A wide variety of underlying conditions can contribute to menstrual disorders. To pinpoint the cause, physicians rely on the patient’s medical history, physical examination and lab and imaging tests. Determining the exact cause of the menstrual disorder is important because it helps the physician plan appropriate treatment.

Physicians begin by obtaining the patient’s medical history as well as menstrual history. The details of a woman’s medical history may help the physician determine the cause of the patient’s menstrual problems. As a result, women are encouraged to be as open and honest as possible when answering the physician’s questions.

The patient may be asked about her sexual development during puberty, as well as current symptoms, medications, sexual activity and contraceptive use. The physician will also determine if the patient has a history of gynecologic disorders, gynecologic surgery, sexually transmitted diseases (STDs) or blood clotting disorders. The patient’s personal history and family history of medical conditions will be noted as well. Patients should also be prepared to answer questions regarding the growth, puberty and menstrual patterns of their female family members.

During the initial office visit, the patient should provide her physician with detailed information regarding any significant physical and emotional changes. This includes changes in weight, eating habits, exercise routine and stress level.

The physician will ask questions about the patient’s menstrual flow and menstrual cycle length. As a result, patients may benefit from recording a “menstrual diary.” This diary should include details such as the dates, type of flow and length of menstrual periods. Patients who do not have this information at the initial office visit may be asked to create and maintain one after the visit. Physicians may also ask patients to monitor their temperature each day to determine when the patient is ovulating (releasing an egg from the ovaries).

The second step in diagnosing a menstrual disorder is the physical examination. A careful evaluation of the patient will include a pelvic examination, which can reveal structural abnormalities that may be contributing to the menstrual problem.

A number of tests may be ordered following the physical exam. The tests are used to detect abnormalities and narrow the field of possible causes by eliminating certain conditions. The exact tests used vary based on the patient’s medical history, symptoms and physical findings. The tests may be performed during the initial visit or during a follow-up visit. Tests commonly used to diagnose underlying causes of menstrual disorders include:

• Urine tests. Uses a sample of urine to detect a variety of illnesses. A urine test may be performed to determine if a patient is pregnant, has a urinary tract infection, sexually transmitted diseases, or is in the process of menopause.
  
  
• Blood tests. Tests used to detect abnormally high or low levels of substances in the blood. Blood tests may be used to measure the patient’s blood count and hormone levels.
  
  
• Pap smear. Involves the collection of a sample of cells from the cervix and upper vagina. The cells are then examined for abnormalities under a microscope. This test may be used to detect infection, inflammation, cervical cancer or abnormal changes.
  
  
• Pelvic ultrasound. High-frequency sound waves are used to produce images of internal organs. This test can reveal abnormalities in the uterus, ovaries, cervix or vagina including thickening of the endometrium.
  
  
• Magnetic resonance imaging (MRI). Uses a powerful magnetic field to create images of structures and organs within the body, allowing a computer to produce clear cross-sectional or three-dimensional images. It may be ordered to determine if hypothalamic or pituitary gland abnormalities exist, as well as the presence of certain types of growths in the reproductive organs.
  
  
• Computed axial tomography (CAT scan). Allows for multiple x-rays to be taken from different angles around the patient. The “slices” or cross-sectional images of the patient’s body are analyzed by a computer. CAT scans can reveal growths or other abnormalities in areas such as the uterus or fallopian tubes.
  
  
• Endometrial biopsy. Involves the collection of a tissue sample from the endometrium (lining of the uterus). The sample is then examined for cancer or other abnormalities under a microscope.
  
  
• Hysteroscopy. A thin, lighted, flexible tube (hysteroscope) is inserted through the vagina. It allows the physician to visually examine the cervix and uterus.
  
  
• Sonohysterogram. Involves the injection of fluid through the vagina and cervix and into the uterus. An ultrasound is then used to evaluate the lining of the uterus and is particularly useful in determining the thickness of the endometrium.
  
  
• Dilation and curettage (D&C). A procedure in which the opening of the cervix is dilated or stretched and tissue from the uterus is collected. The tissue is then examined for abnormalities, signs of cancers or to ensure the complete evacuation of placental tissue after a miscarriage. It can also be performed as a diagnostic procedure for certain kinds of abnormal uterine bleeding.
  
  
• Hysterosalpingography. Involves the injection of dye through the cervix and into the uterus and fallopian tubes. X-rays are then taken to help the physician evaluate the uterus and fallopian tubes.