Abnormal uterine bleeding: Difference between revisions

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__NOTOC__
__NOTOC__


{{CMG}}; {{FK}}
{{CMG}}; {{Nnasiri}}{{FK}}


==Causes==
==Causes==
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{{CMG}} {{AE}} {{Nnasiri}}  
{{CMG}} {{AE}} {{Nnasiri}}  
==Overview==
==Overview==
Abnormal uterine bleeding is defined as any alteration in the amount of [[menstrual]] blood flow or duration of [[menstruation]]. Women can experience heavy menstrual bleeding or irregular menstrual bleeding or combination of both. Normal menstruation occurs every 21 to 35 days and lasts 3 to 7 days.The diagnosis and evaluation of abnormal uterine bleeding is based on patient's assessment of her blood loss and its impact on her health status. There are structural and non-structural causes of abnormal uterine bleeding. Causes of abnormal uterine bleeding can be [[cervical cancer]], cervical [[leiomyoma]], [[polyps]], [[coagulation disorders]].


==Abnormal uterine bleeding differential diagnosis==
==Abnormal uterine bleeding differential diagnosis==
* Abnormal uterine bleeding differential diagnosis include:<ref name="MunroCritchley20112">{{cite journal|last1=Munro|first1=Malcolm G.|last2=Critchley|first2=Hilary O.D.|last3=Broder|first3=Michael S.|last4=Fraser|first4=Ian S.|title=FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age|journal=International Journal of Gynecology & Obstetrics|volume=113|issue=1|year=2011|pages=3–13|issn=00207292|doi=10.1016/j.ijgo.2010.11.011}}</ref>
* Abnormal uterine bleeding differential diagnosis include:<ref name="MunroCritchley20112">{{cite journal|last1=Munro|first1=Malcolm G.|last2=Critchley|first2=Hilary O.D.|last3=Broder|first3=Michael S.|last4=Fraser|first4=Ian S.|title=FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age|journal=International Journal of Gynecology & Obstetrics|volume=113|issue=1|year=2011|pages=3–13|issn=00207292|doi=10.1016/j.ijgo.2010.11.011}}</ref><ref name="MattesonBoardman2009">{{cite journal|last1=Matteson|first1=Kristen A.|last2=Boardman|first2=Lori A.|last3=Munro|first3=Malcolm G.|last4=Clark|first4=Melissa A.|title=Abnormal uterine bleeding: a review of patient-based outcome measures|journal=Fertility and Sterility|volume=92|issue=1|year=2009|pages=205–216|issn=00150282|doi=10.1016/j.fertnstert.2008.04.023}}</ref>
:* Endometrial hyperplasia
:* Endometrial hyperplasia
:* [[Cervical polyp]]
:* [[Cervical polyp]]
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal
vaginal bleeding  
vaginal bleeding  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other Genitourinary/ Gastrointestinal symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other GU/GI symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic
pain
pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Constitutional symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gynecological examinations
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gynecological examinations
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal  
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! style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical cancer<ref name="pmid23336450">{{cite journal |vauthors=Hippisley-Cox J, Coupland C |title=Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm |journal=Br J Gen Pract |volume=63 |issue=606 |pages=e11–21 |date=January 2013 |pmid=23336450 |pmc=3529288 |doi=10.3399/bjgp13X660733 |url=}}</ref><ref name="DunyoEffah2018">{{cite journal|last1=Dunyo|first1=Priscilla|last2=Effah|first2=Kofi|last3=Udofia|first3=Emilia Asuquo|title=Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study|journal=BMC Public Health|volume=18|issue=1|year=2018|issn=1471-2458|doi=10.1186/s12889-018-6065-6}}</ref><ref name="pmid30603660">{{cite journal |vauthors=Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R |title=Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report |journal=Gynecol Oncol Rep |volume=27 |issue= |pages=38–41 |date=February 2019 |pmid=30603660 |pmc=6302027 |doi=10.1016/j.gore.2018.12.006 |url=}}</ref><ref>{{cite journal|doi=10.1097/PAS.0000000000000498.}}</ref><ref name="pmid8828559">{{cite journal |vauthors=Brenner PF |title=Differential diagnosis of abnormal uterine bleeding |journal=Am. J. Obstet. Gynecol. |volume=175 |issue=3 Pt 2 |pages=766–9 |date=September 1996 |pmid=8828559 |doi= |url=}}</ref><ref name="AlcázarArribas2014">{{cite journal|last1=Alcázar|first1=Juan Luis|last2=Arribas|first2=Sara|last3=Mínguez|first3=José Angel|last4=Jurado|first4=Matías|title=The Role of Ultrasound in the Assessment of Uterine Cervical Cancer|journal=The Journal of Obstetrics and Gynecology of India|volume=64|issue=5|year=2014|pages=311–316|issn=0971-9202|doi=10.1007/s13224-014-0622-4}}</ref><ref name="pmid25223869">{{cite journal |vauthors=Qing L, Xiang T, Guofu Z, Weiwei F |title=Leukemoid reaction in cervical cancer: a case report and review of the literature |journal=BMC Cancer |volume=14 |issue= |pages=670 |date=September 2014 |pmid=25223869 |pmc=4174654 |doi=10.1186/1471-2407-14-670 |url=}}</ref><ref name="pmid252238692">{{cite journal |vauthors=Qing L, Xiang T, Guofu Z, Weiwei F |title=Leukemoid reaction in cervical cancer: a case report and review of the literature |journal=BMC Cancer |volume=14 |issue= |pages=670 |date=September 2014 |pmid=25223869 |pmc=4174654 |doi=10.1186/1471-2407-14-670 |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical cancer<ref name="pmid23336450">{{cite journal |vauthors=Hippisley-Cox J, Coupland C |title=Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm |journal=Br J Gen Pract |volume=63 |issue=606 |pages=e11–21 |date=January 2013 |pmid=23336450 |pmc=3529288 |doi=10.3399/bjgp13X660733 |url=}}</ref><ref name="DunyoEffah2018">{{cite journal|last1=Dunyo|first1=Priscilla|last2=Effah|first2=Kofi|last3=Udofia|first3=Emilia Asuquo|title=Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study|journal=BMC Public Health|volume=18|issue=1|year=2018|issn=1471-2458|doi=10.1186/s12889-018-6065-6}}</ref><ref name="pmid30603660">{{cite journal |vauthors=Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R |title=Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report |journal=Gynecol Oncol Rep |volume=27 |issue= |pages=38–41 |date=February 2019 |pmid=30603660 |pmc=6302027 |doi=10.1016/j.gore.2018.12.006 |url=}}</ref><ref>{{cite journal|doi=10.1097/PAS.0000000000000498.}}</ref><ref name="pmid8828559">{{cite journal |vauthors=Brenner PF |title=Differential diagnosis of abnormal uterine bleeding |journal=Am. J. Obstet. Gynecol. |volume=175 |issue=3 Pt 2 |pages=766–9 |date=September 1996 |pmid=8828559 |doi= |url=}}</ref><ref name="AlcázarArribas2014">{{cite journal|last1=Alcázar|first1=Juan Luis|last2=Arribas|first2=Sara|last3=Mínguez|first3=José Angel|last4=Jurado|first4=Matías|title=The Role of Ultrasound in the Assessment of Uterine Cervical Cancer|journal=The Journal of Obstetrics and Gynecology of India|volume=64|issue=5|year=2014|pages=311–316|issn=0971-9202|doi=10.1007/s13224-014-0622-4}}</ref><ref name="pmid25223869">{{cite journal |vauthors=Qing L, Xiang T, Guofu Z, Weiwei F |title=Leukemoid reaction in cervical cancer: a case report and review of the literature |journal=BMC Cancer |volume=14 |issue= |pages=670 |date=September 2014 |pmid=25223869 |pmc=4174654 |doi=10.1186/1471-2407-14-670 |url=}}</ref><ref name="pmid252238692">{{cite journal |vauthors=Qing L, Xiang T, Guofu Z, Weiwei F |title=Leukemoid reaction in cervical cancer: a case report and review of the literature |journal=BMC Cancer |volume=14 |issue= |pages=670 |date=September 2014 |pmid=25223869 |pmc=4174654 |doi=10.1186/1471-2407-14-670 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Postmenopausal  
* [[Postmenopausal]]
* Intermenstrual
* Intermenstrual
* Postcoital  
* Postcoital  
* Bleeding after pelvic exam
* Bleeding after [[pelvic exam]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Dysuria]]
* [[Dysuria]]
* Urinary hesitancy  
* [[Urinary hesitancy]]
* [[Dyspareunia]]
* [[Dyspareunia]]
* [[Vaginal discharge]]
* [[Vaginal discharge]]
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** [[Lymph node]] involvement,
** [[Lymph node]] involvement,
** Metastases to [[bladder]] or [[rectum]]
** Metastases to [[bladder]] or [[rectum]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''[[Cervical intraepithelial neoplasia]]:'''
* CIN1: mild dysplasia
* CIN1: mild [[dysplasia]]


