Dysfunctional uterine bleeding differential diagnosis: Difference between revisions
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(Edited information into a table format, added investigations and their details, hyperlinks, references and overview) |
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{{CMG}} {{AE}}[[User:AroojNaz|Arooj Naz]] ,{{VVS}} | {{CMG}} {{AE}}[[User:AroojNaz|Arooj Naz]] ,{{VVS}} | ||
== Overview == | ==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 complications|pregnancy]] related complications, [[endometrial cancer]] and [[hyperplasia]], as well as [[Polycystic Ovarian Syndrome]]. | 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]]. | ||
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|Anatomic or structural lesions | |Anatomic or structural lesions | ||
| | | | ||
* Uterine or [[cervical polyp]]s | *Uterine or [[cervical polyp]]s | ||
* [[Uterine leiomyoma]] | *[[Uterine leiomyoma]] | ||
* Foreign body | *Foreign body | ||
|Pelvic or transvaginal [[Ultrasonography]] | |Pelvic or transvaginal [[Ultrasonography]] | ||
|- | |- | ||
|[[Coagulation]] disorders | |[[Coagulation]] disorders | ||
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*[[Spontaneous abortions|Spontaneous abortion]] | *[[Spontaneous abortions|Spontaneous abortion]] | ||
*[[Placenta previa]] | *[[Placenta previa]] | ||
|[[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]] | |[[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]] | ||
|- | |- | ||
|[[Endometrial cancer]] <ref name="pmid30252237">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=30252237 | doi= | pmc= | url= }}</ref> | |[[Endometrial cancer]] <ref name="pmid30252237">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages= | pmid=30252237 | doi= | pmc= | url= }}</ref> | ||
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*Chronic [[anovulation]] | *Chronic [[anovulation]] | ||
*[[Ddx:Hypertension|Hypertension]] | *[[Ddx:Hypertension|Hypertension]] | ||
|Upon [[transvaginal ultrasonography]], endometrial cancer will present as a [[thicked endometrial strip]]. Confirmation requires an [[endometrial biopsy]]. | |Upon [[transvaginal ultrasonography]], endometrial cancer will present as a [[thicked endometrial strip]]. Confirmation requires an [[endometrial biopsy]]. | ||
|- | |- | ||
|[[Endometrial hyperplasia]] | |[[Endometrial hyperplasia]] | ||
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*Excess of endogenous estrogen | *Excess of endogenous estrogen | ||
*DUB (dysfunctional uterine bleeding) is a diagnosis of exclusion | *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. | |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> | |[[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: | |Risk factors include: | ||
* Type 1 diabetes | *Type 1 diabetes | ||
* Type 2 diabetes | *Type 2 diabetes | ||
* Obesity | *Obesity | ||
* Hereditary facotors | *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]]. | |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 === | ===Other Causes=== | ||
*Endometrioma | *Endometrioma | ||
Revision as of 08:36, 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 |
|
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:
|
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 [3]
References
- ↑ "StatPearls". 2022. PMID 30252237.
- ↑ 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.
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016