dysmenorrhea:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Pelvic examination and a detailed patient history may help suggest the cause of dysmenorrhea.
Primary dysmenorrhea is diagnosed when secondary causes are ruled out. Appropriate tests (such as laparoscopy, dilatation and curettage, and pelvic ultrasound) are used to diagnose underlying disorders in secondary dysmenorrhea.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Dysmenorrhea:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient complains of dysmenorrhea, have her describe it fully. Is it intermittent or continuous? Sharp, cramping, or aching? Ask where the pain is located and whether it’s bilateral. How long has she been experiencing it? When does the pain begin and end, and when is it severe? Does it radiate to the back? Explore associated signs and symptoms, such as nausea and vomiting, altered elimination habits, bloating, water retention, pelvic or rectal pressure, and unusual fatigue, irritability, or depression.
Then obtain a menstrual and sexual history. Ask the patient if her menstrual flow is heavy or scant. Have her describe any vaginal discharge between menses. Does she experience pain during sexual intercourse? Does it occur with menses? Find out what relieves her cramps. Does she take pain medication? Is it effective? Note her method of contraception, and ask about a history of pelvic infection. Does she have any signs and symptoms of urinary system obstruction, such as pyuria, urine retention, or incontinence? Determine how she copes with stress. Determine her risk for sexually transmitted diseases.
Next, perform a focused physical examination. Take vital signs, noting fever and accompanying chills. Inspect the abdomen for distention, and palpate for tenderness and masses. Note costovertebral angle tenderness.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Metrorrhagia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin your evaluation by obtaining a thorough menstrual history. Ask the patient when she began menstruating and about the duration of menstrual periods, the interval between them, and the average number of tampons or pads she uses. When does metrorrhagia usually occur in relation to her period? Does she experience other signs or symptoms? Find out the date of her last menses, and ask about any other recent changes in her normal menstrual pattern. Get details of any previous gynecologic problems. If applicable, obtain a contraceptive and obstetric history. Record the dates of her last Papanicolaou smear and pelvic examination. Ask the patient when she last had sex and whether or not it was protected. Next, ask about her general health and any recent changes. Is she under emotional stress? If possible, obtain a pregnancy history of the patient’s mother. Was the patient exposed in utero to diethylstilbestrol? (This drug has been linked to vaginal adenosis.)
Perform a pelvic examination if indicated, and obtain blood and urine samples for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Menorrhagia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
When the patient’s condition permits, obtain a history. Determine her age at menarche, the average duration of menstrual periods, and the interval between them. Establish the date of the patient’s last menses, and ask about any recent changes in her normal menstrual pattern. Have the patient describe the character and amount of bleeding. For example, how many pads or tampons does the patient use? Has she noted clots or tissue in the blood? Also ask about the development of other signs and symptoms before and during the menstrual period.
Next, ask if the patient is sexually active. Does she use a method of birth control? If so, what kind? Could the patient be pregnant? Be sure to note the number of pregnancies, the outcome of each, and any pregnancy-related complications. Find out the dates of her most recent pelvic examination and Papanicolaou smear and the details of any previous gynecologic infections or neoplasms. Also, be sure to ask about any previous episodes of abnormal bleeding and the outcome of any treatment. If possible, obtain a pregnancy history of the patient’s mother, and determine if the patient was exposed in utero to diethylstilbestrol. (This drug has been linked to vaginal adenosis.)
Be sure to ask the patient about her general health and medical history. Note particularly if the patient or her family has a history of thyroid, adrenal, or hepatic disease; blood dyscrasias; or tuberculosis because these may predispose the patient to menorrhagia. Also, ask about the patient’s past surgical procedures and any recent emotional stress. Find out if the patient has undergone X-ray or other radiation therapy, because this may indicate prior treatment for menorrhagia. Obtain a thorough drug and alcohol history, noting the use of anticoagulants or aspirin. Perform a pelvic examination, and obtain blood and urine samples for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dysmenorrhea:
History (2)
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. It is extremely important to distinguish primary from secondary dysmenorrhea.
B. Primary dysmenorrhea starts at the onset of menarche, and is thought to be the result of prostaglandin-2α, which produces uterine ischemia. It can be treated with antiprostaglandins and oral contraceptives.
C. Secondary dysmenorrhea starts later in a woman’s ovulatory life and may be caused by endometriosis or pelvic pathology.
D. If abnormal bleeding is associated with either type of dysmenorrhea, it is important to elicit symptoms of pregnancy, such as missed or late menses, breast tenderness, nausea, or urinary frequency (Chapter 11.5).