* CIN2: moderate dysplasia
* CIN2: moderate [[dysplasia]]


* CIN3: high degree of [[dysplasia]]/[[metastases]]
* CIN3: high degree of [[dysplasia]]/[[metastases]]
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| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Large,irregular pelvic mass
* Large,irregular [[Pelvic masses|pelvic mass]]
| style="background: #F5F5F5; padding: 5px;" |±
| style="background: #F5F5F5; padding: 5px;" |±
*  
*  
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* Small tumor cells with large nuclei  
* Small tumor cells with large nuclei  
* High [[mitoses]] and proliferation
* High [[mitoses]] and proliferation
* [[Diffuse large B-cell lymphoma|Diffuse large B-Cell lymphoma]] ([[DLBCL]]) most frequent type.
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]  
* [[Biopsy]]  
* [[Diffuse large B-cell lymphoma|diffuse large B-Cell lymphoma]] ([[DLBCL]]) most frequent type.
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical|Cervical sarcoma]]<ref name="pmid16051326">{{cite journal |vauthors=Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK |title=Cervical sarcomas: an analysis of incidence and outcome |journal=Gynecol. Oncol. |volume=99 |issue=2 |pages=348–51 |date=November 2005 |pmid=16051326 |doi=10.1016/j.ygyno.2005.06.021 |url=}}</ref><ref name="KhoslaGupta2012">{{cite journal|last1=Khosla|first1=Divya|last2=Gupta|first2=Ruchi|last3=Srinivasan|first3=Radhika|last4=Patel|first4=Firuza D.|last5=Rajwanshi|first5=Arvind|title=Sarcomas of Uterine Cervix|journal=International Journal of Gynecological Cancer|volume=22|issue=6|year=2012|pages=1026–1030|issn=1048-891X|doi=10.1097/IGC.0b013e31825a97f6}}</ref><ref name="pmid26587944">{{cite journal |vauthors=Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA |title=Imaging Features of Uncommon Gynecologic Cancers |journal=AJR Am J Roentgenol |volume=205 |issue=6 |pages=1346–59 |date=December 2015 |pmid=26587944 |pmc=5502476 |doi=10.2214/AJR.14.12695 |url=}}</ref><ref>{{cite journal|doi=10.1097/IGC.0b013e31825a97f6.}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical|Cervical sarcoma]]<ref name="pmid16051326">{{cite journal |vauthors=Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK |title=Cervical sarcomas: an analysis of incidence and outcome |journal=Gynecol. Oncol. |volume=99 |issue=2 |pages=348–51 |date=November 2005 |pmid=16051326 |doi=10.1016/j.ygyno.2005.06.021 |url=}}</ref><ref name="KhoslaGupta2012">{{cite journal|last1=Khosla|first1=Divya|last2=Gupta|first2=Ruchi|last3=Srinivasan|first3=Radhika|last4=Patel|first4=Firuza D.|last5=Rajwanshi|first5=Arvind|title=Sarcomas of Uterine Cervix|journal=International Journal of Gynecological Cancer|volume=22|issue=6|year=2012|pages=1026–1030|issn=1048-891X|doi=10.1097/IGC.0b013e31825a97f6}}</ref><ref name="pmid26587944">{{cite journal |vauthors=Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA |title=Imaging Features of Uncommon Gynecologic Cancers |journal=AJR Am J Roentgenol |volume=205 |issue=6 |pages=1346–59 |date=December 2015 |pmid=26587944 |pmc=5502476 |doi=10.2214/AJR.14.12695 |url=}}</ref><ref>{{cite journal|doi=10.1097/IGC.0b013e31825a97f6.}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Cervical Cancer|Cervical]] mass
* [[Cervical Cancer|Cervical]] mass
* Lump protruding  from vagina/vulva
* [[Lump]] protruding  from vagina/vulva
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
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| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Red, glandular area around os of cervix
* Red, [[glandular]] area around os of [[cervix]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
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* [[Squamous metaplasia]]
* [[Squamous metaplasia]]


* Vascular ectasia
* [[Vascular ectasia of the colon|Vascular ectasia]]
* [[Lymphocytic]] infiltration
* [[Lymphocytic]] infiltration
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* May have fever only
* May have fever only
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Red,inflammed swollen cervix  
* Red,inflammed swollen [[cervix]]
* Inflammation/irritation of vulva/vagina  
* Inflammation/irritation of vulva/vagina  
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
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* [[Chlamydia]]
* [[Chlamydia]]


* Gonorrhea
* [[Gonorrhea]]
* [[Herpes simplex]]
* [[Herpes simplex]]
* [[Trichomonas vaginalis]]
* [[Trichomonas vaginalis]]
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| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''


May be detected as retention cysts in cervix.
May be detected as retention cysts in [[cervix]].
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Non-specific, [[lymphocytic]] infiltration may be seen in microscopic histology.  
* Non-specific, [[lymphocytic]] infiltration may be seen in [[microscopic]] histology.  


* [[Koilocyte|Koilocytic]] changes in case of [[HPV]] as cause of chronic cervicitis.
* [[Koilocyte|Koilocytic]] changes in case of [[HPV]] as cause of chronic [[cervicitis]].
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] ([[NAAT]]<nowiki/>s)
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] ([[NAAT]]<nowiki/>s)
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* Often normal
* Often normal


* Vaginal lump
* Vaginal [[lump]]
* [[Pelvic masses|Pelvic mass]]
* [[Pelvic masses|Pelvic mass]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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* Simple hyperplasia with [[atypia]]
* Simple hyperplasia with [[atypia]]


* Complex hyperplasia with atypia (glands are highly irregular in size and shape)  
* Complex [[hyperplasia]] with [[atypia]] (glands are highly irregular in size and shape)  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
* [[Biopsy]]
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* Pain during or after sex
* Pain during or after sex
* [[Infertility]]
* [[Infertility]]
* Watery vaginal discharge
* Watery [[vaginal discharge]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Pelvic pain
* [[Pelvic pain]]
* Back pain
* [[Back pain]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* Immobile uterus
* Immobile uterus
* [[Cervical|Cervica]]<nowiki/>l motion tenderness
* [[Cervical|Cervica]]<nowiki/>l motion tenderness
* Retroverted uterus
* Retroverted [[uterus]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
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* [[MRI]] findings is variable, depending upon the sites of [[endometriosis]] such as [[peritoneal]] implants, ovarian [[endometrioma]], pelvic [[endometriosis]].  
* [[MRI]] findings is variable, depending upon the sites of [[endometriosis]] such as [[peritoneal]] implants, ovarian [[endometrioma]], pelvic [[endometriosis]].  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Endometrial]] type glands and stroma presence is charracteristic [[histology]] findings, suggestive for endometriosis.
* [[Endometrial]] type glands and [[stroma]] presence is charracteristic [[histology]] findings, suggestive for endometriosis.


