Abnormal uterine bleeding: Difference between revisions

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

Choriogonadotropin alfa

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	Histopathology
Cervical cancer^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]	Postmenopausal Intermenstrual Postcoital Bleeding after pelvic exam	Dysuria Urinary hesitancy Dyspareunia Vaginal discharge Itching or burning of the vulva	+	+	+	Cervical mass on exam	+	± HPV Atypical cells on Pap smear STI: ± Chlamydia	↑ CA-125 Leukomoid reaction	Large cervical cancer Angiogenesis on Doppler sonography Bladder involvement Lymph node involvement	T2-weighted MRI : Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement. PET/CT scan: Detect tumor size Lymph node involvement, Metastases to bladder or rectum	Cervical intraepithelial neoplasia: CIN1: mild dysplasia CIN2: moderate dysplasia CIN3: high degree of dysplasia/metastases	Colposcopy/biopsy
Cervical polyp^[11]	Postcoital Intermenstrual Postmenopausal Bleeding after exam	Vaginal discharge Dyspareunia	−	−	−	Mass on exam	−	−	↓ RBC count ↓ Hb, ↓ Hct ↓ Serum Iron	Hyper/hypoechogenic masses with or without cysts Filling the endocervical or vaginal canal		Epithelial cells with no nuclear atypia/mitoses	Hysteroscopy /Biopsy
Cervical leiomyoma^[12]^[13]^[14]^[15]^[16]^[17]^[18]^[19]^[20]	Heavy/prolonged menstrual bleeding Intermenstrual bleeding	Urinary retention Constipation Infertility Bowel obstruction Increase in pregnancy/labor complications Vaginal discharge	+	+	−	Large,irregular pelvic mass	±	−	Erythrocytosis	Well circumscribed hyperechoic mass	T2-weighted MRI: Hypointense masses Homogeneous enhancement Red degeneration	Spindle shaped smooth muscle cells Mature adipocytes Extracellular matrix consist of collagen,fibronectin.	Clinical diagnosis/ and Ultrasound
Cervical lymphoma^[21]^[22]^[23]	Postmenopausal bleeding	Difficulty urinating Post-coital pain	+	+	+	Larrge uterine/cervix mass Irregularity	+	Pap smear: Small round blue cells High nuclear/cytoplasm ratio, Scant cytoplasm	Immunohistochemistry markers: CD19, CD20, CD79a, PAX5	Well-defined, solid, concentric, hypoechoic mass	MRI: Intramyometrial infiltrative nodules	Small tumor cells with large nuclei High mitoses and proliferation Diffuse large B-Cell lymphoma (DLBCL) most frequent type.	Biopsy
Cervical sarcoma^[24]^[25]^[26]^[27]	Intermentrual Postmenopausal	Post-coital pain Fullness in pelvic Vaginal discharge	+	+	±	Cervical mass Lump protruding from vagina/vulva	+	−	Leiomyosarcoma markers: Positive for for S-100 and vimentin and are negative for desmin, myoglobin and actin.	Endometrial mass with heterogeneous echogenicity	MRI: Endometrial polypoid mass Hypointense hypervascular solid components	Poorly circumscribed bulky mass protruding from cervical canal Different subtypes: Leiomyosarcoma Endocervical sarcoma Embryonal rhabdomyosarcoma( Sarcoma botryoides)	Biopsy
Cervical erosion(Ectropion)^[28]^[29]^[30]^[31]^[32]	Light bleeding after pelvic exam Spotting	Post-coital pain Painful cramps Dyspareunia Vaginal discharge Itching of vulvovaginal area	+	+	−	Red, glandular area around os of cervix	−	−	N/A	N/A	N/A	Squamous metaplasia Vascular ectasia Lymphocytic infiltration	Colposcopy and biopsy
Cervicitis^[33]^[34]^[35]^[36]^[37]	Intermenstrual bleeding Postcoital Bleeding after pelvic exam	Pain during urination Pain during sex Painful menstruation Purulent vaginal discharge Itching of vulva	+	+	May have fever only	Red,inflammed swollen cervix Inflammation/irritation of vulva/vagina	−	STI panel: Chlamydia Gonorrhea Herpes simplex Trichomonas vaginalis	↑ WBC + NAAT for chlamydia, gonorrhea		MRI: May be detected as retention cysts in cervix.	Non-specific, lymphocytic infiltration may be seen in microscopic histology. Koilocytic changes in case of HPV as cause of chronic cervicitis.	Nucleic acid amplification tests (NAATs)
Endometrial carcinoma^[38]^[39]^[40]^[41]^[42]	Postmenopausal bleeding Intermesntrual bleeding	Vaginal discharge Pain during urination Pain during sex Fulness in pelvic Difficulty emptying bladder	+	+	±	Often normal Vaginal lump Pelvic mass	+	−	↑ CA-125	Thickened endometrium 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): Deep invasion of the myometrium Poorly differentiated Highly metastatic Not related to endometrial hyperplasia	Hysterectomy and biopsy
Endometrial hyperplasia^[43]^[44]^[45]	Postmenopausal bleeding Intermenstrual bleeding Amenorrhea	Dysmenorrhea Amenorrhea Dyspareunia Heavy menstrual bleeding	+	+	−	Normal or thickened endometrium	±	−	N/A	Thickened endometrium	T1-weighted MRI: Hypo-to-isointense	Simple(cystic) hyperplasia Complex hyperplasia Simple hyperplasia with atypia Complex hyperplasia with atypia (glands are highly irregular in size and shape)	Biopsy
Endometriosis^[46]^[47]^[48]^[49]^[50]^[51]^[52]	Heavy mentrual bleeding	Painful menstruation Burning/painful urination Painful bowel movement Pain during or after sex Infertility Watery vaginal discharge	+	Pelvic pain Back pain	−	Tender uterosacral nodularity Immobile uterus Cervical motion tenderness Retroverted uterus	+	−	↑ IL-6 ↑ TNF-α ↑ CA-125 (limited value)	Ground glass echogenicity of the cyst fluid (Endometrioma) Cysts are unilocular	MRI findings is variable, depending upon the sites of endometriosis such as peritoneal implants, ovarian endometrioma, pelvic endometriosis.	Endometrial type glands and stroma presence is charracteristic histology findings, suggestive for endometriosis.	Visual inspection by laparoscopy
Pelvic inflammatory diseases^[53]^[54]^[55]^[56]	Bleeding after sex Intermenstrual bleeding	Fever Pelvic pain Dyspareunia Dysmenorrhea Dysuria Dyschezia Foul-smelling grey/white/yellow vaginal discharge Itching and burning of vulvovaginal area	+	Pelvic pain Cervical motion tenderness	Oral temperature >101F	Vaginal/vulvar tender lesion depending on microbial causes	−	STI panel: Chlamydia Gonorrhea	↑ CRP ↑ ESR ↑ 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 Hydrosalpinx Tubo-ovarian abscess in chronic PID.	Inflamed, purulent fallopian tubes	Clinical diagnosis is gold standard for diagnosing PID Laparoscopy is confirmatory in acute salpingitis
Adenemyosis^[57]^[58]^[59]^[60]^[61]^[62]	Abnormal uterine bleeding	Painful menstruation	+	+	−	Polypoid mass protruding into the endocervical canal.	Enlarged uterus may present as abdominal mass	−	↑ CA-125	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.	Histology findings post hysterectomy
Cervical ectopic pregnancy^[63]^[64]	Amenorrhea Bleeding after pelvic exam	Pelvic pain	+	−	−	Soft and disporportionally enlarged uterus.	±	−	↑ β-HCG	Empty uterine Thickened endometrium	T2-weighted MRI: Hypointense large mass T1-weighted MRI: Partially hyperintense mass	Necrotic hemorrhagic mass with chorionic villus	Hysterectomy and biopsy
Vaginal cancer^[65]^[66]^[67]^[68]	Postcoital bleeding	Tenesmus Dysuria Urinary frequency Constipation Pelvic pain Vaginal discharge	+	+	±	Ill-defined vaginal ulcer Vaginal lump Inguinal lymphadenopathy Edema and ulceration of vaginal wall Foul-odor blood tinged vaginal discharge Vaginal prolapse Cystocele	In case of metastases to internal organs	Pap smear can be normal ± HPV	↓ RBC count	Ultrasound: Hydronephrosis in case of pelvic metastases Multiple liver metastases	MRI: Isointense on T1-weighted images Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images	Biopsy findings: Squamous cell carcinoma of vagina	Biopsy
