Gynaecological symptoms can arise from different parts of the female reproductive system and may have several possible causes. Abnormal bleeding, pelvic pain, menstrual changes or difficulty conceiving, for example, cannot always be assessed from symptoms alone.
Diagnostic testing can provide information about the uterus, ovaries, cervix, hormone function and other aspects of reproductive health. However, there is no single test that is appropriate for every gynaecological concern.
The investigations considered will usually depend on a woman’s symptoms, medical history, age, reproductive plans and findings during the initial clinical assessment.
Why Might a Gynaecologist Recommend Diagnostic Tests?
A gynaecologist usually begins by discussing the patient’s symptoms and medical history before deciding whether investigations are required.
Information such as menstrual patterns, previous pregnancies, contraception, medications, family history and the duration of symptoms may help determine which tests are relevant.
Testing may be considered when investigating concerns such as:
- Heavy or irregular menstrual bleeding
- Absent periods
- Pelvic pain
- Painful menstruation
- Bleeding between periods
- Bleeding after sexual intercourse
- Symptoms associated with menopause
- Difficulty conceiving
- Suspected fibroids
- Suspected ovarian cysts
- Possible endometriosis
- Abnormal cervical screening results
- Other reproductive or pelvic symptoms
A physical or pelvic examination may also provide information that guides the selection of subsequent tests.
Patients visiting a gynaecology clinic should therefore expect investigations to be selected according to their individual clinical circumstances rather than receiving the same set of tests at every consultation.
Screening and Diagnostic Tests Are Not the Same
Screening is generally offered to eligible people who may not have symptoms. Its purpose is to identify individuals who may require further assessment.
Diagnostic testing, by comparison, is usually performed when symptoms, examination findings or screening results suggest that a particular condition needs investigation.
Cervical cancer screening is an example.
In Singapore, cervical screening recommendations depend partly on age. A Pap test is used for eligible women aged 25 to 29, while HPV testing is used for eligible women aged 30 and above.
An abnormal screening result does not automatically mean that cervical cancer is present. Further assessment, such as colposcopy and sometimes biopsy, may be recommended to examine the cervix and investigate abnormal findings.
Understanding this distinction can help patients know why an additional test may be requested after a screening result.
Pelvic Examination
A pelvic examination is one of the clinical assessments that may form part of a gynaecological consultation.
Depending on the symptoms being investigated, it may involve examination of the external genital area and a speculum examination of the vagina and cervix.
A bimanual examination may also be performed. During this assessment, the doctor examines the pelvic organs using one hand on the abdomen while assessing internally with the other.
A pelvic examination may help identify tenderness, changes in the cervix, vaginal abnormalities or findings that require further investigation.
It does not necessarily provide a diagnosis by itself. Ultrasound, laboratory tests or other investigations may still be required.
Pelvic Ultrasound
Pelvic ultrasound is frequently used when evaluating the uterus and ovaries.
It uses sound waves to produce images of structures within the pelvis and may assist in the assessment of conditions such as:
- Uterine fibroids
- Ovarian cysts
- Adenomyosis
- Endometrial polyps
- Pelvic masses
- Certain causes of abnormal uterine bleeding
- Reproductive concerns
There are two main approaches to pelvic ultrasound.
Transabdominal Ultrasound
A transabdominal scan is performed by moving the ultrasound probe over the lower abdomen.
Patients may be asked to have a full bladder because this can assist visualisation of the pelvic organs.
Transvaginal Ultrasound
A transvaginal scan uses a narrow ultrasound probe inserted into the vagina.
Because the probe is positioned closer to the reproductive organs, it can provide detailed images of the uterus and ovaries in suitable patients.
The approach selected will depend on the patient’s circumstances and the clinical information required.
Pregnancy Testing
Pregnancy testing can be relevant even when the main concern appears to be gynaecological rather than obstetric.
For example, pregnancy is one possible reason for a missed menstrual period.
A urine or blood test can detect human chorionic gonadotropin, commonly known as hCG, which is produced during pregnancy.
Establishing whether pregnancy is present can influence which investigations, medications or treatments are appropriate.
Pregnancy testing may therefore form part of the assessment of absent periods, unusual bleeding, pelvic pain or other symptoms where pregnancy is clinically possible.
