What is the FIRST step in the evaluation of abnormal uterine bleeding?

• A. Transvaginal ultrasound
• B. A thorough history and physical examination
• C. Endometrial biopsy
• D. Hormonal assays

Answer: (B)

The first step in the evaluation of abnormal uterine bleeding is taking a thorough history and conducting a physical examination. This step is crucial as it helps to establish the context of the bleeding, including the patient’s menstrual history, any associated symptoms, and potential risk factors. The history can elucidate patterns such as the duration, volume, and timing of the bleeding, which can hint at various underlying conditions.

During the physical examination, clinicians can gather additional information that might point to causes of the bleeding, such as signs of hormonal imbalance or anatomical issues. This foundational understanding is essential before proceeding with further diagnostic procedures like transvaginal ultrasound, endometrial biopsy, or hormonal assays. These subsequent tests are typically guided by the information obtained during the history and physical examination, making the initial assessment indispensable for appropriate management.