Paget's disease of vulva to cervix^[69]^[70]^[71]^[72]^[73]	Bleeding/oozing from lesion	± Vaginal discharge Pain in vulva Itching or burning sensation in vulva	−	−	−	Scaly eczematoid lesion in vulva. Erythematous plaques with white scaling. Inguinal lymphadenopathy in case of metastases.	−	−	Positive for cytokeratin(CK7) 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 Intraepidermal adenocarcinoma which involves epidermis	Biopsy of lesion
Nabothian cyst^[74]^[75]^[76]^[77]	Postcoital bleeding	Pain during sex Vaginal discharge	In very rare cases depending upon the size of cyst it can cause abdominal pain and amenorrhea	−	−	Majority of them are asymptomatic due to their small size (few milimeters) Cystic mass on exam	−	−	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.	Histopathological exam if large cystic masses
IUD use^[78]^[79]^[80]	Heavy bleeidng	Painful menstruation ± Vaginal discharge	+ In cases of uterine rupture and far migration of IUD, it can cause adhesion, bowel obstruction, perforation.	+	−	Normal	−	−	May have decreased RBC count	Linear echogenic intrauterine structures	N/A	N/A	Transvaginal ultrasound

Pregnancy and pregnancy related conditions	Clinical manifestations			Para-clinical findings					Gold standard	Additional findings
	Symptoms		Physical examination	Para-clinical findings
	Symptoms			Lab Findings	Imaging			Histopathology
	Abnormal uterine bleeding	Other symptoms		Lab Findings	Imaging			Histopathology
Miscarriage^[81]^[82]	+	Pelvic/back pain Spotting Nausea Vomiting	Enlarged uterus Blood clot in cervical os.	↑ β-HCG ↓ RBC	Ultrasound: ‘Sliding sign’ on transvaginal ultrasound Embryo with increase in crown-rump length without visible embryo heart activity Absence of embryo heart activity			Abnormal villi in chromosomal abnormalities Hydropic changes in cases of molar pregnancy	Transvaginal ultrasound
Abruptio placenta^[83]^[84]	+	Pelvic/back pain Abdominal pain Vaginal bleeding Painful uterine contractions	Uterine tenderness ↓ Fetal heart rate ↓ Fetal movement	↑ β-HCG	Ultrasound: Uterine hypertonicity Non-reassuring fetal heart			Hematoma, Fibrin deposition Compressed villi Hemosiderin-laden histiocytes Villous infarctions Decidual destruction, hemorrhage	Transvaginal ultrasound
Placenta previa^[85]^[86]^[87]	+ Usually painless vaginal bleeding	Abdominal pain Pelvic pain	Dilated cervix ↑ Uterine contraction Blood clot or spotting	↑ β-HCG	Ultrasound: Low lying placenta, less than 1cm from cervical os.			Trophoblastic giant cell migration into decidua Hemorrhage into decidua and myometrium	Transvaginal ultrasound
Ectopic pregnancy^[88]^[89]	+	Pelvic pain which is worse on one side Abdominal pain	Abdominal or pelvic tenderness Adnexal mass Hemorrha gic shock	↑ β-HCG	Ultrasound: Empty uterus Adnexal mass Absence of "Sliding sign" on gentle pressure of cervix Tubal rupture			Hemorrhage Product of conception in fallopian tube Empty uterus	Diagnostic laparascopy	Associated conditions: Chronic salpingitis Infertility Tubal rupture
Molar pregnancy^[90]^[91]^[92]	+	Heavy vaginal bleeding Nausea Vomiting	Uterine size larger than date Sign of hyperthyroidism Sign of Anemia	↑↑ β-HCG ↑ Inhibin-A ↑ Activin-A ↓ RBC	Ultrasound: Complex and echogenic intrauterine mass Containing many small cystic spaces Classical "snow storm" appearance			Hydropic villi Empty uterus Fetal tissue in partial hydatiform mole.	Histological confirmation post-curettage	Associated conditions: Choriocarcinoma
Hematologic conditions	Clinical manifestations			Para-clinical findings					Gold standard	Additional findings
	Symptoms		Physical examination	Para-clinical findings
	Symptoms			Lab findings		Imaging		Histopathology
	Abnormal uterine bleeding	Other symptoms		Lab findings		Imaging		Histopathology
Von willebrand disease^[93]^[94]^[95]	+	Epistaxis Easy bruising Gum/dental bleeding Heavy menses Fatigue Blood in stool Blood in urine GI bleeding in rare cases	Bruises on skin Menorrhagia Hematuria Melena	↓ RBC count ↓ Serum Iron + FOBT RBC in Urinalysis ↓ VWF Normal PT, Normal or ↑ PTT, Normal or ↑ Bleeding time Normal or low platelet Normal Fibrinogen		N/A		N/A	Current gold standard diagnostic testing includes: VWF activity(via Ristocetin cofactor) VWF antigen Factor VIII Activity (FVIII)	Most common inherited bleeding disorder History of bleeding disorder in family members.
Factors deficiencies^[96]^[97]	+ Heavy bleeding since the menarche	Easy bleeding Epistaxis Easy bruising Gum/dental bleeding Heavy menses Fatigue Blood in stool Blood in urine	Petechia on skin Intramuscular hematoma Hematemesis Melena Hematuria Abdominal pain Intracranial bleeding signs: Headache Neck stiffness Vomiting Lethargy	`↓ Factors VIII, IX, XI ↑ PTT , Normal PT Normal VWF ↓ RBC count		N/A		N/A	Factor VIII , IX, XI assay	History of bleeding disorder in family members.
Platelet dysfunction^[98]^[99]^[100]^[101]^[102]	±	Skin bruises Epistaxis Gingival bleeding Excessive bleeding after surgery Menorrhagia	Bruises on skin Mucocutaneous bleeding	Thrombocytopenia Normal PT , Normal PTT ↓ RBC count Platelet secretion and dense granules abnormalities Prolonged bleeding time Giant platelet on smear( Bernard-Soulier syndrome)		N/A		N/A	Gold standard diagnostic test: Light transmission aggregometry (LTA) Other useful diagnostic tests: PFA-100 system Flow cytometry for GPIb quantitation VWD factor assay Genotyping Secretion assay, ADP release	Associated conditions: Bernard-Soulier syndrome Glanzmann's thrombasthenia
Metabolic conditions	Clinical manifestations			Para-clinical findings					Gold standard	Additional findings
	Symptoms		Physical examination	Para-clinical findings
	Symptoms			Lab findings			Imaging	Histopathology
	Abnormal uterine bleeding	Other symptoms		Lab findings			Imaging	Histopathology
Hyperthyroidism^[103]^[104]	+	Wet skin/hair thinning Palpitation Insomnia Anxiety Weight loss Heat intolerance Diarrhea	Enlarged thyroid (Goiter) Exophthalmos	High T3,T4 Low TSH TSH receptor antibodies (TRAb)			Ultrasound: Homogenous hypo-echogenicity	Microscopic histology: Lymphocytic infiltration in follicles Enlarged colloids	Total T4 For Grave's disease: TSH receptor antibody	Associated conditions: Osteoprosis Atrial fibrillation
Hypothyroidism^[105]^[106]^[107]^[108]^[109]	+	Fatigue Cold intolerance Decreased sweating Hypothermia Coarse skin Weight gain Constipation Dry skin/hair loss	Dry skin Bradycardia Hair loss Myxedema Delayed relaxation phase of deep tendon reflexes	Low T3,T4 Normal/ low TSH ↑ Total cholesterol ↑ LDL ↑ VLDL			Ultrasound: Homogenous hypo-echogenicity	Microscopic histology: Follicular atrophy Chronic lymphocytic infiltration Hyperplastic change in the follicles Presence of Hurthle cell metaplasia	TSH	Associated conditions with Hashimoto thyroiditis: Sjögren disease Pernicious anemia Diabetes mellitus type 2 Rheumatoid arthritis
Adrenal hyperplasia^[110]^[111]^[112]^[113]^[114]	+	Acne Virilization Irregular menses Percocious puberty Muscle weakness Fatigue	Depending upon deficient enzyme: Ambiguous genitalia in male or female Hypertension/ Hypotension Primary amenorrhea Absence of secondary sexual characteristics Minimal body hair	Depending upon enzyme deficiencies may include the following: Androstenedione Testosterone 11-deoxycortisol Dehydroepiandrosterone sulfate (DHEAS) 17-hydroxypregnenolone Pregnenolone Renin/Aldosterone			CT-Scan: Enlargement of glands	Diffuse cortical hyperplasia	Cosyntropin stimulation test (250 μg cosyntropin intravenously): measuring levels of 17-OHP and androstenedione at baseline and 60 min	Ovarian torsion may be seen due to bleeding in 21-Hydroxilase deficiency infants
