Gynecologic and hematologic evaluation of the patient with HMB
| Evaluation | Component |
| Patient history | Menstrual |
| Medical | |
| Bleeding | |
| Medication, including use of hormonal contraceptives, anticoagulants, and antiplatelet agents | |
| Recent trauma | |
| Vital signs | Blood pressure |
| Heart rate | |
| Speculum and pelvic examinations | Depending on the age of the patient and the clinician’s judgment |
| Depending on the age of the patient and her previous history | |
| Papanicolau test (age >21 y) | |
| Endometrial biopsy (age >45 y or unopposed estrogen) | |
| Endocervix or vaginal swab for gonorrhea and Chlamydia (age <25 y) | |
| Pelvic ultrasound | Depending on clinical judgment (based on diagnostic suspicion and the age of the patient) |
| With intrauterine saline instillation for increased sensitivity (sonohysterography) | |
| Laboratory tests | |
| Immediate | CBC |
| Ferritin | |
| If periods are irregular | Pregnancy test |
| TSH | |
| Prolactin | |
| If signs of androgen excess | DHEA; total testosterone |
| If on warfarin | PT/INR |
| If on a direct oral anticoagulant | Creatinine |
| If a bleeding disorder is suspected | PT |
| aPTT | |
| Fibrinogen level | |
| Additional to consider | VWF and FVIII levels |
| Plasma sample for storage | |
| Serum iron and total iron binding capacity | |
| Liver function | |
| Full hemostatic evaluation including the following tests if indicated (ie, past personal or family history to suggest an underlying disorder of hemostasis) | |
| Platelet aggregation and release studies (cannot be done at time of acute event) | |
| FIX, XI, and XIII | |
| Tests of fibrinolysis | |
| Evaluation | Component |
| Patient history | Menstrual |
| Medical | |
| Bleeding | |
| Medication, including use of hormonal contraceptives, anticoagulants, and antiplatelet agents | |
| Recent trauma | |
| Vital signs | Blood pressure |
| Heart rate | |
| Speculum and pelvic examinations | Depending on the age of the patient and the clinician’s judgment |
| Depending on the age of the patient and her previous history | |
| Papanicolau test (age >21 y) | |
| Endometrial biopsy (age >45 y or unopposed estrogen) | |
| Endocervix or vaginal swab for gonorrhea and Chlamydia (age <25 y) | |
| Pelvic ultrasound | Depending on clinical judgment (based on diagnostic suspicion and the age of the patient) |
| With intrauterine saline instillation for increased sensitivity (sonohysterography) | |
| Laboratory tests | |
| Immediate | CBC |
| Ferritin | |
| If periods are irregular | Pregnancy test |
| TSH | |
| Prolactin | |
| If signs of androgen excess | DHEA; total testosterone |
| If on warfarin | PT/INR |
| If on a direct oral anticoagulant | Creatinine |
| If a bleeding disorder is suspected | PT |
| aPTT | |
| Fibrinogen level | |
| Additional to consider | VWF and FVIII levels |
| Plasma sample for storage | |
| Serum iron and total iron binding capacity | |
| Liver function | |
| Full hemostatic evaluation including the following tests if indicated (ie, past personal or family history to suggest an underlying disorder of hemostasis) | |
| Platelet aggregation and release studies (cannot be done at time of acute event) | |
| FIX, XI, and XIII | |
| Tests of fibrinolysis | |
aPTT, activated partial thromboplastin time; DHEA, dehydroepiandrosterone; FIX, factor IX; INR, international normalized ratio; PT, prothrombin time; TSH, thyroid stimulating hormone.