Dysfunctional uterine bleeding physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S

Overview

Physical findings vary amongst patients but it is common to find pelvic and endocrine as well as skin changes. These include changes associated with underlying anemia such as pallor and a pale conjunctiva. Endocrine findings such as increased hair growth, clitoromegaly and acne may help diagnose underlying endocrine related causes of abnormal bleeding. In those experiencing uterine bleeding due to coagulopathies, signs of platelet deficiencies may be present, such as bruising and petechiae. An extensive physical examination may help in diagnosing the cause of abnormal uterine bleeding.

Physical Examination

General Appearance

Patients often appear in no distress but may experience discomfort and pain during their menstrual cycle.

Vital Signs

• Pulse: Often normal, between 60-100/minute
• Temperature: Often normal, 37 C/98 F
• Respiratory Rate: Often normal, 12-16 breaths/minute

Examination According to Systems

ENT

• No significant findings

Skin

• Signs of anemia such as pallor and pale conjunctiva

Cardiovascular

• No significant findings

Endocrine

Patients should be assessed for endocrine-related causes of abnormal uterine bleeding. This includes an examination of:

• Thyroid gland: look for changes in size and tenderness to palpation
• Changes in hair growth patterns
• Clitoromegaly
• Acne

Pulmonary

• No significant findings

Neurological/ Psychological

• No significant findings

Renal

• No significant findings

GIT

• No significant findings

Muscular

• No significant findings

Genitourinary

• No significant findings

Pelvic/ Abdominal

Palpation of the abdomen may assist in determining the underlying cause.

• Polyps can present with an irregularly enlarged uterus indicating the underlying polyps that vary in shape and size
• A 'boggy' uterus indicates adenomyosis
• Leiomyoma presents as a tender, irregularly enlarged uterus

Hematological

• Signs of anemia; pallor, fatigue
• Signs of coagulopathies; bruising, petechiae, a history of uncontrolled bleeding following minor surgical procedures