Cushing's disease^[115]^[116]	+	Acne Hirsutism/hair loss Weight gain Moon facies Skin bruising Abdominal striae Insomnia, Amenorrhea Decrease libido	Facial plethora Abnormal fat distribution Acanthosis nigricans Ecchymosis Violacious striae Muscle weakness Kyphosis Hypertension Edema Slow deep tendon reflex relaxation Emotional lability Depression Lipodystrophy Glucose intolerance or diabetes mellitus Visual field changes	Low/Normal ACTH High cortisol			T1-weighted MRI: Pituitary macroadenoma	Pituitary macro/micro adenoma	Testing urinary free cortisol over 24 hours (UFC) Overnight Dexamethasone 8 mg, distinguishes Cushing’s syndrome from the ectopic ACTH secretion	Associated conditions: Metabolic syndrome Diabetes mellitus Hypertension Osteoprosis Multiple endocrine neoplasia type1
Polycystic ovarian syndrome^[117]^[118]^[119]^[120]^[121]	+	Pelvic pain Acne Hair thinning Mood swings Irregular mens Amenorrhea Oligomenorrhea Infertility	Enlarged ovaries Hirsutism Weight gain Acanthosis nigricans	↑ DHEAS and androstenedione, testosterone ↓ HDL, ↑ Total cholesterol, LDL, TG ↑ Prolactin in some women ↑ LH/ Normal or ↓ FSH ↑ Serum Anti-mullerian hormone			Ultrasound: ↑ Number of follicles Large ovaries ↑ Ovarian volume Fluid filled ovaries	Multiple cysts in ovaries bilaterally.	Clinical,biochemical and ultrasound	Associated conditions: Increased risk of cardiovascular disease Insulin resistance Diabetes mellitus type 2 Metabolic syndrome
Medication side effects/ Iatrogenic	Clinical manifestations			Para-clinical findings					Gold standard	Additional findings
	Symptoms		Physical examination	Para-clinical findings
	Symptoms			Lab Findings			Imaging	Histopathology
	Abnormal uterine bleeding	Other symptoms		Lab Findings			Imaging	Histopathology
Anticoagulants^[122]^[123]^[124]	+	Heavy menstrual bleeding	Pallor Heavy menstrual bleeding	↑ PT or ↑ PTT , ↑ bleeding time ↓ RBC count ↓ Hemoglobin, ↓ Hematocrit ↓ Serum Iron ↓ Ferritin			N/A	N/A	Complete medication history	History of venous thromboembolism or pulmonary embolism
Antipsychotics^[125]	+	Amenorrhea Sexual dysfunction	Galactorrhea Gynecomastia	↑ Prolactin level			N/A	N/A	Complete medication history Serum prolactin test	History of mood disorders
Oral contraceptive pills^[126]	Break through bleeding	Amenorrhea Menstrual irregularity Mood swings	Heavy bleeding Depressed mood	↓ RBC count ↓ Hemoglobin, ↓ Hematocrit ↓ Serum Iron ↓ Ferritin			N/A	N/A	Ruling out organic cause, complete history of medication use	History of oral contraceptive use
Herbal supplements^[127]^[128]^[129]	+	Heavy menstrual bleeding Menstrual irregularity Amenorrhea	Menorrhagia	↓ RBC count ↓ Hemoglobin, ↓ Hematocrit ↓ Serum Iron ↓ Ferritin			Ultrasound: Thickened endometrium	Disorderd or proliferative pattern of endometrium	Complete medication history	History of Ginseng overuse, soy bean use, Chinese herbal medicine

References

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{CMG}}; {{FK}}
+{{CMG}}; {{Nnasiri}}{{FK}}
 ==Causes==
@@ Line 193: / Line 193: @@
 {{CMG}} {{AE}} {{Nnasiri}}
 ==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:<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
 :* [[Cervical polyp]]
@@ Line 218: / Line 219: @@
 :** Factors deficiency
 {|
-! colspan="12" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal Uterine bleeidng differential diagnosis
+! colspan="14" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Abnormal Uterine bleeidng differential diagnosis'''
-!
-!
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ob-Gyn neoplasm and diseases
@@ Line 235: / Line 234: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal
 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;" |Pelvic
 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;" |Abdominal
@@ Line 254: / Line 253: @@
 ! 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;" |
-* Postmenopausal
+* [[Postmenopausal]]
 * Intermenstrual
 * Postcoital
-* Bleeding after pelvic exam
+* Bleeding after [[pelvic exam]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Dysuria
+* [[Dysuria]]
-* Urinary hesitancy
+* [[Urinary hesitancy]]
-* Dyspareunia
+* [[Dyspareunia]]
-* Vaginal discharge
+* [[Vaginal discharge]]
 * Itching or burning of the vulva
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 271: / Line 270: @@
 * Cervical mass on exam
 | style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |± HPV
+| style="background: #F5F5F5; padding: 5px;" |± [[Human papilloma virus|HPV]]
-* Atypical cells on Pap smear
+* Atypical cells on [[Pap smear]]
-* STI: ±Chlamydia
+* [[STI]]: ± [[Chlamydia]]
 | style="background: #F5F5F5; padding: 5px;" |
-* ↑ CA-125
+* ↑ [[CA-125]]
 * Leukomoid reaction
 | style="background: #F5F5F5; padding: 5px;" |
-* Large cervical cancer
+* Large [[cervical cancer]]
-* Angiogenesis on Doppler sonography
+* [[Angiogenesis]] on [[Doppler sonography]]
-* Bladder involvement
+* [[Bladder]] involvement
-* Lymph node involvement
+* [[Lymph node]] involvement
 | style="background: #F5F5F5; padding: 5px;" |  '''T2-weighted MRI''' :
 * Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement.  '''PET/CT scan''':
 ** Detect tumor size
-** 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]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Colposcopy/biopsy
+* [[Colposcopy]]/[[biopsy]]
 |-
 ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical polyp]]<ref name="pmid151660702">{{cite journal |vauthors=Mitchell H |title=Vaginal discharge--causes, diagnosis, and treatment |journal=BMJ |volume=328 |issue=7451 |pages=1306–8 |date=May 2004 |pmid=15166070 |pmc=420177 |doi=10.1136/bmj.328.7451.1306 |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |
-* Postcoital
+* [[Postcoital contraception|Postcoital]]
 * Intermenstrual
-* Postmenopausal
+* [[Postmenopausal]]
 * Bleeding after exam
 | style="background: #F5F5F5; padding: 5px;" |
-* Vaginal discharge
+* [[Vaginal discharge]]
-* Dyspareunia
+* [[Dyspareunia]]
 | style="background: #F5F5F5; padding: 5px;" | −
 | style="background: #F5F5F5; padding: 5px;" | −
@@ Line 325: / Line 324: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
-* Epithelial cells with no nuclear atypia/mitoses
+* [[Epithelial cells]] with no nuclear [[atypia]]/[[mitoses]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Hysteroscopy /Biopsy
+* [[Hysteroscopy]] /[[Biopsy]]
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 338: / Line 337: @@
 * Intermenstrual bleeding
 | style="background: #F5F5F5; padding: 5px;" |
-* Urinary retention
+* [[Urinary retention]]
 * [[Constipation]]
 * Infertility
 * [[Bowel obstruction]]
-* Increase in pregnancy/labor complications
+* Increase in [[pregnancy]]/labor complications
-* Vaginal discharge
+* [[Vaginal discharge]]
 | 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;" |±
 *
@@ Line 362: / Line 361: @@
 * Red degeneration
 | style="background: #F5F5F5; padding: 5px;" |
-* Spindle shaped smooth muscle cells
+* Spindle shaped [[smooth muscle cells]]
-* Mature adipocytes
+* Mature [[adipocytes]]
-* Extracellular matrix consist of collagen,fibronectin.
