Version May 2024
| Historical feature | Potential significance |
| Menstrual history | |
| Age of menarche | Earlier age at menarche associated with shorter time to establish ovulatory cycles |
| Menstrual pattern (eg, frequency, regularity, duration and volume of flow) | Allows classification into etiologic categories (eg, amenorrhea, irregular menses, excessive menstrual bleeding, intermenstrual bleeding)* |
| Events that coincided with change in menstrual pattern (if there was a change) | May suggest an etiology (eg, hypothalamic dysfunction if coincided with weight loss, stress, or intensive exercise; breakthrough bleeding if coincided with initiation of hormonal contraception) |
| When did abnormal bleeding start (eg, with the first period or sometime thereafter)? | May suggest an etiology (eg, heavy bleeding at onset of menarche may indicate bleeding disorder) |
| Sexual/reproductive history | |
| Use, type, and adherence to contraception | Estrogen-progestin contraceptives: May cause unscheduled bleeding, particularly with poor adherence Progestin-only contraceptive: May cause irregular bleeding Copper IUD: Increases menstrual flow Levonorgestrel IUD: May cause irregular spotting or bleeding soon after insertion |
| Use of condoms; number of partners; new partners | Affects risk of STI |
| History of STI or current symptoms of STI (eg, vaginal discharge, pelvic pain) | Bleeding may be related to STI |
| History of sexual abuse¶, assault, or forced sexual activity | Bleeding may be extrauterine (vaginal, cervical) or related to STI |
| Recent delivery or abortion | Endometritis |
| Past medical history | |
| Chronic medical illness | May affect coagulation (eg, liver disease, renal disease, systemic lupus erythematosus) or HPO axis (eg, diabetes mellitus) |
| Medications, including over-the-counter medications and complementary/alternative agents; ask specifically about aspirin, aspirin-containing medications, and antidepressants | May affect coagulation (eg, aspirin, valproic acid) or HPO axis (eg, antidepressants, antipsychotics) |
| Review of systems | |
| Bleeding symptoms (bruising, epistaxis, bleeding gums, postoperative bleeding) | Bleeding disorder (eg, von Willebrand disease) |
| Orthostatic symptoms | Hypovolemia, significant blood loss |
| Weight change | Weight loss: Hypothalamic dysfunction or other endocrine disorder (eg, diabetes mellitus, hyperthyroidism), malnutrition Weight gain: PCOS, hypercortisolism, hypothyroidism |
| Abdominal pain, fever, and/or vaginal discharge | Pelvic inflammatory disease, endometritis |
| Dysmenorrhea, dyspareunia, infertility | Endometriosis and/or adenomyosis |
| Galactorrhea; heat or cold intolerance, fatigue; visual changes, headaches; hirsutism/acne | Endocrine problem (hyperprolactinemia, thyroid dysfunction, pituitary dysfunction, PCOS) |
| Changes in bowel or bladder function | Extrauterine bleeding (eg, hematuria), abdominal mass |
| Joint hypermobility, joint dislocations, hyperextensible skin, abnormal scarring | Heritable collagen disorders (associated with bleeding abnormalities due to capillary fragility) |
| Changes in hair, skin, or nails | Thyroid dysfunction |
| Family history | |
| Bleeding disorders | Patient may have the same disorder |
| Menstrual disorders | Family members with heavy menstrual bleeding may have undiagnosed bleeding disorders |
| Endocrine disorders (eg, thyroid disease, diabetes mellitus) | Family history of diabetes mellitus or lipid disorders may suggest PCOS |
| Leukemia and other cancers | Some types of cancer run in families and may be associated with increased bleeding |
| Social history | |
| Social stressors, substance use, exercise patterns | May affect the HPO axis |
| School absence, decreased participation in recreational activities (eg, sports, hobbies) | May provide information about effects on quality of life |
IUD: intrauterine device; STI: sexually transmitted infection; HPO: hypothalamic-pituitary-ovarian; PCOS: polycystic ovary syndrome.
* Refer to UpToDate content on evaluation of abnormal uterine bleeding in adolescents for details.
¶ Sexual abuse should be reported in accordance with local regulations. Refer to UpToDate content on management of sexual abuse in children and adolescents for details.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
