Diagnosis of<unk>  starts with a medical history and physical examination. Normal menstrual bleeding patterns vary from woman to woman, so the medical history covers specific details about the woman's individual menstrual bleeding pattern, such as its predictability, length, volume, and whether she experiences cramps or other pain. The healthcare provider will also check to see whether she or any family members have any potentially related health conditions, and whether she is taking medication that might increase or decrease menstrual bleeding, such as herbal supplements, hormonal contraceptives, over-the-counter drugs such as aspirin, or blood thinners. Medical tests include a blood test, to see whether the<unk>  bleeding has caused anemia, and a pelvic ultrasound, to see whether the<unk>  bleeding is caused by a structural problem, such as a<unk>  fibroid. Ultrasound is specifically recommended in those over the age of 35 or those in whom bleeding continues despite initial treatment. Laboratory assessment of thyroid stimulating hormone (TSH), pregnancy, and chlamydia is also recommended. More extensive testing might include an MRI and endometrial sampling. Endometrial sampling is recommended in those over the age of 45 who do not improve with treatment and in those with intermenstrual bleeding that persists.The PALM-COEIN system may be used to classify the<unk>  bleeding.
Abnormal uterine bleeding
Ectopic pregnancy
Vaginal bleeding
Obstetrical bleeding
Vaginal discharge
Heavy menstrual bleeding
Intermenstrual bleeding
Postpartum bleeding