+* Extracellular matrix consist of [[collagen]],[[fibronectin]].
 | style="background: #F5F5F5; padding: 5px;" |
 * Clinical diagnosis/ and
@@ Line 381: / Line 380: @@
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |
-* Larrge uterine/cervix mass
+* Larrge [[uterine]]/[[cervix]] mass
 * Irregularity
 | style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |'''Pap smear:'''
+| style="background: #F5F5F5; padding: 5px;" |'''[[Pap smear]]:'''
 * Small round blue cells
-* High nuclear/cytoplasm ratio,
+* High nuclear/[[cytoplasm]] ratio,
 * Scant cytoplasm
-| style="background: #F5F5F5; padding: 5px;" |'''Immunohistochemistry markers:'''
+| style="background: #F5F5F5; padding: 5px;" |'''[[Immunohistochemistry]] markers:'''
 * [[CD19]], [[CD20]], [[CD79a|CD79]]<nowiki/>a, [[PAX5]]
@@ Line 398: / Line 397: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * 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;" |
-* 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>
@@ Line 410: / Line 409: @@
 * Post-coital pain
 * Fullness in pelvic
-* Vaginal discharge
+* [[Vaginal discharge]]
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 416: / Line 415: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Cervical Cancer|Cervical]] mass
-* Lump protruding  from vagina/vulva
+* [[Lump]] protruding  from vagina/vulva
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |−
@@ Line 422: / Line 421: @@
 * Positive for for [[S-100]] and [[vimentin]] and are negative for [[desmin]], [[myoglobin]] and [[actin]].
 | style="background: #F5F5F5; padding: 5px;" |
-* Endometrial mass with heterogeneous echogenicity
+* [[Endometrial]] mass with heterogeneous echogenicity
 | style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
-* Endometrial polypoid mass
+* [[Endometrial]] polypoid mass
 * Hypointense hypervascular solid components
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 431: / Line 430: @@
 ** [[Leiomyosarcoma]]
 ** Endocervical [[sarcoma]]
-** Embryonal rhabdomyosarcoma( [[Sarcoma botryoides]])
+** [[Embryonal rhabdomyosarcoma]]( [[Sarcoma botryoides]])
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Biopsy]]
@@ Line 445: / Line 444: @@
 * [[Dyspareunia]]
-* Vaginal discharge
+* [[Vaginal discharge]]
 * Itching of vulvovaginal area
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 451: / Line 450: @@
 | 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;" |−
@@ Line 461: / Line 460: @@
 * [[Squamous metaplasia]]
-* Vascular ectasia
+* [[Vascular ectasia of the colon|Vascular ectasia]]
 * [[Lymphocytic]] infiltration
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 467: / Line 466: @@
 | style="background: #F5F5F5; padding: 5px;" |
 |-
-! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervicitis]]<ref name="pmid27243142">{{cite journal |vauthors=Mattson SK, Polk JP, Nyirjesy P |title=Chronic Cervicitis: Presenting Features and Response to Therapy |journal=J Low Genit Tract Dis |volume=20 |issue=3 |pages=e30–3 |date=July 2016 |pmid=27243142 |doi=10.1097/LGT.0000000000000225 |url=}}</ref><ref name="pmid2660084">{{cite journal |vauthors=Rosenfeld WD, Clark J |title=Vulvovaginitis and cervicitis |journal=Pediatr. Clin. North Am. |volume=36 |issue=3 |pages=489–511 |date=June 1989 |pmid=2660084 |doi= |url=}}</ref><ref name="pmid27681919">{{cite journal |vauthors=Meyer T |title=Diagnostic Procedures to Detect Chlamydia trachomatis Infections |journal=Microorganisms |volume=4 |issue=3 |pages= |date=August 2016 |pmid=27681919 |doi=10.3390/microorganisms4030025 |url=}}</ref><ref name="WoodsBailey2011">{{cite journal|last1=Woods|first1=Jennifer L.|last2=Bailey|first2=Sarabeth L.|last3=Hensel|first3=Devon J.|last4=Scurlock|first4=Amy M.|title=Cervicitis in Adolescents: Do Clinicians Understand Diagnosis and Treatment?|journal=Journal of Pediatric and Adolescent Gynecology|volume=24|issue=6|year=2011|pages=359–364|issn=10833188|doi=10.1016/j.jpag.2011.06.006}}</ref>
+! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervicitis]]<ref name="pmid27243142">{{cite journal |vauthors=Mattson SK, Polk JP, Nyirjesy P |title=Chronic Cervicitis: Presenting Features and Response to Therapy |journal=J Low Genit Tract Dis |volume=20 |issue=3 |pages=e30–3 |date=July 2016 |pmid=27243142 |doi=10.1097/LGT.0000000000000225 |url=}}</ref><ref name="pmid2660084">{{cite journal |vauthors=Rosenfeld WD, Clark J |title=Vulvovaginitis and cervicitis |journal=Pediatr. Clin. North Am. |volume=36 |issue=3 |pages=489–511 |date=June 1989 |pmid=2660084 |doi= |url=}}</ref><ref name="pmid27681919">{{cite journal |vauthors=Meyer T |title=Diagnostic Procedures to Detect Chlamydia trachomatis Infections |journal=Microorganisms |volume=4 |issue=3 |pages= |date=August 2016 |pmid=27681919 |doi=10.3390/microorganisms4030025 |url=}}</ref><ref name="WoodsBailey2011">{{cite journal|last1=Woods|first1=Jennifer L.|last2=Bailey|first2=Sarabeth L.|last3=Hensel|first3=Devon J.|last4=Scurlock|first4=Amy M.|title=Cervicitis in Adolescents: Do Clinicians Understand Diagnosis and Treatment?|journal=Journal of Pediatric and Adolescent Gynecology|volume=24|issue=6|year=2011|pages=359–364|issn=10833188|doi=10.1016/j.jpag.2011.06.006}}</ref><ref name="Jayakumar2015">{{cite journal|last1=Jayakumar|first1=Naveen Kumar Bhagavathula|title=Cervicitis: How Often Is It Non-specific!|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2015|issn=2249782X|doi=10.7860/JCDR/2015/11594.5673}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |
 * Intermenstrual bleeding
@@ Line 479: / Line 478: @@
 * Pain during sex
 * Painful menstruation
-* [[Vaginal discharge]]
+* Purulent [[vaginal discharge]]
 * Itching of vulva
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 486: / Line 485: @@
 * May have fever only
 | style="background: #F5F5F5; padding: 5px;" |
-* Red,inflammed swollen cervix
+* Red,inflammed swollen [[cervix]]
 * Inflammation/irritation of vulva/vagina
 | style="background: #F5F5F5; padding: 5px;" |−
@@ Line 492: / Line 491: @@
 * [[Chlamydia]]
-* Gonorrhea
+* [[Gonorrhea]]
 * [[Herpes simplex]]
 * [[Trichomonas vaginalis]]
@@ Line 501: / Line 500: @@
 *
 | style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
+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.
+* [[Koilocyte|Koilocytic]] changes in case of [[HPV]] as cause of chronic [[cervicitis]].
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Nucleic acid amplification technique|Nucleic acid amplification tests]] ([[NAAT]]<nowiki/>s)
@@ Line 512: / Line 516: @@
 bleeding
 | style="background: #F5F5F5; padding: 5px;" |
-* Vaginal discharge
+* [[Vaginal discharge]]
 * Pain during urination
 * Pain during sex
 * Fulness in pelvic
-* Difficulty emptying bladder
+* Difficulty emptying [[bladder]]
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 524: / Line 528: @@
 * Often normal
-* Vaginal lump
+* Vaginal [[lump]]
-* Pelvic mass
+* [[Pelvic masses|Pelvic mass]]
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |−
@@ Line 531: / Line 535: @@
 * ↑ [[CA-125]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Thickened endometrium
+* Thickened [[endometrium]]
 * Myometrial invasion
@@ Line 539: / Line 543: @@
 '''T2-weighted MRI:'''
-* Intermediate signal intensity lower than the normal endometrium
+* Intermediate signal intensity lower than the normal [[endometrium]]
 | style="background: #F5F5F5; padding: 5px;" |'''Type I endometrioid endometrial carcinomas (EECs):'''
 * Moderately differentiated
@@ Line 549: / Line 553: @@
 * Not related to [[endometrial hyperplasia]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Hysterectomy and biopsy
+* [[Hysterectomy]] and [[biopsy]]
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 562: / Line 566: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Dysmenorrhea]]
-* Amenorrhea
+* [[Amenorrhea]]
 * [[Dyspareunia]]
 * Heavy menstrual bleeding
@@ Line 568: / Line 572: @@
 * +
 | style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |N/A
+| style="background: #F5F5F5; padding: 5px;" |−
 | style="background: #F5F5F5; padding: 5px;" |
 * Normal or thickened endometrium
 | style="background: #F5F5F5; padding: 5px;" |±
 | style="background: #F5F5F5; padding: 5px;" |−
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |N/A
 | style="background: #F5F5F5; padding: 5px;" |
 * Thickened [[endometrium]]
@@ Line 586: / Line 590: @@
 * 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;" |
-* Biopsy
+* [[Biopsy]]
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 603: / Line 607: @@
 * Pain during or after sex
 * [[Infertility]]
-* Watery vaginal discharge
+* Watery [[vaginal discharge]]
 | 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;" |
@@ Line 613: / Line 617: @@
 * Immobile uterus
 * [[Cervical|Cervica]]<nowiki/>l motion tenderness
-* Retroverted uterus
+* Retroverted [[uterus]]
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |−
@@ Line 624: / Line 628: @@
 (limited value)
 | style="background: #F5F5F5; padding: 5px;" |
-* Ground glass echogenicity of the cyst fluid (Endonetrioma)
+* Ground glass echogenicity of the cyst fluid ([[Endometrioma]])
 * Cysts are unilocular
 | style="background: #F5F5F5; padding: 5px;" |
-* MRI findings is variable, depending upon 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;" |
-* 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.
