If you’re experiencing irregular periods, heavy bleeding, missed cycles, or unusual symptoms related to your menstrual cycle, your healthcare provider may recommend a menstrual health evaluation. This evaluation helps uncover underlying causes and guide treatment options—whether you’re seeking relief from symptoms, trying to conceive, or managing a chronic condition.
Here’s a step-by-step breakdown of what typically happens during a menstrual health evaluation at a clinic.
1. Initial Intake and Medical History
Your visit will begin with a detailed conversation about your health, lifestyle, and menstrual symptoms. This step is essential for identifying patterns and potential causes.
What Your Provider Will Ask:
- Menstrual history:
- When did your periods start (menarche)?
- How regular are your cycles (average length, frequency)?
- How long do you bleed, and how heavy is the flow?
- Do you experience pain, spotting, clots, or missed periods?
- Symptom patterns:
- Mood swings, acne, breast tenderness, fatigue
- PMS or PMDD symptoms
- Pain with periods (dysmenorrhea) or intercourse
- Reproductive history:
- Any pregnancies, miscarriages, or fertility concerns
- Contraceptive use:
- Type and duration of birth control used
- Lifestyle factors:
- Stress levels, diet, exercise, sleep
- Weight changes or eating patterns
- Substance use (tobacco, alcohol, drugs)
- Family and medical history:
- PCOS, thyroid disease, diabetes, bleeding disorders
- Menstrual or fertility issues in female relatives
2. Physical and Pelvic Examination
Your provider may perform a general physical exam to check for signs of hormonal imbalance or systemic disease, followed by a pelvic exam if appropriate.
What to Expect:
- Weight, height, and BMI measurement
- Blood pressure and pulse
- Skin and hair check (looking for signs of PCOS like acne, hair growth)
- Breast exam (for galactorrhea or lumps)
- Pelvic exam:
- Visual inspection of the vulva and vagina
- Speculum exam to view the cervix and collect samples (e.g., Pap smear if due)
- Bimanual exam to check the size and shape of uterus and ovaries
Note: Pelvic exams may not be necessary for young teens or patients without sexual history unless symptoms strongly suggest reproductive pathology.
3. Menstrual Tracking and Symptom Diary
You may be asked to track your cycle and related symptoms over the next few weeks.
Tools That May Be Recommended:
- Menstrual tracking apps
- Paper charts
- Basal body temperature (BBT) logs
- Ovulation predictor kits (OPKs)
This data helps your provider assess cycle length, ovulatory patterns, and PMS timing.
4. Laboratory Tests
A blood test is often part of the evaluation, especially if your periods are absent, irregular, or unusually heavy.
Common Lab Tests:
| Test | Purpose |
|---|---|
| FSH & LH | Assess pituitary control of ovulation |
| Estradiol | Check estrogen levels |
| Progesterone (day 21) | Confirm ovulation |
| TSH | Rule out thyroid dysfunction |
| Prolactin | Elevated levels can suppress ovulation |
| Testosterone/DHEA | Assess for PCOS or adrenal issues |
| AMH | Evaluates ovarian reserve (especially for fertility) |
| CBC | Detect anemia from heavy bleeding |
| Coagulation profile | If excessive bleeding is a concern |
5. Imaging Tests (if needed)
Depending on your symptoms and exam findings, imaging may be ordered to visualize the reproductive organs.
Common Imaging Tests:
- Pelvic ultrasound (transabdominal or transvaginal):
- Detects ovarian cysts, uterine fibroids, polyps, endometrial thickness, or PCOS features
- Sonohysterogram or hysteroscopy:
- For investigating heavy or irregular bleeding when uterine abnormalities are suspected
- MRI or CT scan:
- Rarely used unless a more complex diagnosis is considered (e.g., pituitary tumor)
6. Specialized Hormonal or Diagnostic Procedures
In more complex cases, additional steps may include:
- Endometrial biopsy (to rule out abnormal uterine lining or cancer)
- Saline infusion sonography (SIS) for detailed uterine evaluation
- 24-hour cortisol test or ACTH stimulation (for adrenal gland issues)
- Karyotype or genetic testing in cases of primary amenorrhea
7. Diagnosis and Treatment Plan Discussion
Once your evaluation is complete, your doctor will summarize the findings and recommend a personalized treatment plan. This may include:
- Lifestyle changes (diet, exercise, stress management)
- Hormonal therapy (e.g., birth control pills, progesterone, IUD)
- Ovulation induction (e.g., letrozole, clomiphene for fertility)
- Surgery (if fibroids, polyps, or endometriosis are found)
- Referrals (e.g., endocrinologist, reproductive specialist, mental health)
Tips to Prepare for Your Appointment
- Bring a log of your last few menstrual cycles (dates, symptoms, flow)
- Write down all medications and supplements
- Note any significant life stressors, weight changes, or emotional changes
- List your questions and concerns
- Be ready to discuss personal and sexual history in a confidential setting
Conclusion
A menstrual health evaluation is a comprehensive process designed to uncover the root cause of any irregularities in your cycle. While it may involve blood work, imaging, and discussion of personal topics, it’s a crucial step toward understanding your reproductive health. Whether you’re dealing with missed periods, heavy bleeding, or fertility concerns, early diagnosis and targeted treatment can help restore balance and improve your overall well-being.
