Menstrual Disorders - Diagnosis

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Ultrasound

Imaging techniques are often used to detect certain conditions that may be causing menstrual disorders. Imaging can help diagnose fibroids, endometriosis, or structural abnormalities of the reproductive organs.

Ultrasound and Sonohysterography. Ultrasound is the standard imaging technique for evaluating the uterus and ovaries, detecting fibroids, ovarian cysts and tumors, and finding obstructions in the urinary tract. It uses sound waves to produce an image of the organs. Ultrasound carries no risk and causes very little discomfort.

Transvaginal sonohysterography uses ultrasound along with saline (salt water) injected into the uterus to enhance the visualization of the uterus.

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Other Diagnostic Procedures

Hysteroscopy. Hysteroscopy is a procedure that can detect the presence of fibroids, polyps, or other causes of bleeding. It may miss cases of uterine cancer, however, and is not a substitute for more invasive procedures, such as dilation and curettage (D&C) or endometrial biopsy, if cancer is suspected.

It is done in the office setting and requires no incisions. The procedure uses a slender flexible or rigid tube called a hysteroscope, which is inserted into the vagina and through the cervix to reach the uterus. A fiber-optic light source and a tiny camera in the tube allow the doctor to view the cavity. The uterus is filled with saline or carbon dioxide to inflate the cavity and provide better viewing. This can cause cramping.

Hysteroscopy is non-invasive, but many women find the procedure painful. The use of an anesthetic spray such as lidocaine may help in preventing pain from this procedure. Other complications include excessive fluid absorption, infection, and uterine perforation. Hysteroscopy is also performed as part of surgical procedures.

Laparoscopy. Diagnostic laparoscopy, an invasive surgical procedure, is currently the only definitive method for diagnosing endometriosis, a common cause of dysmenorrhea. It may also be used to treat endometriosis. Laparoscopy normally requires a general anesthetic, although the patient can go home the same day. The procedure involves inflating the abdomen with gas through a small abdominal incision. A fiber optic tube equipped with small camera lenses (the laparoscope) is then inserted. The doctor uses the laparoscope to view the uterus, ovaries, tubes, and peritoneum (lining of the pelvis). [For more information, see In-Depth Report #74: Endometriosis.]