 *
 | style="background: #F5F5F5; padding: 5px;" |
 * Visual inspection by [[laparoscopy]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-|-
-! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intrauterine device|IUD]] use<ref name="pmid347074">{{cite journal |vauthors=Trobough GE |title=Pelvic pain and the IUD |journal=J Reprod Med |volume=20 |issue=3 |pages=167–74 |date=March 1978 |pmid=347074 |doi= |url=}}</ref><ref>{{cite journal|doi=10.5489/cuaj.11100.}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |
-* Heavy bleeidng
-| style="background: #F5F5F5; padding: 5px;" |
-* Painful menstruation
-* ±Vaginal discharge
-| style="background: #F5F5F5; padding: 5px;" | +
-* 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;" |
-* Normal
-| 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;" |
@@ Line 659: / Line 643: @@
 | style="background: #F5F5F5; padding: 5px;" |
 |-
-! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pelvic inflammatory diseases]]<ref name="pmid30606817">{{cite journal |vauthors=Hoenderboom BM, van Benthem BHB, van Bergen JEAM, Dukers-Muijrers NHTM, Götz HM, Hoebe CJPA, Hogewoning AA, Land JA, van der Sande MAB, Morré SA, van den Broek IVF |title=Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial |journal=Sex Transm Infect |volume= |issue= |pages= |date=January 2019 |pmid=30606817 |doi=10.1136/sextrans-2018-053778 |url=}}</ref><ref name="pmid21822367">{{cite journal |vauthors=Jaiyeoba O, Soper DE |title=A practical approach to the diagnosis of pelvic inflammatory disease |journal=Infect Dis Obstet Gynecol |volume=2011 |issue= |pages=753037 |date=2011 |pmid=21822367 |pmc=3148590 |doi=10.1155/2011/753037 |url=}}</ref>
+! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pelvic inflammatory diseases]]<ref name="pmid30606817">{{cite journal |vauthors=Hoenderboom BM, van Benthem BHB, van Bergen JEAM, Dukers-Muijrers NHTM, Götz HM, Hoebe CJPA, Hogewoning AA, Land JA, van der Sande MAB, Morré SA, van den Broek IVF |title=Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial |journal=Sex Transm Infect |volume= |issue= |pages= |date=January 2019 |pmid=30606817 |doi=10.1136/sextrans-2018-053778 |url=}}</ref><ref name="pmid21822367">{{cite journal |vauthors=Jaiyeoba O, Soper DE |title=A practical approach to the diagnosis of pelvic inflammatory disease |journal=Infect Dis Obstet Gynecol |volume=2011 |issue= |pages=753037 |date=2011 |pmid=21822367 |pmc=3148590 |doi=10.1155/2011/753037 |url=}}</ref><ref name="Czeyda-PommersheimKalb2016">{{cite journal|last1=Czeyda-Pommersheim|first1=Ferenc|last2=Kalb|first2=Bobby|last3=Costello|first3=James|last4=Liau|first4=Joy|last5=Meshksar|first5=Arash|last6=Arif Tiwari|first6=Hina|last7=Martin|first7=Diego|title=MRI in pelvic inflammatory disease: a pictorial review|journal=Abdominal Radiology|volume=42|issue=3|year=2016|pages=935–950|issn=2366-004X|doi=10.1007/s00261-016-1004-4}}</ref><ref name="MitchellPrabhu2013">{{cite journal|last1=Mitchell|first1=Caroline|last2=Prabhu|first2=Malavika|title=Pelvic Inflammatory Disease|journal=Infectious Disease Clinics of North America|volume=27|issue=4|year=2013|pages=793–809|issn=08915520|doi=10.1016/j.idc.2013.08.004}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |
 * Bleeding after sex
@@ Line 673: / Line 657: @@
 * [[Dysuria]]
 * [[Dyschezia]]
-* Smelly grey/white/yellow vaginal discharge
+* Foul-smelling grey/white/yellow [[vaginal discharge]]
 * Itching and burning of vulvovaginal area
-| style="background: #F5F5F5; padding: 5px;" |±
 | style="background: #F5F5F5; padding: 5px;" | +
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Pelvic pain]]
+* [[Cervical motion tenderness]]
 | style="background: #F5F5F5; padding: 5px;" |
 * Oral temperature >101F
 | 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;" |'''STI panel:'''
 * [[Chlamydia]]
 * [[Gonorrhea]]
-| style="background: #F5F5F5; padding: 5px;" |'''Non-specific lab values:'''
+| style="background: #F5F5F5; padding: 5px;" |
 * ↑ [[CRP]]
@@ Line 694: / Line 681: @@
 *
 | 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;" |
+| style="background: #F5F5F5; padding: 5px;" |'''MRI findings:'''
+* Inflammation in [[pelvic]] soft tissue
+* [[Hydrosalpinx]]
+* [[Tubo-ovarian abscess]] in chronic [[PID]].
 | style="background: #F5F5F5; padding: 5px;" |
+* Inflamed, purulent [[fallopian tubes]]
 *
 | style="background: #F5F5F5; padding: 5px;" |
 * 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>
+! 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: #F5F5F5; padding: 5px;" |
 * Abnormal uterine bleeding
@@ Line 714: / Line 708: @@
 * Polypoid mass protruding into the endocervical canal.
 | style="background: #F5F5F5; padding: 5px;" |
-* Enlarged uterus may present as abdominal mass
+* Enlarged [[uterus]] may present as [[abdominal mass]]
 | style="background: #F5F5F5; padding: 5px;" |−
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 721: / Line 715: @@
 * Subendometrial striations
 * 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:'''
 * Thickened junctional zone
 | style="background: #F5F5F5; padding: 5px;" |
+* Presence of ectopic [[endometrial]] glands into the myometrium.
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Histology]] findings post [[hysterectomy]]
 |-
 ! style="background: #DCDCDC; padding: 5px; text-align: center;" |Cervical [[ectopic pregnancy]]<ref name="pmid28955106">{{cite journal |vauthors=Mouhajer M, Obed S, Okpala AM |title=Cervical Ectopic Pregnancy in Resource Deprived Areas: A Rare and Difficult Diagnosis |journal=Ghana Med J |volume=51 |issue=2 |pages=94–97 |date=June 2017 |pmid=28955106 |pmc=5611908 |doi= |url=}}</ref><ref name="RathodSamal2015">{{cite journal|last1=Rathod|first1=Setu|last2=Samal|first2=SunilKumar|title=Cervical ectopic pregnancy|journal=Journal of Natural Science, Biology and Medicine|volume=6|issue=1|year=2015|pages=257|issn=0976-9668|doi=10.4103/0976-9668.149221}}</ref>
@@ Line 745: / Line 741: @@
 * ↑ β-[[HCG]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Empty uterine
+* Empty [[uterine]]
-* Thickened endometrium
+* Thickened [[endometrium]]
 | style="background: #F5F5F5; padding: 5px;" | '''T2-weighted MRI''':
 * Hypointense large mass
@@ Line 753: / Line 749: @@
 * Partially hyperintense mass
 | style="background: #F5F5F5; padding: 5px;" |
-* Necrotic hemorrhagic mass with chorionic villus
+* Necrotic [[hemorrhagic]] mass with chorionic villus
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Hysterectomy]] and biopsy
-|-
-! 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;" |
-* Bleeding from lesion
-* Oozing
-| style="background: #F5F5F5; padding: 5px;" |
-* ±Vaginal discharge
-* Pain in vulva
-* Itching or burning sensation in vulva
-| style="background: #F5F5F5; padding: 5px;" |−
-| style="background: #F5F5F5; padding: 5px;" |−
-| style="background: #F5F5F5; padding: 5px;" |−
-*
-| style="background: #F5F5F5; padding: 5px;" |
-* Scaly eczematoid lesion in vulva.