*  
*  
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Pelvic pain
* [[Pelvic pain]]


* [[Cervical motion tenderness]]
* [[Cervical motion tenderness]]
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* Oral temperature >101F
* Oral temperature >101F
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Vaginal/vulvar  tender lesion depending on microbial causes
* Vaginal/vulvar  tender lesion depending on [[microbial]] causes
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |'''STI panel:'''
| style="background: #F5F5F5; padding: 5px;" |'''STI panel:'''
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*  
*  
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* Thickened, fluid-filled tubes with or without free [[pelvic]] or tuboovarian complex
* Thickened, fluid-filled tubes with or without free [[pelvic]] or tubo-ovarian complex
| style="background: #F5F5F5; padding: 5px;" |'''MRI findings:'''
| style="background: #F5F5F5; padding: 5px;" |'''MRI findings:'''
* Inflammation in pelvic soft tissue
* Inflammation in [[pelvic]] soft tissue


* [[Hydrosalpinx]]
* [[Hydrosalpinx]]
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* Clinical diagnosis is gold standard for diagnosing [[PID]]
* Clinical diagnosis is gold standard for diagnosing [[PID]]


* [[Laparoscopy]] is confirmatory in acute salpengitis
* [[Laparoscopy]] is confirmatory in acute [[salpingitis]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenomyosis|Adenemyosis]]<ref name="pmid30486633">{{cite journal |vauthors=Filip G, Balzano A, Cagnacci A |title=Histological evaluation of the prevalence of adenomyosis, myomas and of their concomitance |journal=Minerva Ginecol |volume= |issue= |pages= |date=November 2018 |pmid=30486633 |doi=10.23736/S0026-4784.18.04291-0 |url=}}</ref><ref name="pmid1492806">{{cite journal |vauthors=Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K |title=Acute abdomen due to adenomyosis of the uterus: a case report |journal=Asia Oceania J Obstet Gynaecol |volume=18 |issue=4 |pages=333–7 |date=December 1992 |pmid=1492806 |doi= |url=}}</ref><ref name="pmid14928062">{{cite journal |vauthors=Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K |title=Acute abdomen due to adenomyosis of the uterus: a case report |journal=Asia Oceania J Obstet Gynaecol |volume=18 |issue=4 |pages=333–7 |date=December 1992 |pmid=1492806 |doi= |url=}}</ref><ref name="pmid9275451">{{cite journal |vauthors=Zhou Y, Wu B, Li H |title=[The value of serum CA125 assays in the diagnosis of uterine adenomyosis] |language=Chinese |journal=Zhonghua Fu Chan Ke Za Zhi |volume=31 |issue=10 |pages=590–3 |date=October 1996 |pmid=9275451 |doi= |url=}}</ref><ref name="TamaiTogashi2005">{{cite journal|last1=Tamai|first1=Ken|last2=Togashi|first2=Kaori|last3=Ito|first3=Tsuyoshi|last4=Morisawa|first4=Nobuko|last5=Fujiwara|first5=Toshitaka|last6=Koyama|first6=Takashi|title=MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls|journal=RadioGraphics|volume=25|issue=1|year=2005|pages=21–40|issn=0271-5333|doi=10.1148/rg.251045060}}</ref><ref name="Dartmouth2014">{{cite journal|last1=Dartmouth|first1=Katherine|title=A systematic review with meta-analysis: the common sonographic characteristics of adenomyosis|journal=Ultrasound|volume=22|issue=3|year=2014|pages=148–157|issn=1742-271X|doi=10.1177/1742271X14528837}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenomyosis|Adenemyosis]]<ref name="pmid30486633">{{cite journal |vauthors=Filip G, Balzano A, Cagnacci A |title=Histological evaluation of the prevalence of adenomyosis, myomas and of their concomitance |journal=Minerva Ginecol |volume= |issue= |pages= |date=November 2018 |pmid=30486633 |doi=10.23736/S0026-4784.18.04291-0 |url=}}</ref><ref name="pmid1492806">{{cite journal |vauthors=Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K |title=Acute abdomen due to adenomyosis of the uterus: a case report |journal=Asia Oceania J Obstet Gynaecol |volume=18 |issue=4 |pages=333–7 |date=December 1992 |pmid=1492806 |doi= |url=}}</ref><ref name="pmid14928062">{{cite journal |vauthors=Fujino T, Watanabe T, Shinmura R, Hahn L, Nagata Y, Hasui K |title=Acute abdomen due to adenomyosis of the uterus: a case report |journal=Asia Oceania J Obstet Gynaecol |volume=18 |issue=4 |pages=333–7 |date=December 1992 |pmid=1492806 |doi= |url=}}</ref><ref name="pmid9275451">{{cite journal |vauthors=Zhou Y, Wu B, Li H |title=[The value of serum CA125 assays in the diagnosis of uterine adenomyosis] |language=Chinese |journal=Zhonghua Fu Chan Ke Za Zhi |volume=31 |issue=10 |pages=590–3 |date=October 1996 |pmid=9275451 |doi= |url=}}</ref><ref name="TamaiTogashi2005">{{cite journal|last1=Tamai|first1=Ken|last2=Togashi|first2=Kaori|last3=Ito|first3=Tsuyoshi|last4=Morisawa|first4=Nobuko|last5=Fujiwara|first5=Toshitaka|last6=Koyama|first6=Takashi|title=MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls|journal=RadioGraphics|volume=25|issue=1|year=2005|pages=21–40|issn=0271-5333|doi=10.1148/rg.251045060}}</ref><ref name="Dartmouth2014">{{cite journal|last1=Dartmouth|first1=Katherine|title=A systematic review with meta-analysis: the common sonographic characteristics of adenomyosis|journal=Ultrasound|volume=22|issue=3|year=2014|pages=148–157|issn=1742-271X|doi=10.1177/1742271X14528837}}</ref>
Line 714: Line 715:
* Subendometrial striations
* Subendometrial striations
* Myometrial cysts  
* Myometrial cysts  
* Asymetrical thickness in myometrium walls
* Asymetrical thickness in [[myometrium]] walls
* Heterogenous exhotexture of myometrum  
* Heterogenous echotexture of myometrum  
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
* Thickened junctional zone  
* Thickened junctional zone  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Presence of ectopic endometrial glands into the myometrium.
* Presence of ectopic [[endometrial]] glands into the myometrium.
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Histology]] findings post [[hysterectomy]]
* [[Histology]] findings post [[hysterectomy]]
Line 756: Line 757:
* Postcoital bleeding
* Postcoital bleeding
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Tenesmus
* [[Tenesmus]]
* [[Dysuria]]
* [[Dysuria]]
* Urinary frequency
* [[Urinary frequency]]
* [[Constipation]]
* [[Constipation]]
* Pelvic pain
* [[Pelvic pain]]
* [[Vaginal discharge]]
* [[Vaginal discharge]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
Line 768: Line 769:
* Ill-defined vaginal ulcer
* Ill-defined vaginal ulcer


