In evaluating and treating abnormal bleeding, there are a number of options that can very useful.

• Pregnancy test
• Examine the patient
• Pap smear
• Biopsy any visible lesions of the cervix or vagina

• Endometrial biopsy for women over age 40
• Pelvic ultrasound scan to look for submucous fibroids
• Sonohysterography if D&C is not planned and abnormal bleeding persists
• Blood count (if bleeding has been heavy and prolonged)
• Correct any underlying medical problems
• Begin OCPs to control abnormal bleeding due to hormonal causes
• Continuous OCPs to suppress menstruation completely
• Depo Provera to suppress ovulation and menstruation
• D&C (with or without hysteroscopy) to remove endometrial polyps

If bleeding is intractable and the patient desires to preserve childbearing, consider myomectomy if submucous fibroids are contributing to the bleeding.

If bleeding is intractable and the patient has completed childbearing, consider balloon or roller-ball ablation of the endometrium, or hysterectomy.