-* Erythematous plaques with white scaling.
-* [[Inguinal]] lymphadenopathy in case of metastases.
-| style="background: #F5F5F5; padding: 5px;" |−
-| style="background: #F5F5F5; padding: 5px;" |−
-| style="background: #F5F5F5; padding: 5px;" |
-* Positive for cytokeratins(CK7)
-* Negative for S-100 and Melan-A
-| style="background: #F5F5F5; padding: 5px;" |N/A
-| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
-* Hyperintense on diffusion weighted imaging
-| style="background: #F5F5F5; padding: 5px;" |
-* Thick vulvar skin
-* "Cake-icing effect", pathognomic for vulvar paget's disease
-* Intraepidermal adenocarcinoma which involves epidermis
-| style="background: #F5F5F5; padding: 5px;" |
-* Biopsy of lesion
 |-
 ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Vaginal cancer]]<ref name="pmid25045355">{{cite journal |vauthors=Tarney CM, Han J |title=Postcoital bleeding: a review on etiology, diagnosis, and management |journal=Obstet Gynecol Int |volume=2014 |issue= |pages=192087 |date=2014 |pmid=25045355 |pmc=4086375 |doi=10.1155/2014/192087 |url=}}</ref><ref name="MiccòSala20152">{{cite journal|last1=Miccò|first1=Maura|last2=Sala|first2=Evis|last3=Lakhman|first3=Yulia|last4=Hricak|first4=Hedvig|last5=Vargas|first5=Hebert Alberto|title=Imaging Features of Uncommon Gynecologic Cancers|journal=American Journal of Roentgenology|volume=205|issue=6|year=2015|pages=1346–1359|issn=0361-803X|doi=10.2214/AJR.14.12695}}</ref><ref name="KimSong2013">{{cite journal|last1=Kim|first1=Hwi-Gon|last2=Song|first2=Yong Jung|last3=Na|first3=Yong Jin|last4=Choi|first4=Ook-Hwan|title=A Case of Vaginal Cancer with Uterine Prolapse|journal=Journal of Menopausal Medicine|volume=19|issue=3|year=2013|pages=139|issn=2288-6478|doi=10.6118/jmm.2013.19.3.139}}</ref><ref name="pmid17139994">{{cite journal |vauthors=Karateke A, Tugrul S, Yakut Y, Gürbüz A, Cam C |title=Management of a case of primary vaginal cancer with irreducible massive uterine prolapse--a case report |journal=Eur. J. Gynaecol. Oncol. |volume=27 |issue=5 |pages=528–30 |date=2006 |pmid=17139994 |doi= |url=}}</ref>
@@ Line 796: / Line 757: @@
 * Postcoital bleeding
 | style="background: #F5F5F5; padding: 5px;" |
-* Tenesmus
+* [[Tenesmus]]
 * [[Dysuria]]
-* Urinary frequency
+* [[Urinary frequency]]
 * [[Constipation]]
-* Pelvic pain
+* [[Pelvic pain]]
 * [[Vaginal discharge]]
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 808: / Line 769: @@
 * 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]]
 * [[Cystocele]]
 | style="background: #F5F5F5; padding: 5px;" |
-* In case of metastases to internal organs
+* In case of [[metastases]] to internal organs
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Pap smear]] can be normal
@@ Line 823: / Line 784: @@
 * ↓ [[RBC]] count
 | 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:'''
 * Isointense on T1-weighted images
@@ Line 831: / Line 792: @@
 * [[Squamous cell carcinoma]] of vagina
 | style="background: #F5F5F5; padding: 5px;" |
-* Biopsy
+* [[Biopsy]]
+|-
+! 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;" |
+* Bleeding/oozing from lesion
+| style="background: #F5F5F5; padding: 5px;" |
+* ± [[Vaginal discharge]]
+* Pain in vulva
+* Itching or burning sensation in vulva
+| style="background: #F5F5F5; padding: 5px;" |−
+| style="background: #F5F5F5; padding: 5px;" |−
+| style="background: #F5F5F5; padding: 5px;" |−
+*
+| style="background: #F5F5F5; padding: 5px;" |
+* Scaly eczematoid lesion in vulva.
+* [[Erythematous]] plaques with white scaling.
+* [[Inguinal]] [[lymphadenopathy]] in case of metastases.
+| style="background: #F5F5F5; padding: 5px;" |−
+| style="background: #F5F5F5; padding: 5px;" |−
+| style="background: #F5F5F5; padding: 5px;" |
+* Positive for [[cytokeratin]](CK7)
+* Negative for [[S-100]] and Melan-A
+| style="background: #F5F5F5; padding: 5px;" |N/A
+| style="background: #F5F5F5; padding: 5px;" |'''MRI:'''
+* Hyperintense on diffusion weighted imaging
+| style="background: #F5F5F5; padding: 5px;" |
+* Thick vulvar skin
+* "Cake-icing effect", pathognomic for vulvar [[paget's disease]]
+* Intraepidermal [[adenocarcinoma]] which involves [[epidermis]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Biopsy]] of lesion
 |-
 ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nabothian cyst]]<ref name="pmid21270291">{{cite journal |vauthors=Casey PM, Long ME, Marnach ML |title=Abnormal cervical appearance: what to do, when to worry? |journal=Mayo Clin. Proc. |volume=86 |issue=2 |pages=147–50; quiz 151 |date=February 2011 |pmid=21270291 |pmc=3031439 |doi=10.4065/mcp.2010.0512 |url=}}</ref><ref name="Bin ParkLee2010">{{cite journal|last1=Bin Park|first1=Sung|last2=Lee|first2=Jong Hwa|last3=Lee|first3=Young Ho|last4=Song|first4=Mi Jin|last5=Choi|first5=Hye Jeong|title=Multilocular Cystic Lesions in the Uterine Cervix: Broad Spectrum of Imaging Features and Pathologic Correlation|journal=American Journal of Roentgenology|volume=195|issue=2|year=2010|pages=517–523|issn=0361-803X|doi=10.2214/AJR.09.3619}}</ref><ref name="Torky2016">{{cite journal|last1=Torky|first1=Haitham A.|title=Huge Nabothian cyst causing Hematometra (case report)|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|volume=207|year=2016|pages=238–240|issn=03012115|doi=10.1016/j.ejogrb.2016.10.042}}</ref><ref name="OkamotoTanaka2003">{{cite journal|last1=Okamoto|first1=Yoshikazu|last2=Tanaka|first2=Yumiko O.|last3=Nishida|first3=Masato|last4=Tsunoda|first4=Hajime|last5=Yoshikawa|first5=Hiroyuki|last6=Itai|first6=Yuji|title=MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation|journal=RadioGraphics|volume=23|issue=2|year=2003|pages=425–445|issn=0271-5333|doi=10.1148/rg.232025065}}</ref>
@@ Line 840: / Line 835: @@
 * [[Vaginal discharge]]
 | 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;" |
-* 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
@@ Line 859: / Line 854: @@
 * Multiple benign cystic masses, usually few milimieters in diameter.