* Vaginal lump
* Vaginal [[lump]]
* Inguinal [[lymphadenopathy]]
* [[Inguinal]] [[lymphadenopathy]]
* Edema and ulceration of vaginal wall
* [[Edema]] and ulceration of vaginal wall
* Foul-odor blood tinged vaginal discharge
* Foul-odor blood tinged [[vaginal discharge]]
* [[Vaginal prolapse]]
* [[Vaginal prolapse]]
* [[Cystocele]]
* [[Cystocele]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* In case of metastases to internal organs
* In case of [[metastases]] to internal organs
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Pap smear]] can be normal
* [[Pap smear]] can be normal
Line 783: Line 784:
* ↓ [[RBC]] count
* ↓ [[RBC]] count
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* [[Hydronephrosis]] in case of pelvic metastases  
* [[Hydronephrosis]] in case of [[pelvic]] [[metastases]]
* Multiple [[liver]] metastases
* Multiple [[liver]] metastases
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
Line 795: Line 796:
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Paget's disease]] of vulva to cervix<ref name="van der LindenMeeuwis2016">{{cite journal|last1=van der Linden|first1=M.|last2=Meeuwis|first2=K.A.P.|last3=Bulten|first3=J.|last4=Bosse|first4=T.|last5=van Poelgeest|first5=M.I.E.|last6=de Hullu|first6=J.A.|title=Paget disease of the vulva|journal=Critical Reviews in Oncology/Hematology|volume=101|year=2016|pages=60–74|issn=10408428|doi=10.1016/j.critrevonc.2016.03.008}}</ref><ref name="pmid10605411">{{cite journal |vauthors=Lloyd J, Evans DJ, Flanagan AM |title=Extension of extramammary Paget disease of the vulva to the cervix |journal=J. Clin. Pathol. |volume=52 |issue=7 |pages=538–40 |date=July 1999 |pmid=10605411 |pmc=501500 |doi= |url=}}</ref><ref name="pmid19952933">{{cite journal |vauthors=Shaco-Levy R, Bean SM, Vollmer RT, Papalas JA, Bentley RC, Selim MA, Robboy SJ |title=Paget disease of the vulva: a histologic study of 56 cases correlating pathologic features and disease course |journal=Int. J. Gynecol. Pathol. |volume=29 |issue=1 |pages=69–78 |date=January 2010 |pmid=19952933 |doi=10.1097/PGP.0b013e3181b1cc5e |url=}}</ref><ref name="AsmoukiOumouloud2012">{{cite journal|last1=Asmouki|first1=Hamid|last2=Oumouloud|first2=Rachid|last3=Aboulfalah|first3=Abderrahim|last4=Soummani|first4=Abderraouf|last5=Marrat|first5=Abdelouahed|title=Paget’s Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report|journal=Case Reports in Oncological Medicine|volume=2012|year=2012|pages=1–4|issn=2090-6706|doi=10.1155/2012/854827}}</ref><ref name="Gonçalves AmorimBatista Fraga Mendes2015">{{cite journal|last1=Gonçalves Amorim|first1=Andressa|last2=Batista Fraga Mendes|first2=Brunelle|last3=Neves Ferreira|first3=Rodrigo|last4=Chambô Filho|first4=Antônio|title=Paget Disease of the Vulva: Diagnosis by Immunohistochemistry|journal=Case Reports in Dermatological Medicine|volume=2015|year=2015|pages=1–5|issn=2090-6463|doi=10.1155/2015/162483}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Paget's disease]] of vulva to cervix<ref name="van der LindenMeeuwis2016">{{cite journal|last1=van der Linden|first1=M.|last2=Meeuwis|first2=K.A.P.|last3=Bulten|first3=J.|last4=Bosse|first4=T.|last5=van Poelgeest|first5=M.I.E.|last6=de Hullu|first6=J.A.|title=Paget disease of the vulva|journal=Critical Reviews in Oncology/Hematology|volume=101|year=2016|pages=60–74|issn=10408428|doi=10.1016/j.critrevonc.2016.03.008}}</ref><ref name="pmid10605411">{{cite journal |vauthors=Lloyd J, Evans DJ, Flanagan AM |title=Extension of extramammary Paget disease of the vulva to the cervix |journal=J. Clin. Pathol. |volume=52 |issue=7 |pages=538–40 |date=July 1999 |pmid=10605411 |pmc=501500 |doi= |url=}}</ref><ref name="pmid19952933">{{cite journal |vauthors=Shaco-Levy R, Bean SM, Vollmer RT, Papalas JA, Bentley RC, Selim MA, Robboy SJ |title=Paget disease of the vulva: a histologic study of 56 cases correlating pathologic features and disease course |journal=Int. J. Gynecol. Pathol. |volume=29 |issue=1 |pages=69–78 |date=January 2010 |pmid=19952933 |doi=10.1097/PGP.0b013e3181b1cc5e |url=}}</ref><ref name="AsmoukiOumouloud2012">{{cite journal|last1=Asmouki|first1=Hamid|last2=Oumouloud|first2=Rachid|last3=Aboulfalah|first3=Abderrahim|last4=Soummani|first4=Abderraouf|last5=Marrat|first5=Abdelouahed|title=Paget’s Disease of the Vulva in Premenopausal Woman Treated with Only Surgery: A Case Report|journal=Case Reports in Oncological Medicine|volume=2012|year=2012|pages=1–4|issn=2090-6706|doi=10.1155/2012/854827}}</ref><ref name="Gonçalves AmorimBatista Fraga Mendes2015">{{cite journal|last1=Gonçalves Amorim|first1=Andressa|last2=Batista Fraga Mendes|first2=Brunelle|last3=Neves Ferreira|first3=Rodrigo|last4=Chambô Filho|first4=Antônio|title=Paget Disease of the Vulva: Diagnosis by Immunohistochemistry|journal=Case Reports in Dermatological Medicine|volume=2015|year=2015|pages=1–5|issn=2090-6463|doi=10.1155/2015/162483}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Bleeding from lesion
* Bleeding/oozing from lesion
* Oozing
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* ±Vaginal discharge
* ± [[Vaginal discharge]]


* Pain in vulva
* Pain in vulva
Line 809: Line 809:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Scaly eczematoid lesion in vulva.
* Scaly eczematoid lesion in vulva.
* Erythematous plaques with white scaling.
* [[Erythematous]] plaques with white scaling.
* [[Inguinal]] lymphadenopathy in case of metastases.
* [[Inguinal]] [[lymphadenopathy]] in case of metastases.
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
Line 822: Line 822:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Thick vulvar skin
* Thick vulvar skin
* "Cake-icing effect", pathognomic for vulvar paget's disease
* "Cake-icing effect", pathognomic for vulvar [[paget's disease]]


* Intraepidermal [[adenocarcinoma]] which involves epidermis  
* Intraepidermal [[adenocarcinoma]] which involves [[epidermis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]] of lesion
* [[Biopsy]] of lesion
Line 835: Line 835:
* [[Vaginal discharge]]
* [[Vaginal discharge]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* In very rare cases depending upon the size of cyst it can cause abdominal pain and amenorhea
* In very rare cases depending upon the size of cyst it can cause [[abdominal pain]] and [[amenorrhea]]
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Majority of them are asymptomatic due to their small size( few milimeters)  
* Majority of them are asymptomatic due to their small size (few milimeters)  


* [[Cystic]] mass on exam
* [[Cystic]] mass on exam
Line 861: Line 861:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Painful menstruation
* Painful menstruation
* ±Vaginal discharge
* ± [[Vaginal discharge]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
* In cases of uterine rupture and far migration of IUD, it can cause adhesion, bowel obstruction, perforation.
* In cases of uterine rupture and far migration of [[IUD]], it can cause [[adhesion]], [[bowel obstruction]], [[perforation]].
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |−
| style="background: #F5F5F5; padding: 5px;" |−
Line 913: Line 913:
* ↓ [[RBC]]  
* ↓ [[RBC]]  
| colspan="3" style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
| colspan="3" style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* ‘Sliding sign’ on transvaginal ultrasound
* ‘Sliding sign’ on [[transvaginal ultrasound]]
* [[Embryo]] with increase in crown-rump length without visible embryo heart activity  
* [[Embryo]] with increase in crown-rump length without visible embryo heart activity  
* Absence of [[embryo]] heart activity
* Absence of [[embryo]] heart activity
Line 928: Line 928:
* Pelvic/back pain
* Pelvic/back pain
* [[Abdominal]] pain
* [[Abdominal]] pain
* Vaginal bleeding
* [[Vaginal bleeding]]
* Painful uterine contractions
* Painful [[uterine]] contractions
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Uterine]] tenderness
* [[Uterine]] tenderness
Line 956: Line 956:
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Placenta previa]]<ref name="pmid30688129">{{cite journal |vauthors=Alouini S, Megier P, Fauconnier A, Huchon C, Fievet A, Ramos A, Megier C, Valéry A |title=Diagnosis and management of placenta previa and low placental implantation |journal=J. Matern. Fetal. Neonatal. Med. |volume= |issue= |pages=1–6 |date=January 2019 |pmid=30688129 |doi=10.1080/14767058.2019.1570118 |url=}}</ref><ref name="pmid27751423">{{cite journal |vauthors=Kawabe A, Wang L, Kikugawa A, Shibata Y, Kuromaki K, Takagi A |title=Severe abdominal pain exacerbated by fetal movement is an early sign of the onset of uterine rupture |journal=Taiwan J Obstet Gynecol |volume=55 |issue=5 |pages=721–723 |date=October 2016 |pmid=27751423 |doi=10.1016/j.tjog.2015.12.021 |url=}}</ref><ref name="pmid10078576">{{cite journal |vauthors=Biswas R, Sawhney H, Dass R, Saran RK, Vasishta K |title=Histopathological study of placental bed biopsy in placenta previa |journal=Acta Obstet Gynecol Scand |volume=78 |issue=3 |pages=173–9 |date=March 1999 |pmid=10078576 |doi= |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Placenta previa]]<ref name="pmid30688129">{{cite journal |vauthors=Alouini S, Megier P, Fauconnier A, Huchon C, Fievet A, Ramos A, Megier C, Valéry A |title=Diagnosis and management of placenta previa and low placental implantation |journal=J. Matern. Fetal. Neonatal. Med. |volume= |issue= |pages=1–6 |date=January 2019 |pmid=30688129 |doi=10.1080/14767058.2019.1570118 |url=}}</ref><ref name="pmid27751423">{{cite journal |vauthors=Kawabe A, Wang L, Kikugawa A, Shibata Y, Kuromaki K, Takagi A |title=Severe abdominal pain exacerbated by fetal movement is an early sign of the onset of uterine rupture |journal=Taiwan J Obstet Gynecol |volume=55 |issue=5 |pages=721–723 |date=October 2016 |pmid=27751423 |doi=10.1016/j.tjog.2015.12.021 |url=}}</ref><ref name="pmid10078576">{{cite journal |vauthors=Biswas R, Sawhney H, Dass R, Saran RK, Vasishta K |title=Histopathological study of placental bed biopsy in placenta previa |journal=Acta Obstet Gynecol Scand |volume=78 |issue=3 |pages=173–9 |date=March 1999 |pmid=10078576 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
* Usually painless vaginal bleeding
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Abdominal pain]]
* [[Abdominal pain]]
Line 995: Line 996:
* Tubal rupture
* Tubal rupture
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Hemorrhage
* [[Hemorrhage]]


