1) Identify the patient’s normal menstrual pattern

-Age of menarche (Her age when she first had her first menses)

-The frequency of the cycle.

-For how long does she have the bleeding in each cycle. (how many days?)

-estimated quantity of bleeding (No. of pads used)

-Is there associated pain during the menses?How severe is it?

-Is there passage of any clots/ altered blood

-When was the last date of menstruation-that is the period of amenorrhoea (POA).

2) Identification of the current irregularity in relation to that of the individual patient’s normal pattern.

The following should be compared with her previous normal periods

-Is the cycle lengthened or shortened? (cycle frequency)

-Is the quantity of bleeding increased, decreased or normal?

-Characteristics of the menstrual blood (Is it fresh blood,clots or altered blood?).

-Is there pain during her periods. What is the nature of the pain-is i colicky. What is its timing in relation to the cycle.

3) The history of the current menstrual irregularity should be taken:

-How long ago did the problem start (that is the onset of the problem-The last normal menstrual period)

-Are the symptoms getting worse, better or the same (The progression of the symptoms).

-How does she feel now (current status)

-Has she received any treatment, since the onset of the symptoms/present problem.

4) Ask a few questions to find the possible aetiological (Cause) factor:

-Depending on the pattern of menstrual irregularity, the probable cause should be identified, features that support or contradict your tentative diagnosis should also be noted

-It is important to ask for a past history of contraceptive usage.Hormonal contraceptives usage eg DMPA, OCP should also be noted.

-Pregnancy, lactation and use of contraceptives should be excluded

5)Ask questions to determine if there are any complications in her present problem/illness

-Look for clinical features of anaemia ,such as pallor etc.This is important in menorrhagia.

-Are there any associated problems such as subfertility.

-How does the present illness affect her general physical and social well being?

-Are there any associated disabilities? Can she perform the activities of daily living? (ADL) such as bathing, brushing her teeth etc.

-Look for any more complications related to the aetiological factor.

References:

Introduction to Clinical Gynaecology and Obstetrics for Undergraduates. Compiled by Dr WDN De Alwis, Dr  .R Gnansekeram, Dr .N.Gunawansa. Edited by Dr C. Randeniya MBBS, MS, FRCOG. Senior Lecturer, Dept. of Obstetrics and Gynaecology, Faculty of Medicine, Colombo. Honorary Consultant, De Soysa Hospital for Women and the National Hospital of Sri Lanka.

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