Blood Tests and Hormone Testing
Blood tests can provide information that cannot be obtained through examination or imaging alone.
The particular tests ordered depend on the condition being investigated.
Blood Count
A full blood count may be considered when a patient has heavy or prolonged menstrual bleeding.
This can help assess for anaemia, which may develop when blood loss is substantial or persistent.
Hormone Tests
Hormone testing may be considered when investigating menstrual irregularities, absent periods, ovulation problems or other symptoms suggesting a hormonal cause.
Depending on the clinical situation, tests may include:
- Follicle-stimulating hormone
- Luteinising hormone
- Oestradiol
- Prolactin
- Testosterone
- Thyroid function tests
The timing and selection of these tests can depend on the patient’s symptoms and menstrual cycle.
Hormone tests should therefore be interpreted together with medical history, examination findings and other investigations rather than considered in isolation.
Cervical Screening: Pap and HPV Tests
Cervical screening differs from tests ordered because a patient has symptoms.
Both Pap and HPV testing involve collecting cells from the cervix using a small brush after a speculum is gently inserted into the vagina.
Pap Test
A Pap test examines cervical cells for abnormal changes.
Under current Singapore screening recommendations, Pap testing is used for eligible women aged 25 to 29 who have had sexual activity.
HPV Test
An HPV test detects types of human papillomavirus associated with an increased risk of cervical cancer.
For eligible women aged 30 and above who have had sexual activity, HPV testing is used for cervical cancer screening in Singapore.
Screening results need to be interpreted according to the type of test performed. An abnormal Pap test or detection of a high-risk HPV type does not by itself establish a diagnosis of cervical cancer.
Depending on the findings, additional assessment may be recommended.
Colposcopy
Colposcopy is an examination of the cervix that may be recommended following certain abnormal cervical screening results.
A colposcope is a magnifying instrument that allows the doctor to examine the cervix closely. The instrument remains outside the body while the cervix is viewed through a speculum.
A solution may be applied to the cervix to make abnormal areas easier to identify.
If an area requires further assessment, a small tissue sample may be taken for laboratory examination.
Cervical Biopsy
A biopsy involves removing a small sample of tissue so that it can be examined under a microscope.
Unlike cervical screening, which identifies whether further assessment may be needed, a biopsy provides tissue that can be evaluated for abnormal cellular changes.
Whether a biopsy is required depends on the colposcopy findings and the patient’s previous screening results.
Hysteroscopy
Hysteroscopy allows the doctor to look directly inside the uterine cavity.
A narrow instrument with a camera, known as a hysteroscope, is passed through the vagina and cervix into the uterus.
Diagnostic hysteroscopy may be considered when investigating conditions such as:
- Abnormal uterine bleeding
- Endometrial polyps
- Certain fibroids
- Abnormalities within the uterine cavity
- Selected fertility concerns
Hysteroscopy may also allow tissue to be sampled when necessary.
In some situations, a hysteroscopic procedure can be used to assess and treat an abnormality during the same care pathway, depending on the condition involved and planned procedure.
Endometrial Sampling and Biopsy
The endometrium is the tissue lining the inside of the uterus.
An endometrial sample may be obtained when the doctor needs to assess this tissue, particularly in selected cases of abnormal uterine bleeding.
The sample is sent for laboratory examination so that changes in the endometrial tissue can be evaluated.
Whether endometrial sampling is appropriate depends on factors such as:
- Age
- Pattern of bleeding
- Medical history
- Menopausal status
- Other clinical findings
It is not routinely required for every patient experiencing menstrual changes.
Hysterosalpingography
Hysterosalpingography, commonly abbreviated as HSG, is an imaging test used mainly when assessing the uterus and fallopian tubes.
During the procedure, contrast material is introduced through the cervix, followed by X-ray imaging.
The test can provide information about whether the fallopian tubes appear open and may also identify certain abnormalities involving the uterine cavity.
HSG can therefore form part of fertility assessment in selected patients where tubal patency needs to be evaluated.
Not every patient experiencing difficulty conceiving requires this test. Fertility investigations are selected according to the couple’s reproductive history and other clinical findings.
Tests Used When Assessing Ovarian Cysts
Pelvic ultrasound is commonly used when an ovarian cyst is suspected or has already been identified.
