Establishing the Diagnosis

  • Roger P. Smith


As in most of medicine, effective treatment of a patient’s concerns or symptoms demands an accurate diagnosis of the problem. Unfortunately, in the cases of painful or heavy menses, the process of establishing a diagnosis is not always straightforward. For women with painful menses, there is the non-specific nature of the symptoms, the variability of presentation, and the youth and sexual innocence of many of its sufferers; women who report heavy menstrual bleeding have no reliable index for measurement or comparison. In both cases, the actual symptoms often happen far from the clinical setting, physically or temporally. These challenges may be surmounted with a systematic approach to the diagnostic process, most of which is driven by a careful, thorough review of the patient’s history. For this discussion, we will ignore situations in which the diagnostic process for symptoms of pain or heavy bleeding is trivial, such as following the placement of an intrauterine contraceptive device, subsequent to a prolonged period of amenorrhea as in anovulation or polycystic ovary syndrome, or iatrogenic interventions such as anticoagulation.


Diagnosis Physical examination Laboratory evaluation Imaging History Symptoms Decision tree Ultrasonography Empiric treatment 


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Roger P. Smith
    • 1
  1. 1.Florida Atlantic UniversityBoca RatonUSA

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