Abnormal Bleeding Evaluation — Finding the Cause, Not Just Managing the Symptom
Abnormal uterine bleeding — whether heavy, irregular, prolonged, postmenopausal, or occurring between periods — always has an identifiable cause. At Lapeer Women’s Health, Dr. Andrei performs a structured diagnostic evaluation to find that cause before recommending any treatment. Managing bleeding without a diagnosis produces temporary relief at best and delays appropriate care at worst.
The abnormal bleeding evaluation is not a single test. It is a clinical process — beginning with a thorough history and physical exam, followed by targeted imaging, laboratory testing, and in-office procedural evaluation when indicated. Every step is coordinated by Dr. Andrei at the Lapeer or Rochester Hills office. You do not navigate between multiple providers to piece together your results.
Most causes of abnormal uterine bleeding are highly treatable once identified. The evaluation visit is where that process begins.
Components of the Abnormal Bleeding Evaluation
The evaluation is tailored to your age, bleeding pattern, and clinical picture. These are the core components Dr. Andrei uses to identify the cause of abnormal uterine bleeding.
Detailed menstrual history
Cycle length, flow volume, clotting, spotting patterns, duration of symptoms, and prior evaluations reviewed in full. The history guides which diagnostic steps are most likely to yield answers.
Pelvic examination
Speculum and bimanual exam to assess cervical appearance, uterine size and contour, adnexal structures, and any identifiable source of visible bleeding on the cervix or vaginal walls.
Transvaginal ultrasound
Endometrial stripe measurement, uterine cavity assessment for fibroids and polyps, and ovarian evaluation. Ordered at the same visit when indicated — results reviewed with you immediately.
Endometrial biopsy
In-office tissue sampling of the uterine lining to evaluate for endometrial hyperplasia, cancer, or hormonal changes. Performed when indicated by age, bleeding pattern, or ultrasound findings. Pathology results in 1–2 weeks.
Hormonal and metabolic lab panel
Targeted bloodwork to assess thyroid function, prolactin, FSH, estradiol, and coagulation when clinically indicated. Identifies hormonal contributors to bleeding irregularity that imaging cannot detect.
Hysteroscopy when needed
If ultrasound suggests an intrauterine abnormality requiring direct visualization, in-office hysteroscopy allows Dr. Andrei to examine the uterine cavity directly and remove polyps or take targeted biopsies at the same visit.
Bleeding Patterns That Require Workup
Any bleeding pattern that falls outside your normal should be evaluated — not monitored indefinitely. These are the presentations Dr. Andrei sees most frequently in the abnormal bleeding evaluation.
- Soaking through a pad or tampon every 1–2 hours for multiple consecutive hours
- Periods lasting longer than 7 days consistently
- Bleeding or spotting between menstrual periods
- Bleeding after sexual intercourse on more than one occasion
- Any vaginal bleeding 12 or more months after your last menstrual period
- Periods that have become progressively heavier or more irregular over 3–6 months
“Abnormal bleeding is one of the most common reasons women see a gynecologist — and one of the most under-evaluated. Every bleeding pattern has an explanation. My goal is to find it, explain it clearly, and offer a treatment plan that actually addresses the cause.”
- Postmenopausal bleeding is never normal — always requires prompt evaluation
- Heavy bleeding causing fatigue, dizziness, or iron-deficiency anemia warrants urgent workup
- New onset of irregular bleeding after years of regular cycles requires investigation
- Bleeding pattern changes after starting a new medication should be reported
- If a prior evaluation did not produce a clear answer, a second evaluation at LWH is appropriate
Questions About the Abnormal Bleeding Evaluation
Abnormal Bleeding Deserves
a Real Diagnosis.
Heavy, irregular, or postmenopausal bleeding always has a cause. Dr. Andrei performs structured in-office bleeding evaluations at both the Lapeer and Rochester Hills offices — history, exam, ultrasound, biopsy, and labs coordinated in one place.
The information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.