E. If severe pain develops during the first part of the menstrual cycle, ascertain the history of a new sexual partner, abnormal vaginal discharge, or dyspareunia. These symptoms could point toward pelvic inflammatory disease (PID) (Chapter 11.3).
F. Pain that develops during menses, but not related to pregnancy or infection, can also be caused by tumor. In younger women, secondary dysmenorrhea sufficiently severe to affect daily functioning or relationships suggests endometriosis. This condition can affect as many as 10% of women. Deep dyspareunia and sacral backache with menses are common symptoms. Premenstrual tenesmus or diarrhea correlates with endometriosis of the rectosigmoid area, whereas cyclic hematuria or dysuria may indicate bladder endometriosis.
G. Infertility is often a consequence of endometriosis.
Physical examination
As with all menstrual complaints, a thorough physical examination is an essential part of making a diagnosis.
A. The general condition of the patient needs to be assessed. Are the vital signs stable or is the patient showing signs of systemic illness such as fever, which can indicate pelvic infection. Hypotension and pallor can indicate a ruptured ectopic pregnancy.
B. A general physical assessment with attention to the back, sacrum, spine abdomen, and bladder is important.
C. A thorough pelvic examination is key. The external genitalia may show signs of cyanosis, as is seen with pregnancy, or abnormal discharge, as is seen with infection. Palpate the vaginal area for nodules which may present on the anterior cul-de-sac or on the posterior vaginal fornix on bimanual examination; they could indicate endometriosis. Cervical motion tenderness and cervical leukorrhea may be present in PID. Uterine tenderness is often present and uterine displacement and fixation may be noted. Ovarian enlargement or adnexa fixation, which correlates with endometriosis or adnexal mass from neoplastic or infectious cause, may be found. Nodules may also be palpated along the uterosacral ligaments on rectovaginal examination.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Menorrhagia:
History (2)
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. A menstrual and reproductive history is necessary. First, assess the first day of the last menstrual period and the first day of the previous menstrual period; the regularity, duration, frequency, and intermenstrual flow; and the number of pads or tampons per period.
B. Pregnancy should always be considered and diagnosed, if present. Complications of pregnancy (e.g., spontaneous abortion, ectopic pregnancy, abruptio placentae, and placenta previa) need to be considered if pregnancy is diagnosed.
C. Weight loss or gain, excessive exercise, anxiety or stress disorders, as well as symptoms of systemic disease (e.g., coagulopathy; thyroid, renal, and hepatic disease), must be considered when taking the history.
D. A key question. Is the patient having ovulatory or anovulatory cycles? Do molimenal symptoms (e.g., edema, abdominal bloating, pelvic cramping, and breast fullness) precede menses that follow an ovulatory cycle. If these symptoms are not present and the patient has irregular, heavy periods, the patient is anovulatory and has dysfunctional uterine bleeding.
E. How old is the patient?
1. Menarche to 16 years. Without molimenal symptoms and with irregularity, the problem in the young woman is most probably anovulatory. Whereas some irregularity is normal, it is not normal to soak 25 to
30 tampons or pads per day. In this setting, pregnancy remains a consideration if the patient is sexually active. Fever and pelvic pain can indicate pelvic inflammatory disease (PID). Easy bruising suggests a coagulopathy and neurologic symptoms (e.g., blurred vision, visual field defects, and headache) point to a pituitary lesion.
2. Age 16 to 40 years. Anovulation is a less common cause of abnormal bleeding; up to 8% of problems are caused by pregnancy and contraception complications in this age group. Endometriosis, endometrial hyperplasia, and endometrial polyps increase in frequency as a woman ages. PID and endocrinopathies also occur in this age group.
3. Age 40 years and above. Abnormal bleeding in this age group should arouse suspicion of cancer, until proved otherwise. Of women in this age group, 90% who have abnormal bleeding are anovulatory. Menopausal symptoms, use of estrogens, and personal or family history of malignancy are important to elicit.
Physical examination
A. Assess vital signs and the patient’s general appearance. Signs of impending shock (e.g., hypotension and tachycardia) are likely related to pregnancy, particularly in the younger age group, but they can be related to trauma, sepsis, or cancer.
B. Pallor not associated with hypovolemia can be found with chronic blood loss associated with anovulatory cycles, leiomyoma, blood dyscrasia, or malignancy (Chapter 16.1).
C. Fever, leukocytosis, and pelvic tenderness are usually found in acute PID (Chapter 2.6).
D. Pelvic masses found on physical examination point toward abscess, ectopic pregnancy, or malignancy.
E. Signs of thyroid disease (e.g., rapid or slow pulse, reflex changes, hair changes, and thyromegaly) can be associated with menstrual abnormalities.