* Product of conception in [[fallopian tube]]  
* Product of conception in [[fallopian tube]]  
Line 1,071: Line 1,072:
* Blood in stool
* Blood in stool
* Blood in urine
* Blood in urine
* GI bleeding in rare cases
* [[GI bleeding]] in rare cases
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Bruises on skin
* Bruises on skin
Line 1,091: Line 1,092:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Current gold standard diagnostic testing includes:  
* Current gold standard diagnostic testing includes:  
** [[Von Willebrand factor|VWF]] Activity(via [[Ristocetin]] cofactor)
** [[Von Willebrand factor|VWF]] activity(via [[Ristocetin]] cofactor)
** VWF Antigen  
** [[VWF antigen]]  
** [[Factor VIII]] Activity (FVIII)
** [[Factor VIII]] Activity (FVIII)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Most common inherited [[bleeding disorder]]
* History of bleeding disorder in family members.
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Factor IX|Factors deficiencies]]<ref name="pmid30574513">{{cite journal |vauthors=Al-Shbool G, Vakiti A |title=Acquired Hemophilia A Presenting as Intramuscular Hematoma |journal=J Investig Med High Impact Case Rep |volume=6 |issue= |pages=2324709618817572 |date=2018 |pmid=30574513 |pmc=6299309 |doi=10.1177/2324709618817572 |url=}}</ref><ref name="pmid25999618">{{cite journal |vauthors=Mansouritorghabeh H |title=Clinical and laboratory approaches to hemophilia a |journal=Iran J Med Sci |volume=40 |issue=3 |pages=194–205 |date=May 2015 |pmid=25999618 |pmc=4430880 |doi= |url=}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Factor IX|Factors deficiencies]]<ref name="pmid30574513">{{cite journal |vauthors=Al-Shbool G, Vakiti A |title=Acquired Hemophilia A Presenting as Intramuscular Hematoma |journal=J Investig Med High Impact Case Rep |volume=6 |issue= |pages=2324709618817572 |date=2018 |pmid=30574513 |pmc=6299309 |doi=10.1177/2324709618817572 |url=}}</ref><ref name="pmid25999618">{{cite journal |vauthors=Mansouritorghabeh H |title=Clinical and laboratory approaches to hemophilia a |journal=Iran J Med Sci |volume=40 |issue=3 |pages=194–205 |date=May 2015 |pmid=25999618 |pmc=4430880 |doi= |url=}}</ref>
Line 1,115: Line 1,118:
* [[Petechia]] on skin
* [[Petechia]] on skin


* Intramuscular hematoma
* Intramuscular [[hematoma]]


* [[Hematemesis]]
* [[Hematemesis]]
Line 1,122: Line 1,125:
* [[Hematuria]]
* [[Hematuria]]


* Abdominal pain  
* [[Abdominal pain]]
* Intracranial bleeding signs:
* Intracranial bleeding signs:
** [[Headache]]  
** [[Headache]]  
Line 1,140: Line 1,143:
* [[Factor VIII]] , [[Factor IX|IX]], XI assay
* [[Factor VIII]] , [[Factor IX|IX]], XI assay
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* History of bleeding disorder in family members.
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Platelet]] dysfunction<ref name="pmid21113246">{{cite journal |vauthors=Kirchmaier CM, Pillitteri D |title=Diagnosis and Management of Inherited Platelet Disorders |journal=Transfus Med Hemother |volume=37 |issue=5 |pages=237–246 |date=2010 |pmid=21113246 |pmc=2980508 |doi=10.1159/000320257 |url=}}</ref><ref name="pmid16684008">{{cite journal |vauthors=Hayward CP, Rao AK, Cattaneo M |title=Congenital platelet disorders: overview of their mechanisms, diagnostic evaluation and treatment |journal=Haemophilia |volume=12 Suppl 3 |issue= |pages=128–36 |date=July 2006 |pmid=16684008 |doi=10.1111/j.1365-2516.2006.01270.x |url=}}</ref><ref>{{cite journal|doi=10.1111/jth.12555.}}</ref><ref name="KandaKunishima2017">{{cite journal|last1=Kanda|first1=Kenji|last2=Kunishima|first2=Shinji|last3=Sato|first3=Aya|last4=Abe|first4=Daisuke|last5=Nishijima|first5=Setsuko|last6=Ishigami|first6=Tsuyoshi|title=A Brazilian case of Bernard–Soulier syndrome with two distinct founder mutations|journal=Human Genome Variation|volume=4|year=2017|pages=17030|issn=2054-345X|doi=10.1038/hgv.2017.30}}</ref><ref name="Nurden2006">{{cite journal|last1=Nurden|first1=Alan T|title=Glanzmann thrombasthenia|journal=Orphanet Journal of Rare Diseases|volume=1|issue=1|year=2006|issn=1750-1172|doi=10.1186/1750-1172-1-10}}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Platelet]] dysfunction<ref name="pmid21113246">{{cite journal |vauthors=Kirchmaier CM, Pillitteri D |title=Diagnosis and Management of Inherited Platelet Disorders |journal=Transfus Med Hemother |volume=37 |issue=5 |pages=237–246 |date=2010 |pmid=21113246 |pmc=2980508 |doi=10.1159/000320257 |url=}}</ref><ref name="pmid16684008">{{cite journal |vauthors=Hayward CP, Rao AK, Cattaneo M |title=Congenital platelet disorders: overview of their mechanisms, diagnostic evaluation and treatment |journal=Haemophilia |volume=12 Suppl 3 |issue= |pages=128–36 |date=July 2006 |pmid=16684008 |doi=10.1111/j.1365-2516.2006.01270.x |url=}}</ref><ref>{{cite journal|doi=10.1111/jth.12555.}}</ref><ref name="KandaKunishima2017">{{cite journal|last1=Kanda|first1=Kenji|last2=Kunishima|first2=Shinji|last3=Sato|first3=Aya|last4=Abe|first4=Daisuke|last5=Nishijima|first5=Setsuko|last6=Ishigami|first6=Tsuyoshi|title=A Brazilian case of Bernard–Soulier syndrome with two distinct founder mutations|journal=Human Genome Variation|volume=4|year=2017|pages=17030|issn=2054-345X|doi=10.1038/hgv.2017.30}}</ref><ref name="Nurden2006">{{cite journal|last1=Nurden|first1=Alan T|title=Glanzmann thrombasthenia|journal=Orphanet Journal of Rare Diseases|volume=1|issue=1|year=2006|issn=1750-1172|doi=10.1186/1750-1172-1-10}}</ref>
Line 1,147: Line 1,151:
* [[Epistaxis]]
* [[Epistaxis]]
* [[Gingival]] bleeding
* [[Gingival]] bleeding
* Excessive bleeding after surgery
* Excessive bleeding after [[surgery]]


