Supporting examination :

a). Gynecological examination

Careful gynecological examination is needed. In regular and correct use of contraception,
a speculum examination should be performed if there are complaints of permanent
bleeding, or changes in bleeding after at least 3 months of contraceptive use are not
successful with medical therapy, or if cervical cancer screening has not been done. Use of
correct and consistent contraception, in addition to speculum examination, bimanual
examination must be carried out if bleeding complaints are accompanied by other
symptoms (such as pain, dyspareunia or severe bleeding).
b). PAP smear
The possibility of uterine myoma, polyps, endometrial hyperplasia or malignancy should
be excluded.
c). USG
Pelvic USG, both abdominal (suprapubic) and transvaginal, Doppler ultrasonography
provides additional information that is useful for identifying abnormalities of the
endometrium and myometrium. Hysteroscopy or hysterosonography can be used as a
second-line procedure if an ultrasound examination shows an intrauterine abnormality or
if medical treatment fails after 3-6 months. In patients with risk factors for endometrial
cancer should be combined with a directed biopsy.