 | style="background: #F5F5F5; padding: 5px;" |
-* Histopathological exam if large cystic masses
+* [[Histopathological]] exam if large cystic masses
+|-
+! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intrauterine device|IUD]] use<ref name="pmid347074">{{cite journal |vauthors=Trobough GE |title=Pelvic pain and the IUD |journal=J Reprod Med |volume=20 |issue=3 |pages=167–74 |date=March 1978 |pmid=347074 |doi= |url=}}</ref><ref name="NowitzkiHoimes2015">{{cite journal|last1=Nowitzki|first1=Kristina M.|last2=Hoimes|first2=Matthew L.|last3=Chen|first3=Byron|last4=Zheng|first4=Larry Z.|last5=Kim|first5=Young H.|title=Ultrasonography of intrauterine devices|journal=Ultrasonography|volume=34|issue=3|year=2015|pages=183–194|issn=2288-5919|doi=10.14366/usg.15010}}</ref><ref>{{cite journal|doi=10.5489/cuaj.11100.}}</ref>
+| style="background: #F5F5F5; padding: 5px;" |
+* Heavy bleeidng
+| style="background: #F5F5F5; padding: 5px;" |
+* Painful menstruation
+* ± [[Vaginal discharge]]
+| style="background: #F5F5F5; padding: 5px;" | +
+* 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;" |
+* Normal
+| style="background: #F5F5F5; padding: 5px;" |−
+| style="background: #F5F5F5; padding: 5px;" |−
+| style="background: #F5F5F5; padding: 5px;" |
+* May have decreased [[RBC]] count
+| style="background: #F5F5F5; padding: 5px;" |
+* Linear echogenic intrauterine structures
+| style="background: #F5F5F5; padding: 5px;" |N/A
+| style="background: #F5F5F5; padding: 5px;" |N/A
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Transvaginal ultrasound]]
 |}
 <br>
@@ Line 895: / Line 913: @@
 * ↓ [[RBC]]
 | 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
-* Absence of embryo heart activity
+* Absence of [[embryo]] heart activity
 | style="background: #F5F5F5; padding: 5px;" |
 * Abnormal villi in [[Chromosome abnormality|chromosomal abnormalities]]
@@ Line 910: / Line 928: @@
 * Pelvic/back pain
 * [[Abdominal]] pain
-* Vaginal bleeding
+* [[Vaginal bleeding]]
-* Painful uterine contractions
+* Painful [[uterine]] contractions
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Uterine]] tenderness
@@ Line 931: / Line 949: @@
 * Villous infarctions
-* Decidual destruction, [[hemorrhage]]
+* [[Decidual cells|Decidual]] destruction, [[hemorrhage]]
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Transvaginal ultrasound]]
@@ Line 938: / 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: #F5F5F5; padding: 5px;" | +
+* Usually painless vaginal bleeding
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Abdominal pain]]
@@ Line 954: / Line 973: @@
 * [[Hemorrhage]] into [[decidua]] and [[myometrium]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Transvaginal [[sonography]]
+* [[Transvaginal ultrasound]]
 | style="background: #F5F5F5; padding: 5px;" |
 |-
@@ Line 960: / Line 979: @@
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |
-* Pelvic pain which is worse on one side
+* [[Pelvic pain]] which is worse on one side
 * [[Abdominal]] pain
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Abdominal|Abdomina]]<nowiki/>l or pelvic tenderness
+* [[Adnexal mass causes|Adnexal]] <nowiki/>[[Adnexal mass causes|mass]]
-* [[Hemorrhagic shock]]
+* [[Hemorrhagic shock|Hemorrha]]<nowiki/>[[Hemorrhagic shock|gic shock]]
 | style="background: #F5F5F5; padding: 5px;" |
 * ↑ β-[[Human chorionic gonadotropin|HCG]]
@@ Line 977: / Line 996: @@
 * Tubal rupture
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Hemorrhage]]
+* Product of conception in [[fallopian tube]]
+* Empty [[uterus]]
 | style="background: #F5F5F5; padding: 5px;" |
 * Diagnostic [[Laparoscopy|laparascopy]]
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |'''Associated conditions:'''
+* Chronic [[salpingitis]]
+* [[Infertility]]
+* Tubal rupture
 |-
 ! style="background: #DCDCDC; padding: 5px;" text-align: center;" |[[Molar pregnancy]]<ref name="pmid28892983">{{cite journal |vauthors=Virmani S, Srinivas SB, Bhat R, Rao R, Kudva R |title=Transient Thyrotoxicosis in Molar Pregnancy |journal=J Clin Diagn Res |volume=11 |issue=7 |pages=QD01–QD02 |date=July 2017 |pmid=28892983 |doi=10.7860/JCDR/2017/28561.10133 |url=}}</ref><ref name="pmid8253548">{{cite journal |vauthors=Jeffers MD, O'Dwyer P, Curran B, Leader M, Gillan JE |title=Partial hydatidiform mole: a common but underdiagnosed condition. A 3-year retrospective clinicopathological and DNA flow cytometric analysis |journal=Int. J. Gynecol. Pathol. |volume=12 |issue=4 |pages=315–23 |date=October 1993 |pmid=8253548 |doi= |url=}}</ref><ref name="pmid19375983">{{cite journal |vauthors=Alhamdan D, Bignardi T, Condous G |title=Recognising gestational trophoblastic disease |journal=Best Pract Res Clin Obstet Gynaecol |volume=23 |issue=4 |pages=565–73 |date=August 2009 |pmid=19375983 |doi=10.1016/j.bpobgyn.2009.03.001 |url=}}</ref>
@@ Line 990: / Line 1,016: @@
 * [[Vomiting]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Uterine size larger than date
+* [[Uterine]] size larger than date
 * Sign of [[hyperthyroidism]]
@@ Line 1,008: / Line 1,034: @@
 * Empty uterus
-* Fetal tissue in partial hydatiform mole.
+* [[Fetal]] tissue in partial [[hydatiform mole]].
 | style="background: #F5F5F5; padding: 5px;" |
 * Histological confirmation post-curettage
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |'''Associated conditions:'''
+* [[Choriocarcinoma]]
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" | Hematologic conditions
@@ Line 1,045: / Line 1,072: @@
 * Blood in stool
 * Blood in urine
-* GI bleeding in rare cases
+* [[GI bleeding]] in rare cases
 | style="background: #F5F5F5; padding: 5px;" |
 * Bruises on skin
@@ Line 1,065: / Line 1,092: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * 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)
 | 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>
@@ Line 1,089: / Line 1,118: @@
 * [[Petechia]] on skin
-* Intramuscular hematoma
+* Intramuscular [[hematoma]]
 * [[Hematemesis]]
@@ Line 1,096: / Line 1,125: @@
 * [[Hematuria]]
-* Abdominal pain
+* [[Abdominal pain]]
 * Intracranial bleeding signs:
 ** [[Headache]]
@@ Line 1,114: / Line 1,143: @@
 * [[Factor VIII]] , [[Factor IX|IX]], XI assay
 | 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>
+! 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: #F5F5F5; padding: 5px;" |±
 | style="background: #F5F5F5; padding: 5px;" |
 * Skin bruises
 * [[Epistaxis]]
-* Excessive bleeding after surgery
+* [[Gingival]] bleeding
+* Excessive bleeding after [[surgery]]
-* Menorrhagia
+* [[Menorrhagia]]
 *
 | style="background: #F5F5F5; padding: 5px;" |
 * Bruises on skin
+* [[Mucocutaneous]] bleeding
 | colspan="2" style="background: #F5F5F5; padding: 5px;" |
 * [[Thrombocytopenia]]
@@ Line 1,131: / Line 1,163: @@
 * ↓ [[RBC]] count
 * [[Platelet]] secretion and dense granules abnormalities
+* Prolonged [[bleeding time]]
+* Giant platelet on smear( [[Bernard-Soulier syndrome]])
 | 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;" |
+| style="background: #F5F5F5; padding: 5px;" |'''Gold standard diagnostic test:'''
-| style="background: #F5F5F5; padding: 5px;" |
+* Light transmission aggregometry (LTA)
+'''Other useful diagnostic tests:'''
+* [[PFA-100]] system
+* [[Flow cytometry]] for [[GPIb]] quantitation
+* [[VWD]] factor assay
+* [[Genotyping]]
+* [[Secretion assay]], [[ADP]] release
+| style="background: #F5F5F5; padding: 5px;" |'''Associated conditions:'''
+* [[Bernard-Soulier syndrome]]
+* [[Glanzmann's thrombasthenia]]
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Metabolic conditions
@@ Line 1,180: / Line 1,225: @@
 * Enlarged colloids
 | style="background: #F5F5F5; padding: 5px;" |
-* Total T4
+* Total [[T4]]
 For [[Grave's disease]]:
 * [[TSH]] receptor antibody
@@ Line 1,213: / Line 1,258: @@
 * Normal/ low [[Thyroid-stimulating hormone|TSH]]
-* ↑ Total cholesterol
