Dysfunctional uterine bleeding differential diagnosis: Difference between revisions

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Latest revision as of 01:13, 7 August 2022

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

Overview

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

Differential Diagnosis

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

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

Other Causes

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

Endometrioma
Hyperprolactinemia
Hypo- or Hyperthyroidism
Hypothalamic lesion
Medications (e.g., Norepinephrine)
Nonuterine bleeding
- Rectal
- Urinary
- Vaginal
- Cervical
Pelvic infection
Anorexia Nervosa, Nutritional status (Very low caloric intake) & intense exercise
Immature hypothalamic-pituitary-ovarian axis
Peri-menopause
Psychological distress^[3]

References

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

Template:WH Template:WS

[pmid30252237-1] "StatPearls". 2022. PMID 30252237.

[pmid24379699-2] Sirmans SM, Pate KA (2013). "Epidemiology, diagnosis, and management of polycystic ovary syndrome". Clin Epidemiol. 6: 1–13. doi:10.2147/CLEP.S37559. PMC 3872139. PMID 24379699.

[3] Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
- __NOTOC__
+__NOTOC__
-[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Dysfunctional_uterine_bleeding]]
+{{Dysfunctional uterine bleeding}}
-{{CMG}} {{AE}} {{VVS}}
+{{CMG}} {{AE}}[[User:AroojNaz|Arooj Naz, M.B.B.S]] ,{{VVS}}
-== Differential Diagnosis ==
+==Overview==
+There are many differential diagnosis' for dysfunctional uterine bleeding, many of them resulting in abnormal presentation of bleeding. Some prevalent conditions include anatomical or structural defects, [[coagulation]] disorders, [[Pregnancy complications|pregnancy]] related complications, [[endometrial cancer]] and [[hyperplasia]], as well as [[Polycystic Ovarian Syndrome]].
-* Anatomic or structural lesions
+==Differential Diagnosis==
-*:* Uterine or [[cervical polyp]]s
+Differential diagnosis' for dysfunctional uterine bleeding include anatomical defects, [[coagulation disorders]], [[pregnancy complications]], and endometrial conditions such as [[Endometrial cancer|malignancy]] and [[PCOS]].
-*:* [[Uterine leiomyoma]]
+{| class="wikitable"
-*:* Foreign body
+|+
-* Coagulation disorders
+Differential Diagnosis
-*:* Clotting factor disorder: [[Hemophilia]], hepatic disease, anticoagulant use, renal disease, [[Von Willebrand's Disease]]
+!Condition
-*:* Platelet dysfunction: [[Leukemia]], [[Thrombocytopenia]], and related medications
+!Common Underlying Causes
-* Pregnancy complications
+!Workup
-*:* Placental abruption
+|-
-*:* [[Ectopic Pregnancy]]
+|Anatomic or structural lesions
-*:* Miscarriage
+|
-*:* Spontaneous abortion
+*Uterine or [[cervical polyp]]s
-*:* [[Placenta previa]]
+*[[Uterine leiomyoma]]
-* Endometrial cancer
+*[[Foreign body]]
-*:* Risk Factors:
+|Pelvic or transvaginal [[Ultrasonography]]
-*:*:* [[Diabetes Mellitus]]
+|-
-*:*:* Unopposed estrogen
+|[[Coagulation]]<nowiki/> disorders
-*:*:* [[Obesity]]
+|
-*:*:* Older age
+*Clotting factor disorder: [[Hemophilia]], hepatic disease, anticoagulant use, renal disease, [[Von Willebrand's Disease]]
-*:*:* Chronic anovulation
+*Platelet dysfunction: [[Leukemia]], [[Thrombocytopenia]], and related medications
-*:*:* [[Ddx:Hypertension|Hypertension]]
+|[[Coagulation]] studies; [[PT]], [[aPTT]], [[Bleeding time|Bleeding Time]], and [[Clotting factors|clotting factor studies]]
-* Endometrial hyperplasia
+|-
-*:* Exogenous extrogen
+|[[Pregnancy complications]]
-*:* Excess of endogenous estrogen