The ultrasound can provide information about the cyst’s size, appearance and internal characteristics.
In selected cases where the findings raise concern, a doctor may also request blood testing such as CA125.
CA125 should not be interpreted as a stand-alone test for ovarian cancer. Levels can also be raised in non-cancerous conditions, including endometriosis and fibroids.
The result therefore needs to be considered alongside ultrasound findings, symptoms, age and other clinical information.
CT and MRI Scans
Ultrasound is often used initially for many gynaecological conditions, but CT or MRI may sometimes be required when additional anatomical information is needed.
Magnetic Resonance Imaging
MRI can provide detailed images of pelvic structures and may be considered when characterising certain uterine, ovarian or pelvic abnormalities.
Computed Tomography
CT imaging may be used in selected circumstances where assessment beyond routine ultrasound is required.
These scans are not automatically needed for every gynaecological condition. The doctor will consider whether the additional information is likely to influence diagnosis or management.
Do You Need Every Gynaecological Test?
The purpose of diagnostic testing is not to perform as many investigations as possible. Each test should address a clinical question.
- Irregular or absent periods may lead to pregnancy testing, hormone tests and pelvic ultrasound.
- Heavy menstrual bleeding may involve blood tests, ultrasound or further evaluation of the uterine cavity.
- Suspected ovarian cysts are commonly assessed with ultrasound, with additional investigations considered according to the findings.
- An abnormal cervical screening result may require colposcopy and possibly biopsy.
- Difficulty conceiving may involve ovulation assessment, pelvic imaging and assessment of the fallopian tubes, alongside evaluation of the male partner.
- A suspected abnormality within the uterus may warrant ultrasound or hysteroscopy.
A gynaecologist in Singapore may therefore select different investigations for two patients who initially report similar symptoms.
What Should You Ask Before a Gynaecological Test?
Patients may find it useful to understand why an investigation has been recommended before undergoing it.
Questions can include:
- What is the test assessing?
- Why is this test relevant to my symptoms?
- Is any preparation required?
- Will the test involve an internal examination?
- Is discomfort expected?
- How long will the test take?
- When will the results be available?
- What could happen if the result is abnormal?
- Will another investigation be required?
What Happens After the Test Results Are Available?
A test result should generally be interpreted in the context of the original symptoms and other clinical findings.
A normal result may help rule out certain conditions but may not always explain persistent symptoms. Conversely, an abnormal finding does not automatically indicate that treatment is required.
Depending on the result, the next step may involve:
- No further investigation
- Monitoring
- Repeat testing
- An additional diagnostic test
- Medication
- A procedure
- Referral for another area of specialist care
For women seeking gynaecology in Singapore, discussing what the result means for their particular circumstances is an important part of the diagnostic process.
Diagnostic tests in gynaecology serve different purposes. Ultrasound can provide images of the uterus and ovaries, blood tests can assess selected hormonal or general health factors, and procedures such as colposcopy or hysteroscopy allow particular areas of the reproductive system to be examined directly.
The appropriate investigation depends on the clinical concern rather than on a standard set of tests. Understanding why a test has been recommended, what it assesses and how the result may influence subsequent care can help women take an informed role in decisions about their gynaecological health.
Frequently Asked Questions
What is the common test for checking the uterus and ovaries?
Pelvic ultrasound is frequently used to examine the uterus and ovaries. Depending on the circumstances, it may be performed through the abdomen or using a transvaginal probe.
Is a Pap test a diagnostic test?
A Pap test is primarily a cervical cancer screening test. If abnormal cervical cells are detected, further assessment such as colposcopy or biopsy may be recommended.
What tests may be used for irregular periods?
The investigations depend on the patient’s history and symptoms. They may include a pregnancy test, hormone blood tests and pelvic ultrasound.
Can a blood test diagnose an ovarian cyst?
An ovarian cyst is generally characterised using ultrasound. Selected blood tests may provide additional information in particular circumstances, but they are interpreted alongside the ultrasound and other clinical findings.
Is hysteroscopy the same as an ultrasound?
No. Ultrasound uses sound waves to produce images of the pelvic organs. Hysteroscopy involves passing a small camera through the cervix to examine the inside of the uterus directly.
This article is for general information only and should not replace medical advice from a qualified healthcare professional.
