This sheet explains the common examinations used if you are experiencing abnormal vaginal bleeding. If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor.

In most cases it will be possible for a friend or relative to accompany you for all or part of the procedure. Please ask your nurse or doctor.

What is abnormal vaginal bleeding?

Vaginal bleeding may be considered abnormal when:

  • Your periods stopped over a year ago.
  • You are bleeding in-between periods.
  • You experience bleeding after having sex.

Investigations for abnormal vaginal bleeding include:

  • Ultrasound.
  • Hysteroscopy and biopsy.
  • MRI (Magnetic Resonance Imaging).
  • Blood tests.

How are these investigations carried out?

If you require any of the above investigations, you will be given clear instructions regarding where and when these will take place. You may need to visit the hospital for these tests in quite a short timeframe to get your diagnosis as soon as possible.

Ultrasound

You may be asked to have a transvaginal ultrasound so the doctor can look more closely inside your body at your pelvic organs (the area between your stomach and your legs). This involves a small probe being placed into your vagina to enable the doctor to see your womb and ovaries on the screen. The scan is not painful and doesn’t take very long. If a transvaginal ultrasound is not possible, your lower abdomen (stomach) will be scanned instead. Clear gel will be applied first to help the probe slide across your skin more easily. This is not painful, but you may feel some pressure as you will need to have a full bladder.

Hysteroscopy and biopsy

A hysteroscopy is an examination of the inside of the uterus (womb) using a fine telescope. At the same time a small sample of the womb lining will be taken and sent away for analysis. This is a straightforward procedure taking about 20 minutes, which can be done during an out-patient appointment, or as a surgical procedure under a general anaesthetic.

Your doctor will discuss with you which is the best option for you. In either case, you will normally be able to return home the same day. You will need a friend or family member to accompany you.

If the doctor is unable to view your womb due to narrowing in the cervix, an MRI scan will be arranged instead.

MRI (Magnetic Resonance Imaging) scan

You may be asked to have an MRI of your pelvis, in which case, you may need to fast for two hours before this scan. You will also need to have a blood test to check your kidney function.

This is because you will be given a small injection of some dye, which will show your pelvic organs up clearly, and we need to ensure your kidneys can remove the dye from your body afterwards. You will be inside the MRI scanner for about 30 minutes. It is quite noisy, and you will be given headphones and a buzzer so you can speak to the radiographer throughout.

The images will help your doctor diagnose the cause of your symptoms and develop the best treatment plan for you.

Blood tests

Blood tests (apart from the one required for the MRI, above) are sometimes required to give your doctor more information.

After your investigations

Once all the investigations are complete, your results will be reviewed and discussed by a multi-disciplinary team of doctors and nurses involved in your care. You will find out the results either by letter or at a follow up appointment.