* [[Menorrhagia]]
* [[Menorrhagia]]
Line 1,153: Line 1,157:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Bruises on skin  
* Bruises on skin  
* Mucocutaneous bleeding  
* [[Mucocutaneous]] bleeding  
| colspan="2" style="background: #F5F5F5; padding: 5px;" |
| colspan="2" style="background: #F5F5F5; padding: 5px;" |
* [[Thrombocytopenia]]  
* [[Thrombocytopenia]]  
Line 1,159: Line 1,163:
* ↓ [[RBC]] count
* ↓ [[RBC]] count
* [[Platelet]] secretion and dense granules abnormalities
* [[Platelet]] secretion and dense granules abnormalities
* Prolonged bleeding time
* Prolonged [[bleeding time]]
* Giant platelet on smear
* Giant platelet on smear( [[Bernard-Soulier syndrome]])
| colspan="2" style="background: #F5F5F5; padding: 5px;" |N/A
| colspan="2" style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |'''Gold standard diagnostic test:'''
| style="background: #F5F5F5; padding: 5px;" |'''Gold standard diagnostic test:'''
* Light transmission aggregometry (LTA)  
* Light transmission aggregometry (LTA)  


'''Other useful diagnostic tests:'''
'''Other useful diagnostic tests:'''
* [[Peripheral blood smear]]
* [[PFA-100]] system
* [[Flow cytometry]] for [[GPIb]] quantitation
* [[Flow cytometry]] for [[GPIb]] quantitation
* [[VWD]] factor assay
* [[VWD]] factor assay
* Genotyping
* [[Genotyping]]
* Secretion assay, [[ADP]] release
* [[Secretion assay]], [[ADP]] release
| style="background: #F5F5F5; padding: 5px;" |'''Associated conditions:'''
| style="background: #F5F5F5; padding: 5px;" |'''Associated conditions:'''
* [[Bernard-Soulier syndrome]]
* [[Bernard-Soulier syndrome]]
Line 1,254: Line 1,258:


* Normal/ low [[Thyroid-stimulating hormone|TSH]]
* Normal/ low [[Thyroid-stimulating hormone|TSH]]
* ↑ Total cholesterol  
* ↑ Total [[cholesterol]]
* ↑ [[LDL]]
* ↑ [[LDL]]
* ↑ [[VLDL]]
* ↑ [[VLDL]]
Line 1,260: Line 1,264:
* Homogenous hypo-echogenicity
* Homogenous hypo-echogenicity
| style="background: #F5F5F5; padding: 5px;" |'''Microscopic histology:'''
| style="background: #F5F5F5; padding: 5px;" |'''Microscopic histology:'''
* Follicular atrophy
* Follicular [[atrophy]]


* Chronic [[lymphocytic]] infiltration
* Chronic [[lymphocytic]] infiltration
* [[Hyperplastic]] change in the follicles
* [[Hyperplastic]] change in the follicles
* Presence of [[Hurthle cells|Hurthle cell]] metaplasia
* Presence of [[Hurthle cells|Hurthle cell]] [[metaplasia]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[TSH]]
* [[TSH]]
| style="background: #F5F5F5; padding: 5px;" |Associated conditions with [[Hashimoto thyroiditis]]:
| style="background: #F5F5F5; padding: 5px;" |'''Associated conditions with''' [[Hashimoto thyroiditis]]:
* [[Sjögren's syndrome|Sjögren]] disease
* [[Sjögren's syndrome|Sjögren]] disease


Line 1,284: Line 1,288:
* Irregular menses
* Irregular menses


* Percocious puberty
* Percocious [[puberty]]
* Muscle weakness
* [[Muscle weakness]]
* Fatigue
* [[Fatigue]]
| style="background: #F5F5F5; padding: 5px;" |Depending upon deficient enzyme:  
| style="background: #F5F5F5; padding: 5px;" |Depending upon deficient enzyme:  
*[[Ambiguous genitalia]] in male or female
*[[Ambiguous genitalia]] in male or female
*[[Hypertension]]/ Hypotension
*[[Hypertension]]/ [[Hypotension]]


*[[Primary amenorrhea]]
*[[Primary amenorrhea]]
Line 1,324: Line 1,328:
* [[Moon facies]]  
* [[Moon facies]]  
* Skin bruising
* Skin bruising
* Abdominal striae
* Abdominal [[striae]]


* [[Insomnia]],
* [[Insomnia]],
Line 1,330: Line 1,334:
* Decrease [[libido]]
* Decrease [[libido]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Facial plethora
* Facial [[plethora]]
* Abnormal fat distribution
* Abnormal fat distribution


Line 1,383: Line 1,387:
* [[Acne]]
* [[Acne]]
* Hair thinning  
* Hair thinning  
* Mood swings
* [[Mood swings]]
* Irregular mens
* Irregular mens
* [[Amenorrhea]]
* [[Amenorrhea]]
Line 1,391: Line 1,395:
* Enlarged ovaries
* Enlarged ovaries
* [[Hirsutism]]
* [[Hirsutism]]
* Weight gain
* [[Weight gain]]
* [[Acanthosis nigricans]]
* [[Acanthosis nigricans]]
| colspan="3" style="background: #F5F5F5; padding: 5px;" |
| colspan="3" style="background: #F5F5F5; padding: 5px;" |
Line 1,400: Line 1,404:
* ↑ [[Prolactin]] in some women
* ↑ [[Prolactin]] in some women
* ↑ [[LH]]/ Normal or ↓ [[FSH]]
* ↑ [[LH]]/ Normal or ↓ [[FSH]]
* ↑ Serum Anti-mullerian hormone
* ↑ Serum Anti-[[Anti-Müllerian hormone|mullerian]] hormone
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* ↑ Number of follicles
* ↑ Number of follicles
Line 1,410: Line 1,414:
* Fluid filled ovaries
* Fluid filled ovaries
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Multiple cysts in ovaries bilaterally.
* Multiple cysts in [[ovaries]] bilaterally.
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Clinical,biochemical and [[ultrasound]]
* Clinical,biochemical and [[ultrasound]]
Line 1,444: Line 1,448:
* Heavy menstrual bleeding
* Heavy menstrual bleeding
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Pallor
* [[Pallor]]
* Heavy menstrual bleeding
* Heavy menstrual bleeding


Line 1,491: Line 1,495:


* Menstrual irregularity
* Menstrual irregularity
* Mood swings
* [[Mood swings]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Heavy bleeding
* Heavy bleeding


