Diagnostic Quality of the Laboratory Work-up for Menstrual Disorders: Hormonal Timing, Appropriateness of Prescriptions, Reclassification and Clinico-therapeutic Impact — A Real-world, Prospective, Observational, Multicentre Study in 2,000 Women Aged 10 to 45 years

Abstract

Menstrual disorders are common in adolescents and women of reproductive age. Laboratory diagnostic value depends on clinical context, age, hormonal status, sampling timing and interpretation. This study evaluated laboratory work-up quality and its diagnostic and therapeutic impact. A prospective multicentre observational study was conducted from January 2024 to June 2026 in five healthcare facilities in eastern Algeria. Women aged 10–45 years presenting with menstrual disorders were included. Clinical, ultrasound and laboratory data were collected prospectively. Test appropriateness was assessed according to indication, timing, interpretation and clinical contribution. Multivariable and multilevel analyses were performed. Among 2,000 participants, 1,894 (94.7%) underwent laboratory testing. Biological abnormalities were identified in 56.3%, but only 37.4% were clinically contributive. Inappropriate prescription or interpretation occurred in 21.9%, while clinico-biological discordance occurred in 20.3%. Hormonal timing was appropriate in 58.4% of evaluable cases. An unfavourable DLQC was observed in 36.9%. Diagnostic reclassification occurred in 10.5% and therapeutic changes in 26.1%. Adolescent age, extensive testing and inadequate cycle-timing documentation were the main factors associated with poorer diagnostic quality. Laboratory quality in menstrual disorders depends primarily on clinical relevance, appropriate timing and contextual interpretation, rather than test volume. An age-adapted diagnostic-stewardship strategy may reduce low-value testing, inappropriate diagnoses and diagnostic delays while improving clinical decision-making.