Abnormal uterine bleeding

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

Causes

Common Causes

• Dysfunctional uterine bleeding
• Leiomyomas (fibroids)
• Endometrial hyperplasia
• Abortion
• Cervicitis
• Endometrial Carcinoma
• Endometritis
• Pelvic Inflammatory Disease
• Vaginitis

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

Adenomyosis Anticoagulants Atrophy of the tissue lining the vagina and uterus Blood thinners Breakthrough bleeding in women using hormonal birth control Cancer or precancer of the cervix Cancer or precancer of the endometrium Cervicitis Chlamydia Chronic renal disease Clotting disorders Diabetes Ectopic pregnancy Endometrial hyperplasia Endometritis First few months after the first menstrual period First few weeks after abortion First few weeks after delivery Foreign body Genitourinary tract infection Gonorrhea Hyperthyroidism

Hypothyroidism Intrauterine device Irritation of the genital area due to bubble baths, soaps, lotions or infection Liver disease Miscarriage Ovarian cancer Ovarian cysts Placenta previa Polycystic ovarian syndrome Radiation therapy Retained products of conception Sexual abuse Trauma Uterine cancer Uterine fibroids Uterine infection Uterine polyps Uterine sarcoma Von Willebrand disease

Treatmen

Drugs contraindicated

• Choriogonadotropin alfa