+* ↑ Total [[cholesterol]]
 * ↑ [[LDL]]
 * ↑ [[VLDL]]
@@ Line 1,219: / Line 1,264: @@
 * Homogenous hypo-echogenicity
 | style="background: #F5F5F5; padding: 5px;" |'''Microscopic histology:'''
-* Follicular atrophy
+* Follicular [[atrophy]]
 * Chronic [[lymphocytic]] infiltration
 * [[Hyperplastic]] change in the follicles
-* Presence of [[Hurthle cells|Hurthle cell]] metaplasia
+* Presence of [[Hurthle cells|Hurthle cell]] [[metaplasia]]
 | style="background: #F5F5F5; padding: 5px;" |
 * [[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
@@ Line 1,243: / Line 1,288: @@
 * Irregular menses
-* Percocious puberty
+* Percocious [[puberty]]
-* Muscle weakness
+* [[Muscle weakness]]
-* Fatigue
+* [[Fatigue]]
 | style="background: #F5F5F5; padding: 5px;" |Depending upon deficient enzyme:
 *[[Ambiguous genitalia]] in male or female
-*[[Hypertension]]/ Hypotension
+*[[Hypertension]]/ [[Hypotension]]
 *[[Primary amenorrhea]]
@@ Line 1,277: / Line 1,322: @@
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |
-* Acne
+* [[Acne]]
 * [[Hirsutism]]/hair loss
-* Weight gain
+* [[Weight gain]]
-* Moon facies
+* [[Moon facies]]
 * Skin bruising
-* Abdominal striae
+* Abdominal [[striae]]
 * [[Insomnia]],
@@ Line 1,289: / Line 1,334: @@
 * Decrease [[libido]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Facial plethora
+* Facial [[plethora]]
+* Abnormal fat distribution
 * [[Acanthosis nigricans]]
-* Ecchymosis
+* [[Ecchymosis]]
 * Violacious striae
-* Muscle weakness
+* [[Muscle weakness]]
 * [[Kyphosis]]
@@ Line 1,305: / Line 1,351: @@
 * [[Edema]]
-* Slow deep tendon reflex relaxation
+* Slow [[deep tendon reflex]] relaxation
 * Emotional lability
@@ Line 1,312: / Line 1,358: @@
 * [[Lipodystrophy]]
 * [[Glucose]] intolerance or [[diabetes mellitus]]
+* Visual field changes
 | colspan="3" style="background: #F5F5F5; padding: 5px;" |
 * Low/Normal [[ACTH]]
@@ Line 1,319: / Line 1,366: @@
 * [[Pituitary macroadenoma]]
 | style="background: #F5F5F5; padding: 5px;" |
-* [[Pituitary]] macro/micro adenoma
+* [[Pituitary]] macro/micro [[adenoma]]
 | style="background: #F5F5F5; padding: 5px;" |
 * Testing urinary free [[cortisol]] over 24 hours (UFC)
 * Overnight [[Dexamethasone]] 8 mg, distinguishes [[Cushing’s syndrome]] from the ectopic [[ACTH]] secretion
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |'''Associated conditions:'''
+* [[Metabolic syndrome]]
+* [[Diabetes mellitus]]
+* [[Hypertension]]
+* [[Osteoprosis]]
+* [[Multiple endocrine neoplasia type1]]
 |-
 ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Polycystic ovary syndrome|Polycystic ovarian syndrome]]<ref name="Lie FongLaven2017">{{cite journal|last1=Lie Fong|first1=S.|last2=Laven|first2=J.S.E.|last3=Duhamel|first3=A.|last4=Dewailly|first4=D.|title=Polycystic ovarian morphology and the diagnosis of polycystic ovary syndrome: redefining threshold levels for follicle count and serum anti-Müllerian hormone using cluster analysis|journal=Human Reproduction|volume=32|issue=8|year=2017|pages=1723–1731|issn=0268-1161|doi=10.1093/humrep/dex226}}</ref><ref name="pmid28854584">{{cite journal |vauthors=Lie Fong S, Laven JSE, Duhamel A, Dewailly D |title=Polycystic ovarian morphology and the diagnosis of polycystic ovary syndrome: redefining threshold levels for follicle count and serum anti-Müllerian hormone using cluster analysis |journal=Hum. Reprod. |volume=32 |issue=8 |pages=1723–1731 |date=August 2017 |pmid=28854584 |doi=10.1093/humrep/dex226 |url=}}</ref><ref name="pmid20734696">{{cite journal |vauthors=Pembe AB, Abeid MS |title=Polycystic ovaries and associated clinical and biochemical features among women with infertility in a tertiary hospital in Tanzania |journal=Tanzan J Health Res |volume=11 |issue=4 |pages=175–80 |date=October 2009 |pmid=20734696 |doi= |url=}}</ref><ref name="pmid16222950">{{cite journal |vauthors=Fleischman A, Mansfield J |title=Diagnosis and treatment of polycystic ovarian syndrome and insulin resistance |journal=Pediatr Ann |volume=34 |issue=9 |pages=733–8, 741–2 |date=September 2005 |pmid=16222950 |doi= |url=}}</ref><ref name="McManusLevitsky2013">{{cite journal|last1=McManus|first1=Shilpa|last2=Levitsky|first2=Lynne|last3=Misra|first3=Madhusmita|title=Polycystic Ovary Syndrome: Clinical Presentation in Normal-Weight Compared with Overweight Adolescents|journal=Endocrine Practice|volume=19|issue=3|year=2013|pages=471–478|issn=1530-891X|doi=10.4158/EP12235.OR}}</ref>
@@ Line 1,332: / Line 1,387: @@
 * [[Acne]]
 * Hair thinning
-* Mood swings
+* [[Mood swings]]
 * Irregular mens
 * [[Amenorrhea]]
@@ Line 1,340: / Line 1,395: @@
 * Enlarged ovaries
 * [[Hirsutism]]
-* Weight gain
+* [[Weight gain]]
 * [[Acanthosis nigricans]]
 | colspan="3" style="background: #F5F5F5; padding: 5px;" |
@@ Line 1,349: / Line 1,404: @@
 * ↑ [[Prolactin]] in some women
 * ↑ [[LH]]/ Normal or ↓ [[FSH]]
-* ↑ Serum Anti-mullerian hormone
+* ↑ Serum Anti-[[Anti-Müllerian hormone|mullerian]] hormone
 | style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
 * ↑ Number of follicles
@@ Line 1,359: / Line 1,414: @@
 * Fluid filled ovaries
 | style="background: #F5F5F5; padding: 5px;" |
-* Multiple cysts in ovaries bilaterally.
+* Multiple cysts in [[ovaries]] bilaterally.
 | style="background: #F5F5F5; padding: 5px;" |
 * Clinical,biochemical and [[ultrasound]]
-| style="background: #F5F5F5; padding: 5px;" |Associated conditions:
+| style="background: #F5F5F5; padding: 5px;" |'''Associated conditions:'''
 * Increased risk of [[cardiovascular disease]]
@@ Line 1,393: / Line 1,448: @@
 * Heavy menstrual bleeding
 | style="background: #F5F5F5; padding: 5px;" |
-* Pallor
+* [[Pallor]]
 * Heavy menstrual bleeding
@@ Line 1,418: / Line 1,473: @@
 * [[Amenorrhea]]
+* Sexual dysfunction
+| style="background: #F5F5F5; padding: 5px;" |
 * [[Galactorrhea]]
 * [[Gynecomastia]]
-* Sexual dysfunction
-| style="background: #F5F5F5; padding: 5px;" |
 | colspan="3" style="background: #F5F5F5; padding: 5px;" |
 * ↑ [[Prolactin]] level
@@ Line 1,432: / Line 1,486: @@
 * Serum [[prolactin]] test
 | style="background: #F5F5F5; padding: 5px;" |
+* History of mood disorders
 |-
 ! style="background: #DCDCDC; padding: 5px;" text-align: center;" | [[Oral contraceptive pills]]<ref name="ShakerinejadHidarnia2013">{{cite journal|last1=Shakerinejad|first1=Ghodratollah|last2=Hidarnia|first2=Alireza|last3=Motlagh|first3=Mohammad Esmaeil|last4=Karami|first4=Khodabakhsh|last5=Niknami|first5=Shamsoddin|last6=Montazeri|first6=Ali|title=Factors predicting mood changes in oral contraceptive pill users|journal=Reproductive Health|volume=10|issue=1|year=2013|issn=1742-4755|doi=10.1186/1742-4755-10-45}}</ref>
@@ Line 1,440: / Line 1,495: @@
 * Menstrual irregularity
-* Mood swings
+* [[Mood swings]]
 | style="background: #F5F5F5; padding: 5px;" |
 * Heavy bleeding
-* Depressed mood
+* [[Depressed mood]]
 | 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;" |
+* 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: #F5F5F5; padding: 5px;" |
 |-
-! 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>
+! 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: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |
+* Heavy menstrual bleeding
+* Menstrual irregularity
+* [[Amenorrhea]]
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Menorrhagia]]
 | colspan="3" style="background: #F5F5F5; padding: 5px;" |
+* ↓ [[RBC]] count
+* ↓ [[Hemoglobin]], ↓ [[Hematocrit]]
+* ↓ Serum [[Iron]]
+* ↓ [[Ferritin]]
 | style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
 * Thickened [[endometrium]]
 | style="background: #F5F5F5; padding: 5px;" |
+* Disorderd or proliferative pattern of [[endometrium]]
 | style="background: #F5F5F5; padding: 5px;" |
+* Complete medication history
 | style="background: #F5F5F5; padding: 5px;" |
+* History of [[Ginseng overuse]], soy bean use, Chinese herbal medicine
 |}