Dysfunctional uterine bleeding differential diagnosis

Dysfunctional uterine bleeding Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Dysfunctional uterine bleeding from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Dysfunctional uterine bleeding differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Dysfunctional uterine bleeding differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Dysfunctional uterine bleeding differential diagnosis
CDC on Dysfunctional uterine bleeding differential diagnosis
Dysfunctional uterine bleeding differential diagnosis in the news
Blogs on Dysfunctional uterine bleeding differential diagnosis
Directions to Hospitals Treating Dysfunctional uterine bleeding
Risk calculators and risk factors for Dysfunctional uterine bleeding differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S ,Vishnu Vardhan Serla M.B.B.S. [2]

Overview

There are many differential diagnosis' for dysfunctional uterine bleeding, many of them resulting in abnormal presentation of bleeding. Some prevalent conditions include anatomical or structural defects, coagulation disorders, pregnancy related complications, endometrial cancer and hyperplasia, as well as Polycystic Ovarian Syndrome.

Differential Diagnosis

Differential diagnosis' for dysfunctional uterine bleeding include anatomical defects, coagulation disorders, pregnancy complications, and endometrial conditions such as malignancy and PCOS.

Differential Diagnosis

Condition	Common Underlying Causes	Workup
Anatomic or structural lesions	Uterine or cervical polyps Uterine leiomyoma Foreign body	Pelvic or transvaginal Ultrasonography
Coagulation disorders	Clotting factor disorder: Hemophilia, hepatic disease, anticoagulant use, renal disease, Von Willebrand's Disease Platelet dysfunction: Leukemia, Thrombocytopenia, and related medications	Coagulation studies; PT, aPTT, Bleeding Time, and clotting factor studies
Pregnancy complications	Placental abruption Ectopic Pregnancy Miscarriage Spontaneous abortion Placenta previa	B-hCG should be the first test to detect the presence of pregnancy. Visualization of the defect requires pelvic or transvaginal ultrasonography
Endometrial cancer	Risk factors include: Diabetes Mellitus Unopposed estrogen Obesity Older age Chronic anovulation Hypertension	Upon transvaginal ultrasonography, endometrial cancer will present as a thicked endometrial strip. Confirmation requires an endometrial biopsy.
Endometrial hyperplasia	Exogenous estrogen Excess of endogenous estrogen DUB (dysfunctional uterine bleeding) is a diagnosis of exclusion	Endometrial hyperplasia related changes may be seen on ultrasonography. Obtaining a detailed history of medication use may be of assistance in coming to a diagnosis.
Polycystic Ovarian Syndrome (Stein Leventhal Syndrome)	Risk factors include: Type 1 diabetes Type 2 diabetes Obesity Hereditary factors	PCOS may initially be suspected upon physical examination, commonly presenting with hirsutism and weight gain. Confirmation requires FSH/LH level abnormalities as well as multiple ovarian cysts seen on ultrasonography.

Other Causes

Apart from common diseases, there are some other causes that may be potential differential diagnosis'. These include:

• Endometrioma
• Hyperprolactinemia
• Hypo- or Hyperthyroidism
• Hypothalamic lesion
• Medications (e.g., Norepinephrine)
• Nonuterine bleeding

  • Rectal
  • Urinary
  • Vaginal
  • Cervical

• Pelvic infection
• Anorexia Nervosa, Nutritional status (Very low caloric intake) & intense exercise
• Immature hypothalamic-pituitary-ovarian axis
• Peri-menopause
• Psychological distress