* Depressed mood
* [[Depressed mood]]
| colspan="3" style="background: #F5F5F5; padding: 5px;" |
| colspan="3" style="background: #F5F5F5; padding: 5px;" |
* ↓ [[RBC]] count
* ↓ [[Hemoglobin]], ↓ [[Hematocrit]]
* ↓ Serum [[Iron]]
* ↓ [[Ferritin]]
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
Line 1,502: Line 1,513:
* Ruling out organic cause, complete history of medication use
* Ruling out organic cause, complete history of medication use
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* History of [[oral contraceptive]] use
|-
|-
! style="background: #DCDCDC; padding: 5px;" text-align: center;" | [[Herbal supplements]]<ref name="pmid23062258">{{cite journal |vauthors=van Hunsel FP, Kampschöer P |title=[Postmenopausal bleeding and dietary supplements: a possible causal relationship with hop- and soy-containing preparations] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=156 |issue=41 |pages=A5095 |date=2012 |pmid=23062258 |doi= |url=}}</ref><ref name="TuHuang2009">{{cite journal|last1=Tu|first1=Xiang|last2=Huang|first2=Gaomin|last3=Tan|first3=Shengkui|title=Chinese Herbal Medicine for Dysfunctional Uterine Bleeding: A Meta-Analysis|journal=Evidence-Based Complementary and Alternative Medicine|volume=6|issue=1|year=2009|pages=99–105|issn=1741-427X|doi=10.1093/ecam/nem063}}</ref><ref name="pmid15385077">{{cite journal |vauthors=Kabalak AA, Soyal OB, Urfalioglu A, Saracoglu F, Gogus N |title=Menometrorrhagia and tachyarrhythmia after using oral and topical ginseng |journal=J Womens Health (Larchmt) |volume=13 |issue=7 |pages=830–3 |date=September 2004 |pmid=15385077 |doi= |url=}}</ref>
! style="background: #DCDCDC; padding: 5px;" text-align: center;" | [[Herbal supplements]]<ref name="pmid23062258">{{cite journal |vauthors=van Hunsel FP, Kampschöer P |title=[Postmenopausal bleeding and dietary supplements: a possible causal relationship with hop- and soy-containing preparations] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=156 |issue=41 |pages=A5095 |date=2012 |pmid=23062258 |doi= |url=}}</ref><ref name="TuHuang2009">{{cite journal|last1=Tu|first1=Xiang|last2=Huang|first2=Gaomin|last3=Tan|first3=Shengkui|title=Chinese Herbal Medicine for Dysfunctional Uterine Bleeding: A Meta-Analysis|journal=Evidence-Based Complementary and Alternative Medicine|volume=6|issue=1|year=2009|pages=99–105|issn=1741-427X|doi=10.1093/ecam/nem063}}</ref><ref name="pmid15385077">{{cite journal |vauthors=Kabalak AA, Soyal OB, Urfalioglu A, Saracoglu F, Gogus N |title=Menometrorrhagia and tachyarrhythmia after using oral and topical ginseng |journal=J Womens Health (Larchmt) |volume=13 |issue=7 |pages=830–3 |date=September 2004 |pmid=15385077 |doi= |url=}}</ref>
Line 1,510: Line 1,522:
* Menstrual irregularity
* Menstrual irregularity


* Amenorrhea
* [[Amenorrhea]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Menorrhagia
* [[Menorrhagia]]
| colspan="3" style="background: #F5F5F5; padding: 5px;" |
| colspan="3" style="background: #F5F5F5; padding: 5px;" |
* ↓ [[RBC]] count
* ↓ [[RBC]] count

Latest revision as of 02:45, 22 February 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Nima Nasiri, M.D.[2]Farman Khan, MD, MRCP [3]

Causes

Common Causes


Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect Blood thinners, breakthrough bleeding in women using hormonal birth control, copper intrauterine device , depo-Provera

hormone replacement therapy, tamoxifen, corticosteroids, chemotherapy, clomiphene, dilantin, antipsychotic drugs , antibiotics ( due to toxic epidermal necrolysis or Stevens-Johnson syndrome )

Ear Nose Throat No underlying causes
Endocrine Diabetes, hyperthyroidism, hypothyroidism, Cushing's syndrome, Hormone secreting adrenal and ovarian tumors
Environmental No underlying causes
Gastroenterologic Liver disease
Genetic No underlying causes
Hematologic Clotting disorders, Von Willebrand disease, thrombocytopenia or platelet dysfunction,

acute leukemia ,Some factor deficiencies, Advanced liver disease

Iatrogenic Radiation therapy
Infectious Disease Chlamydia, gonorrhea, uterine infection, genitourinary tract infection, bacterial vaginosis

sexually transmitted diseases, atrophic vaginitis

Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic Adenomyosis, atrophy of the tissue lining the vagina and uterus, cervicitis, ectopic pregnancy, endometrial hyperplasia, endometritis, uterine sarcoma, first few months after the first menstrual period, first few weeks after abortion, first few weeks after delivery, intrauterine device, miscarriage, ovarian cysts, placenta previa, polycystic ovarian syndrome, retained products of conception, uterine fibroids, uterine polyps, diseases involving the vulva for example Crohn's disease, Behcet's syndrome , pemphigoid , pemphigus , erosive lichen planus , lymphoma, skin tags, sebaceous cysts, condylomata, angiokerataoma
Oncologic Cancer or precancer of the cervix , cancer or precancer of the endometrium, ovarian cancer, uterine cancer, uterine sarcoma
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte Chronic renal disease
Rheum / Immune / Allergy No underlying causes
Sexual Sexual abuse
Trauma Sexual intercourse , sexual abuse , foreign bodies (including IUD) , pelvic trauma, Straddle injuries
Urologic Genitourinary tract infection
Dental No underlying causes
Miscellaneous Foreign body, irritation of the genital area due to bubble baths, soaps, lotions or infection, smoking,

Excessive exercise

Causes in Alphabetical Order


Treatment

Contraindicated medications


Template:Abnormal uterine bleeding Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[5]

Overview

Abnormal uterine bleeding is defined as any alteration in the amount of menstrual blood flow or duration of menstruation. Women can experience heavy menstrual bleeding or irregular menstrual bleeding or combination of both. Normal menstruation occurs every 21 to 35 days and lasts 3 to 7 days.The diagnosis and evaluation of abnormal uterine bleeding is based on patient's assessment of her blood loss and its impact on her health status. There are structural and non-structural causes of abnormal uterine bleeding. Causes of abnormal uterine bleeding can be cervical cancer, cervical leiomyoma, polyps, coagulation disorders.

Abnormal uterine bleeding differential diagnosis

  • Abnormal uterine bleeding differential diagnosis include:[1][2]
  • Endometrial hyperplasia
  • Cervical polyp
  • Cervical leiomyoma
  • Cervical lymphoma
  • Cervical sarcoma
  • Metastases to the cervix
  • Cervical ectopic pregnancy
  • Cervicitis
  • Cervical erosion ( Ectropion )
  • IUD use
  • Pelvic inflammatory disease
  • Endometriosis
  • Adenomyosis
  • Postcoital bleeding
  • Clear cell adenocarcinoma
  • Hematologic causes:
    • Von willebrand disease
    • Thrombocytopenia
    • Clotting disorder
    • Platelet dysfunction
    • Factors deficiency
Abnormal Uterine bleeidng differential diagnosis
Ob-Gyn neoplasm and diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical exam Lab Findings Imaging Histopathology
Abnormal

vaginal bleeding

Other GU/GI symptoms Abdominal pain Pelvic

pain

Constitutional symptoms Gynecological examinations Abdominal

mass

HPV

Pap smear

STI panel

Other labs Ultrasound Other

imagings

Cervical cancer[3][4][5][6][7][8][9][10]

+

+ +
  • Cervical mass on exam
+ ± HPV T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement. PET/CT scan:
Cervical intraepithelial neoplasia:
Cervical polyp[11]
  • Mass on exam
  • RBC count
  • ↓ Hb, ↓ Hct
  • ↓ Serum Iron
  • Hyper/hypoechogenic masses with or without cysts
  • Filling the endocervical or vaginal canal
Cervical leiomyoma[12][13][14][15][16][17][18][19][20]
  • Heavy/prolonged menstrual bleeding
  • Intermenstrual bleeding
+ + ±
  • Well circumscribed hyperechoic mass
T2-weighted MRI:
  • Hypointense masses
  • Homogeneous

enhancement

  • Red degeneration
  • Clinical diagnosis/ and
Cervical lymphoma[21][22][23]
  • Difficulty urinating
  • Post-coital pain
+ + +
  • Irregularity
+ Pap smear:
  • Small round blue cells
  • High nuclear/cytoplasm ratio,
  • Scant cytoplasm
Immunohistochemistry markers:
  • Well-defined, solid, concentric, hypoechoic mass
MRI:
  • Intramyometrial infiltrative nodules
Cervical sarcoma[24][25][26][27] + + ± + Leiomyosarcoma markers: MRI:
  • Endometrial polypoid mass
  • Hypointense hypervascular solid components
Cervical erosion(Ectropion)[28][29][30][31][32]
  • Light bleeding after pelvic exam
  • Spotting
  • Post-coital pain
  • Painful cramps
+ + N/A N/A N/A
Cervicitis[33][34][35][36][37]
  • Intermenstrual bleeding
  • Postcoital
  • Bleeding after pelvic exam
  • Pain during urination
+ +
  • May have fever only
  • Red,inflammed swollen cervix
  • Inflammation/irritation of vulva/vagina
STI panel:
MRI:

May be detected as retention cysts in cervix.

