A pelvic examination may reveal an irregularly shaped, lumpy, or enlarged uterus. Frequently, this diagnosis is reliable. In some cases, diagnosis of fibroids is difficult, especially in obese women. Fibroid tumors have been mistaken for ovarian tumors, inflammation of the fallopian tubes, and pregnancy.
A transvaginal ultrasound or pelvic ultrasound may be done to confirm the diagnosis of fibroids.
An endometrial biopsy (biopsy of the uterine lining) or a pelvic laparoscopy may be needed to rule out cancer.
A doctor will perform a pelvic examination to check for pregnancy-related conditions and signs of fibroids or other abnormalities, such as ovarian cysts.
Medical and Personal History
The doctor needs to have a complete history of any medical or personal conditions that might be causing heavy bleeding, including:
Any family history of menstrual problems or bleeding disorders.
The presence or history of any medical conditions that might be causing heavy bleeding. Women who visit their gynecologist with menstrual complaints, particularly heavy bleeding, pelvic pain, or both may actually have an underlying medical disorder, which must be ruled out.
The pattern of the menstrual bleeding. (If it occurs during regular menstruation, nonhormonal treatments are tried first. If bleeding is irregular, occurs between periods, with premenstrual pain, after sex, or is associated with pelvic pain, the doctor should look for specific conditions that may cause these problems.)
Regular use of any medications (including vitamins and over-the-counter drugs).
Diet history, including caffeine and alcohol intake.
Past or present contraceptive use.
Any recent stressful events.
Sexual history. (It is very important that the patient trust the doctor enough to describe any sexual activity that might be risky.)
Ruling out Other Conditions that Cause Heavy Bleeding (Menorrhagia)
Almost all women, at some time in their reproductive life, bleeding heavily during menstrual periods (menorrhagia). Being taller, older, and having a higher number of pregnancies increase the chances for heavier-than-average bleeding. In some cases the cause of heavy bleeding is unknown, but a number of conditions can cause menorrhagia or contribute to the risk:
Miscarriage. An isolated instance of heavy bleeding usually after the period due date may be due to a miscarriage. If the bleeding occurs at the usual time of menstruation, however, miscarriage is less likely to be a cause.
Having late periods or approaching menopause. These events may cause occasional menorrhagia.
Uterine polyps. (These are small benign growths in the uterus.)
Certain contraceptives. (Oral contraceptives or an intrauterine device, an IUD.)