+|
-*:* DUB (dysfunctional uterine bleeding) is a diagnosis of exclusion
+*[[Placental abruption]]
-* Endometrioma
+*[[Ectopic Pregnancy]]
-* Hyperprolactinemia
+*[[Miscarriage]]
-* Hypo- or [[Hyperthyroidism]]
+*[[Spontaneous abortions|Spontaneous abortion]]
-* Hypothalamic lesion
+*[[Placenta previa]]
-* Medications (e.g., [[Norepinephrine]])
+|[[Human chorionic gonadotropin|B-hCG]] should be the first test to detect the presence of [[pregnancy]]. Visualization of the defect requires pelvic or transvaginal [[ultrasonography]]
-* Nonuterine bleeding
+|-
-*:* Rectal
+|[[Endometrial cancer]]<ref name="pmid30252237">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume=  | issue=  | pages=  | pmid=30252237 | doi= | pmc= | url= }}</ref>
-*:* Urinary
+|Risk factors include:
-*:* Vaginal
-*:* Cervical
+*[[Diabetes Mellitus]]
-* Other malignancy
+*Unopposed [[estrogen]]
-* Pelvic infection
+*[[Obesity]]
-* [[Polycystic Ovarian Syndrome]] ([[Stein Leventhal Syndrome]])
+*Older age
-* Systemic disease
+*Chronic [[anovulation]]
-* [[Anorexia Nervosa]]
+*[[Ddx:Hypertension|Hypertension]]
-* Immature hypothalamic-pituitary-ovarian axis
+|Upon [[transvaginal ultrasonography]], endometrial cancer will present as a [[thicked endometrial strip]]. Confirmation requires an [[endometrial biopsy]].
-* Intense exercise
+|-
-* Nutritional status (Very low calorie diets)
+|[[Endometrial hyperplasia]]
-* Peri-menopause
+|
-* Psychologic stress <ref>Sailer, Christian, Wasner, Susanne.  Differential Diagnosis Pocket.  Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref>
+*Exogenous [[estrogen]]
+*Excess of endogenous estrogen
+*DUB (dysfunctional uterine bleeding) is a diagnosis of exclusion
+|[[Endometrial hyperplasia]] related changes may be seen on [[ultrasonography]]. Obtaining a detailed history of medication use may be of assistance in coming to a diagnosis.
+|-
+|[[Polycystic Ovarian Syndrome]] ([[Stein Leventhal Syndrome]])<ref name="pmid24379699">{{cite journal| author=Sirmans SM, Pate KA| title=Epidemiology, diagnosis, and management of polycystic ovary syndrome. | journal=Clin Epidemiol | year= 2013 | volume= 6 | issue=  | pages= 1-13 | pmid=24379699 | doi=10.2147/CLEP.S37559 | pmc=3872139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24379699  }}</ref>
+|Risk factors include:
+*[[Type 1 diabetes]]
+*[[Type 2 diabetes]]
+*[[Obesity]]
+*[[Hereditary]] factors
+|[[Polycystic ovary syndrome|PCOS]] may initially be suspected upon physical examination, commonly presenting with [[hirsutism]] and [[weight gain]]. Confirmation requires [[FSH]]/[[LH]] level abnormalities as well as multiple [[ovarian cysts]] seen on [[ultrasonography]].
+|}
+===Other Causes===
+Apart from common diseases, there are some other causes that may be potential differential diagnosis'. These include:
+*[[Endometrioma]]
+*[[Hyperprolactinemia]]
+*Hypo- or [[Hyperthyroidism]]
+*[[Hypothalamic|Hypothalamic lesion]]
+*Medications (e.g., [[Norepinephrine]])
+*Nonuterine bleeding
+*:*[[Rectal bleeding|Rectal]]
+*:*Urinary
+*:*[[Vaginal bleeding|Vaginal]]
+*:*Cervical
+*[[PID|Pelvic infection]]
+*[[Anorexia Nervosa]],  Nutritional status (Very low caloric intake) & intense exercise
+*Immature hypothalamic-pituitary-ovarian axis
+*Peri-menopause
+*Psychological distress<ref>Sailer, Christian, Wasner, Susanne.  Differential Diagnosis Pocket.  Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref>
 ==References==
@@ Line 54: / Line 85: @@
 {{WH}}
 {{WS}}
-[[Category:Needs overview]]
-[[Category:Primary care]]
+[[Category:Needs content]]
 [[Category:Disease]]
 [[Category:Gynecology]]