Bed rest is recommended if bleeding is heavy.

The number of pads or tampons used over time should be recorded (so that the amount of bleeding can be determined).

Because aspirin may prolong bleeding, it should be avoided if possible.

• You are pregnant
• There is any unexplained bleeding between periods
• There is any bleeding after menopause
• Abnormal bleeding is accompanied by other symptoms

The medical history will be obtained and a physical examination performed.

Medical history questions documenting vaginal bleeding between periods detail may include:

• Time pattern
  • When did this bleeding between periods begin?
  • Does it occur consistently, such as every month?
  • When (during the course of a menstrual cycle) does this bleeding begin?
  • How long does the in-between bleeding last?
• Quality
  • Is the bleeding heavy?
  • How many tampons or pads are required?
  • Do cramps accompany the bleeding?
• Aggravating factors
  • What makes it worse?
  • Does increased physical activity make the bleeding worse?
  • Does intercourse bring on the bleeding?
  • Is increased stress associated with the bleeding?
• Relieving factors
  • Does anything relieve or prevent it?
• Other symptoms
  • What other symptoms are also present?
  • Do you have abdominal pain or cramps?
  • Increased bruising elsewhere on the body?
  • Do you have any difficulty, pain or burning with urination?
  • Is there bloody urine or blood in the stools?
• Other important information
  • Are you pregnant?
  • Have you had a miscarriage or abortion?
  • Have you had a D and C?
  • What medications are being taken?
  • Are tampons used? What kind? What size?
  • At what age did menstruation start?
  • Have there been normal periods without bleeding between in the past?
  • Is sexual activity occurring?
  • Is there a history of sexually transmitted disease?
  • Is birth control being used? What kind?
  • Have there been any injuries?
  • Have there been any medical or surgical treatments?

A thorough menstrual history will be obtained and a physical examination performed with an emphasis on the pelvic area. Uterine blood loss can be estimated if the patient knows how many sanitary napkins or tampons were used during a period.

Diagnostic tests that may be performed include:

• Urine pregnancy test
• Cervical cultures for sexually transmitted diseases
• Blood tests for thyroid and ovarian functions.
• Pap smear (if bleeding is inactive)
• Endometrial biopsy
• Pelvic ultrasound