Endometrial biopsy confirms diagnosis REF: Novak's gynecology 13' edition - page 152 Causes of mennorhagia in adoloscese Anovulatory bleeding Pregnancy-related Bleeding Exogenous Hormones Hematologic Abnormalities Infections Anatomic Causes Obstructive or paially obstructive genital anomalies typically present during adolescence. mUllerian abnormalities, such as obstructing longitudinal vaginal septa or uterus didelphisolycystic ovarian syndrome Diagnosis Any adolescent with abnormal bleeding should undergo sensitive pregnancy testing, regardless of whether she states that she has had intercourse. Laboratory Testing In addition to a pregnancy test, laboratory testing should include a complete blood count with platelets, coagulation studies, and bleeding time. Thyroid studies also may be appropriate. A complete pelvic examination is appropriate if the patient has been sexually active, is having severe pain, or an anomaly is suspected. Cultures for gonorrhea and testing for chlamydia infection are appropriate if the patient has been sexually active. Some young teens who have a history that is classic for anovulation, who deny sexual activity, and who agree to return for follow-up evaluation may be managed with a limited gynecologic examination and pelvic ultrasonography Imaging Studies If the pregnancy test is positive, pelvic imaging using ultrasonography may be necessary to confirm a ble intrauterine pregnancy and rule out a spontaneous aboion or ectopic pregnancy. If a pelvic mass is suspected on examination, or if the examination is inadequate (more likely to be the case in an adolescent than an older woman) and additional information is required, pelvic ultrasonography may be helpful Management Management of bleeding abnormalities related to pregnancy, thyroid dysfunction, hepatic abnormalities, hematologic abnormalities, or androgen excess syndromes should be directed to treating the underlying condition. Oral contraceptives can be extremely helpful in managing androgen excess syndromes. After specific diagnoses have been ruled out by appropriate laboratory testing, anovulation or dysfunctional bleeding becomes the diagnosis of exclusion.