Endometrial carcinoma[38][39][40][41][42]

bleeding

  • Pain during sex
  • Fulness in pelvic
  • Difficulty emptying bladder
+ + ±
  • Often normal
+
  • Myometrial invasion

T1-weighted MRI:

  • Hypo-to-isointense

T2-weighted MRI:

  • Intermediate signal intensity lower than the normal endometrium
Type I endometrioid endometrial carcinomas (EECs):
  • Moderately differentiated
  • Superficial invasion into the myometrium

Type II non-endometrioid endometrial carcinomas (NEECs):

Endometrial hyperplasia[43][44][45]
  • +
+
  • Normal or thickened endometrium
± N/A

T1-weighted MRI:

  • Hypo-to-isointense
  • Complex hyperplasia
  • Simple hyperplasia with atypia
Endometriosis[46][47][48][49][50][51][52]
  • Heavy mentrual bleeding
+ +

(limited value)

  • Ground glass echogenicity of the cyst fluid (Endometrioma)
  • Cysts are unilocular
Pelvic inflammatory diseases[53][54][55][56]
  • Bleeding after sex
  • Intermenstrual bleeding
  • Pelvic pain
+
  • Oral temperature >101F
  • Vaginal/vulvar tender lesion depending on microbial causes
STI panel:
  • WBC
  • Oral temperature >101F
Ultrasound:
  • Thickened, fluid-filled tubes with or without free pelvic or tubo-ovarian complex
MRI findings:
  • Inflammation in pelvic soft tissue
  • Clinical diagnosis is gold standard for diagnosing PID
Adenemyosis[57][58][59][60][61][62]
  • Abnormal uterine bleeding
  • Painful menstruation
+ +
  • Polypoid mass protruding into the endocervical canal.
  • Subendometrial striations
  • Myometrial cysts
  • Asymetrical thickness in myometrium walls
  • Heterogenous echotexture of myometrum
MRI:
  • Thickened junctional zone
  • Presence of ectopic endometrial glands into the myometrium.
Cervical ectopic pregnancy[63][64] +
  • Soft and disporportionally enlarged uterus.
± T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
Vaginal cancer[65][66][67][68]
  • Postcoital bleeding
+ + ±
  • Ill-defined vaginal ulcer
Ultrasound: MRI:
  • Isointense on T1-weighted images
  • Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images
Biopsy findings:
Paget's disease of vulva to cervix[69][70][71][72][73]
  • Bleeding/oozing from lesion
  • Pain in vulva
  • Itching or burning sensation in vulva
  • Negative for S-100 and Melan-A
N/A MRI:
  • Hyperintense on diffusion weighted imaging
  • Thick vulvar skin
  • "Cake-icing effect", pathognomic for vulvar paget's disease
Nabothian cyst[74][75][76][77]
  • Postcoital bleeding
  • Majority of them are asymptomatic due to their small size (few milimeters)
N/A
  • Anechoic well defined cystic lesions
T1-weighted
  • Intermediate or slightly high signal intensity T2-weighted
  • High signal intensity on T2-weighted images
  • Benign cystic lesion
  • Multiple benign cystic masses, usually few milimieters in diameter.
IUD use[78][79][80]
  • Heavy bleeidng
+ +
  • Normal
  • May have decreased RBC count
  • Linear echogenic intrauterine structures
N/A N/A


Pregnancy and pregnancy related conditions Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Abnormal uterine bleeding Other symptoms
Miscarriage[81][82] +
  • Enlarged uterus
  • Blood clot in cervical os.
Ultrasound:
Abruptio placenta[83][84] +
  • Uterine tenderness
  • ↓ Fetal heart rate
  • ↓ Fetal movement

Ultrasound:

  • Uterine hypertonicity
  • Non-reassuring fetal heart
Placenta previa[85][86][87] +
  • Usually painless vaginal bleeding
  • Uterine contraction
  • Blood clot or spotting
Ultrasound:
  • Low lying placenta, less than 1cm from cervical os.
Ectopic pregnancy[88][89] + Ultrasound:
  • Absence of "Sliding sign" on gentle pressure of cervix
  • Tubal rupture
Associated conditions:
Molar pregnancy[90][91][92] +
  • Heavy vaginal bleeding
Ultrasound:
  • Complex and echogenic intrauterine mass
  • Containing many small cystic spaces
  • Classical "snow storm" appearance
  • Hydropic villi
  • Histological confirmation post-curettage
Associated conditions:
Hematologic conditions Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab findings Imaging Histopathology
Abnormal uterine

bleeding

Other symptoms
Von willebrand disease[93][94][95] +
  • Easy bruising
  • Gum/dental bleeding
  • Heavy menses
N/A N/A
  • Most common inherited bleeding disorder
  • History of bleeding disorder in family members.
Factors deficiencies[96][97] +
  • Easy bruising
  • Gum/dental bleeding
  • Heavy menses
  • Fatigue
  • Blood in stool
  • Blood in urine
N/A N/A
  • History of bleeding disorder in family members.
Platelet dysfunction[98][99][100][101][102] ± N/A N/A Gold standard diagnostic test:
  • Light transmission aggregometry (LTA)

Other useful diagnostic tests:

Associated conditions:
Metabolic conditions Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab findings Imaging Histopathology
Abnormal uterine bleeding Other symptoms
Hyperthyroidism[103][104] +
  • Wet skin/hair thinning
  • Low TSH
  • TSH receptor antibodies (TRAb)
Ultrasound:
  • Homogenous hypo-echogenicity
Microscopic histology:
  • Lymphocytic infiltration in follicles
  • Enlarged colloids

For Grave's disease:

  • TSH receptor antibody
Associated conditions:
Hypothyroidism[105][106][107][108][109] +
  • Dry skin
  • Hair loss
Ultrasound:
  • Homogenous hypo-echogenicity
Microscopic histology: Associated conditions with Hashimoto thyroiditis:
Adrenal hyperplasia[110][111][112][113][114] +
  • Irregular menses
Depending upon deficient enzyme:

Depending upon enzyme deficiencies may include the following:

CT-Scan:
  • Enlargement of glands
  • Cosyntropin stimulation test (250 μg cosyntropin intravenously):
Cushing's disease[115][116] +
  • Facial plethora
  • Abnormal fat distribution
  • Violacious striae
  • Emotional lability
T1-weighted MRI: Associated conditions:
Polycystic ovarian syndrome[117][118][119][120][121] + Ultrasound:
  • ↑ Number of follicles
  • ↑ Ovarian volume
  • Fluid filled ovaries
  • Multiple cysts in ovaries bilaterally.
Associated conditions:
  • Insulin resistance
Medication side effects/ Iatrogenic Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Abnormal uterine bleeding Other symptoms
Anticoagulants[122][123][124]
  • +
  • Heavy menstrual bleeding
  • Pallor
  • Heavy menstrual bleeding
N/A N/A
  • Complete medication history
Antipsychotics[125] +
  • Sexual dysfunction
N/A N/A
  • Complete medication history
  • Serum prolactin test
  • History of mood disorders
Oral contraceptive pills[126]
  • Break through bleeding
  • Heavy bleeding
N/A N/A
  • Ruling out organic cause, complete history of medication use
Herbal supplements[127][128][129] +
  • Heavy menstrual bleeding
  • Menstrual irregularity
Ultrasound:
  • Complete medication history

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