F. Excessive bruising can indicate nutritional deficiency, eating disorder, trauma, abuse, medication overuse, or coagulopathy (Chapter 15.3).
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Dysmenorrhea:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient complains of dysmenorrhea, have her describe it fully. Is it intermittent or continuous? Sharp, cramping, or aching? Ask where the pain is located and whether it's bilateral. When does the pain begin and end, and when is it severe? Does it radiate to the back? How long has she been experiencing the pain? If it's a recent complaint, obtain a human chorionic gonadotropin level to determine if the patient is or was pregnant, because miscarriage can cause painful bleeding. Explore associated signs and symptoms, such as nausea and vomiting, altered bowel or urinary habits, bloating, water retention, pelvic or rectal pressure, and unusual fatigue, irritability, or depression.
Then obtain a menstrual and sexual history. Ask the patient if her menstrual flow is heavy or scant. Have her describe vaginal discharge between menses. Does she experience pain during sexual intercourse? Does it occur with menses? Find out what relieves her cramps. Does she take pain medication? Is it effective? Note her method of contraception, and ask about a history of pelvic infection. Does she have signs and symptoms of urinary system obstruction, such as pyuria, urine retention, or incontinence? Determine how she copes with stress. Determine her risk of sexually transmitted diseases.
Next, perform a focused physical examination. Take the patient's vital signs, noting fever and accompanying chills. Inspect the abdomen for distention, and palpate for tenderness and masses. Note costovertebral angle tenderness.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Metrorrhagia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin your evaluation by obtaining a thorough menstrual history. Ask the patient when she began menstruating, the duration of menses, the interval between them, and the average number of tampons or pads she uses each month. Establish when metrorrhagia occurs in relation to her menses. Does she experience other signs or symptoms? Find out the date of her last menses, and ask about other changes in her normal menstrual pattern. Ask for details of previous gynecologic problems. If applicable, obtain a contraceptive and obstetric history. Record the dates of her last Papanicolaou (Pap) smear and pelvic examination. Ask the patient if she is sexually active. Next, ask about her general health and any recent changes. Is she under emotional stress? If possible, obtain a pregnancy history of the patient's mother. Was the patient exposed in utero to diethylstilbestrol? (This drug has been linked to vaginal adenosis.)
Prepare the patient for a pelvic examination if indicated, and obtain blood samples and a urine specimen for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Menorrhagia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
When the patient's condition permits, obtain a history. Determine her age at menarche, the duration of menses, and the interval between them. Establish the date of the patient's last menses, and ask about recent changes in her normal menstrual pattern. Have the patient describe the character and amount of bleeding. For example, how many pads or tampons does the patient use per period? Has she noted clots or tissue in the blood? Also ask about the development of other signs and symptoms before and during her menses.
Next, ask if the patient is sexually active. Does she use a method of birth control? If so, what kind? Could the patient be pregnant? Be sure to note the number of pregnancies, the outcome of each, and any pregnancy-related complications. Find out the dates of her most recent pelvic examination and Papanicolaou smear and the details of any previous gynecologic infections or neoplasms. Also, be sure to ask about previous episodes of abnormal bleeding and the outcome of any treatment. If possible, obtain a pregnancy history of the patient's mother, and determine if the patient was exposed in utero to diethylstilbestrol. (This drug has been linked to vaginal adenosis.)
Be sure to ask the patient about her general health and medical history. Note particularly if the patient or her family has a history of thyroid, adrenal, or hepatic disease; blood dyscrasias; or tuberculosis because these may predispose the patient to menorrhagia. Also, ask about the patient's past surgical procedures and recent emotional stress. Find out if the patient has undergone X-ray or other radiation therapy, because this may indicate prior treatment for menorrhagia. Obtain a thorough drug and alcohol history, noting the use of anticoagulants or aspirin. Prepare the patient for a pelvic examination, and obtain blood samples and urine specimens for pregnancy testing.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
DYSMENORRHEA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The clinical approach to dysmenorrhea is simply to rule out significant
organic disease by a thorough pelvic and rectal examination. A smear and
culture for gonococcus and Chlamydia should be done. A course of contraceptives or
progesterone in adequate doses may then be tried. Diuretics may be indicated
if examination suggests pelvic congestion. When the aforementioned measures
fail, a dilatation and curettage (D & C) may be indicated. A gynecologist
may decide to do a culdoscopy, a peritoneoscopy, or an exploratory
laparotomy.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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