Dysfunctional uterine bleeding differential diagnosis: Difference between revisions

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{{CMG}} {{AE}}[[User:AroojNaz|Arooj Naz]] ,{{VVS}}
== Differential Diagnosis ==
 
== Overview ==
* Anatomic or structural lesions
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 complications|pregnancy]] related complications, [[endometrial cancer]] and [[hyperplasia]], as well as [[Polycystic Ovarian Syndrome]].
*:* Uterine or [[cervical polyp]]s
 
*:* [[Uterine leiomyoma]]
==Differential Diagnosis==
*:* Foreign body
{| class="wikitable"
* Coagulation disorders
|+
*:* Clotting factor disorder: [[Hemophilia]], hepatic disease, anticoagulant use, renal disease, [[Von Willebrand's Disease]]
!Condition
*:* Platelet dysfunction: [[Leukemia]], [[Thrombocytopenia]], and related medications  
!Common Underlying Causes
* Pregnancy complications
!Workup
*:* Placental abruption
|-
*:* [[Ectopic Pregnancy]]
|Anatomic or structural lesions
*:* Miscarriage  
|
*:* Spontaneous abortion
* Uterine or [[cervical polyp]]s
*:* [[Placenta previa]]
* [[Uterine leiomyoma]]
* Endometrial cancer  
* Foreign body
*:* Risk Factors:
|Pelvic or transvaginal [[Ultrasonography]]
*:*:* [[Diabetes Mellitus]]
|-
*:*:* Unopposed estrogen
|[[Coagulation]] disorders
*:*:* [[Obesity]]
|
*:*:* Older age
*Clotting factor disorder: [[Hemophilia]], hepatic disease, anticoagulant use, renal disease, [[Von Willebrand's Disease]]
*:*:* Chronic anovulation
*Platelet dysfunction: [[Leukemia]], [[Thrombocytopenia]], and related medications
*:*:* [[Ddx:Hypertension|Hypertension]]  
|[[Coagulation]] studies; [[PT]], [[aPTT]], [[Bleeding time|Bleeding Time]], and [[Clotting factors|clotting factor studies]]
* Endometrial hyperplasia
|-
*:* Exogenous extrogen
|[[Pregnancy complications]]
*:* Excess of endogenous estrogen  
|
*:* DUB (dysfunctional uterine bleeding) is a diagnosis of exclusion
*[[Placental abruption]]
* Endometrioma
*[[Ectopic Pregnancy]]
* Hyperprolactinemia
*[[Miscarriage]]
* Hypo- or [[Hyperthyroidism]]
*[[Spontaneous abortions|Spontaneous abortion]]
* Hypothalamic lesion
*[[Placenta previa]]
* Medications (e.g., [[Norepinephrine]])
|[[Human chorionic gonadotropin|B-hCG]] should be the first test to detect the presence of pregnancy. Visualization of the defect requires pelvic or transvaginal [[ultrasonography]]
* Nonuterine bleeding
|-
*:* Rectal
|[[Endometrial cancer]] <ref name="pmid30252237">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume=  | issue=  | pages=  | pmid=30252237 | doi= | pmc= | url= }}</ref>
*:* Urinary
|Risk factors include:
*:* Vaginal
 
*:* Cervical
*[[Diabetes Mellitus]]
* Other malignancy
*Unopposed [[estrogen]]
* Pelvic infection
*[[Obesity]]
* [[Polycystic Ovarian Syndrome]] ([[Stein Leventhal Syndrome]])
*Older age
* Systemic disease
*Chronic [[anovulation]]
* [[Anorexia Nervosa]]  
*[[Ddx:Hypertension|Hypertension]]
* Immature hypothalamic-pituitary-ovarian axis
|Upon [[transvaginal ultrasonography]], endometrial cancer will present as a [[thicked endometrial strip]]. Confirmation requires an [[endometrial biopsy]].
* Intense exercise
|-
* Nutritional status (Very low calorie diets)
|[[Endometrial hyperplasia]]
* Peri-menopause
|
* Psychologic stress <ref>Sailer, Christian, Wasner, Susanne.  Differential Diagnosis Pocket.  Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref>
*Exogenous extrogen
*Excess of endogenous estrogen
*DUB (dysfunctional uterine bleeding) is a diagnosis of exclusion
|Endometrial hyperplasia realted 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]]) <ref name="pmid24379699">{{cite journal| author=Sirmans SM, Pate KA| title=Epidemiology, diagnosis, and management of polycystic ovary syndrome. | journal=Clin Epidemiol | year= 2013 | volume= 6 | issue=  | pages= 1-13 | pmid=24379699 | doi=10.2147/CLEP.S37559 | pmc=3872139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24379699  }}</ref>
|Risk factors include:
 
* Type 1 diabetes
* Type 2 diabetes
* Obesity
* Hereditary facotors
|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 ===
 
*Endometrioma
*Hyperprolactinemia
*Hypo- or [[Hyperthyroidism]]
*Hypothalamic lesion
*Medications (e.g., [[Norepinephrine]])
*Nonuterine bleeding
*:*Rectal
*:*Urinary
*:*Vaginal
*:*Cervical
*Other malignancy
*Pelvic infection
*[[Polycystic Ovarian Syndrome]] ([[Stein Leventhal Syndrome]])
*Systemic disease
*[[Anorexia Nervosa]]
*Immature hypothalamic-pituitary-ovarian axis
*Intense exercise
*Nutritional status (Very low calorie diets)
*Peri-menopause
*Psychologic stress <ref>Sailer, Christian, Wasner, Susanne.  Differential Diagnosis Pocket.  Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref>


==References==
==References==

Revision as of 08:31, 2 March 2022

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

Condition Common Underlying Causes Workup
Anatomic or structural lesions Pelvic or transvaginal Ultrasonography
Coagulation disorders Coagulation studies; PT, aPTT, Bleeding Time, and clotting factor studies
Pregnancy complications B-hCG should be the first test to detect the presence of pregnancy. Visualization of the defect requires pelvic or transvaginal ultrasonography
Endometrial cancer [1] Risk factors include: Upon transvaginal ultrasonography, endometrial cancer will present as a thicked endometrial strip. Confirmation requires an endometrial biopsy.
Endometrial hyperplasia
  • Exogenous extrogen
  • Excess of endogenous estrogen
  • DUB (dysfunctional uterine bleeding) is a diagnosis of exclusion
 Endometrial hyperplasia realted 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) [2] Risk factors include:
  • Type 1 diabetes
  • Type 2 diabetes
  • Obesity
  • Hereditary facotors
 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

References

  1. ↑ "StatPearls". 2022. PMID 30252237.
  2. ↑ Sirmans SM, Pate KA (2013). "Epidemiology, diagnosis, and management of polycystic ovary syndrome". Clin Epidemiol. 6: 1–13. doi:10.2147/CLEP.S37559. PMC 3872139. PMID 24379699.
  3. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

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