Abnormal uterine bleeding: Difference between revisions
Nima Nasiri (talk | contribs) No edit summary |
Nima Nasiri (talk | contribs) No edit summary |
||
Line 218: | Line 218: | ||
:** Factors deficiency | :** Factors deficiency | ||
{| | {| | ||
! colspan=" | ! colspan="12" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal Uterine bleeidng differential diagnosis | ||
! | ! | ||
! | ! | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ob-Gyn neoplasm and diseases | ! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ob-Gyn neoplasm and diseases | ||
| colspan=" | | colspan="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations''' | ||
! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings | ! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings | ||
| colspan="1" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | | colspan="1" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | ||
|- | |- | ||
! colspan=" | ! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms | ||
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam | ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam | ||
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings | ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings | ||
Line 235: | Line 235: | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal | ||
vaginal bleeding | vaginal bleeding | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other Genitourinary/ Gastrointestinal symptoms | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic | ||
pain | pain | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B symptoms | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |B symptoms | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gynecological examinations | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gynecological examinations | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal | ||
Line 260: | Line 258: | ||
* Postcoital | * Postcoital | ||
* Bleeding after pelvic exam | * Bleeding after pelvic exam | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Dysuria | * Dysuria | ||
Line 267: | Line 263: | ||
* Dyspareunia | * Dyspareunia | ||
* Vaginal discharge | * Vaginal discharge | ||
* Itching or burning of the vulva | |||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Cervical mass on exam | * Cervical mass on exam | ||
Line 305: | Line 303: | ||
* Postmenopausal | * Postmenopausal | ||
* Bleeding after exam | * Bleeding after exam | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Vaginal discharge | * Vaginal discharge | ||
* Dyspareunia | * Dyspareunia | ||
| 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 335: | Line 332: | ||
* Heavy/prolonged menstrual bleeding | * Heavy/prolonged menstrual bleeding | ||
* Intermenstrual bleeding | * Intermenstrual bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Urinary retention | * Urinary retention | ||
Line 344: | Line 339: | ||
* 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;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Large,irregular pelvic mass | * Large,irregular pelvic mass | ||
Line 371: | Line 367: | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Postmenopausal bleeding | * Postmenopausal bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Difficulty urinating | * Difficulty urinating | ||
* Post-coital pain | * Post-coital pain | ||
| 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 399: | Line 394: | ||
* Intermentrual | * Intermentrual | ||
* Postmenopausal | * Postmenopausal | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Post-coital pain | * Post-coital pain | ||
* Fullness in pelvic | * Fullness in pelvic | ||
* ± Vaginal discharge | * ± Vaginal discharge | ||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Cervical mass | * Cervical mass | ||
Line 423: | Line 417: | ||
* Light bleeding after pelvic exam | * Light bleeding after pelvic exam | ||
* Spotting | * Spotting | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Post-coital pain | * Post-coital pain | ||
Line 432: | Line 424: | ||
* Dyspareunia | * Dyspareunia | ||
* Vaginal discharge | * Vaginal discharge | ||
* Itching of vulvovaginal area | |||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Red, glandular area around os of cervix | * Red, glandular area around os of cervix | ||
Line 445: | Line 439: | ||
| style="background: #F5F5F5; padding: 5px;" | | | 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> | | 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="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: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Intermenstrual bleeding | * Intermenstrual bleeding | ||
Line 452: | Line 446: | ||
* Bleeding after pelvic exam | * Bleeding after pelvic exam | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Pain during urination | * Pain during urination | ||
Line 461: | Line 452: | ||
* Painful menstruation | * Painful menstruation | ||
* Vaginal discharge | * Vaginal discharge | ||
* Itching of vulva | |||
| style="background: #F5F5F5; padding: 5px;" |+ | |||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* May have fever only | * May have fever only | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Red,inflammed swollen cervix | * Red,inflammed swollen cervix | ||
Line 481: | Line 474: | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Endometrial carcinoma | | style="background: #DCDCDC; padding: 5px; text-align: center;" | Endometrial carcinoma<ref name="BeddyO'Neill2012">{{cite journal|last1=Beddy|first1=Peter|last2=O'Neill|first2=Ailbhe C.|last3=Yamamoto|first3=Adam K.|last4=Addley|first4=Helen C.|last5=Reinhold|first5=Caroline|last6=Sala|first6=Evis|title=FIGO Staging System for Endometrial Cancer: Added Benefits of MR Imaging|journal=RadioGraphics|volume=32|issue=1|year=2012|pages=241–254|issn=0271-5333|doi=10.1148/rg.321115045}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Postmenopausal bleeding | * Postmenopausal bleeding | ||
* Intermesntrual | * Intermesntrual | ||
bleeding | bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Vaginal discharge | * Vaginal discharge | ||
* Pain during urination | |||
* Pain during sex | |||
* Fulness in pelvic | |||
* Difficulty emptying bladder | |||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
Line 505: | Line 502: | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Endometrial hyperplasia | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Endometrial hyperplasia<ref name="PalmerPerunovic2008">{{cite journal|last1=Palmer|first1=Julia E|last2=Perunovic|first2=Branko|last3=Tidy|first3=John A|title=Endometrial hyperplasia|journal=The Obstetrician & Gynaecologist|volume=10|issue=4|year=2008|pages=211–216|issn=14672561|doi=10.1576/toag.10.4.211.27436}}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Postmenopausal bleeding | * Postmenopausal bleeding | ||
* Intermenstrual bleeding | * Intermenstrual bleeding | ||
* Amenorrhea | * Amenorrhea | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
Line 540: | Line 536: | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Heavy mentrual bleeding | * Heavy mentrual bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Painful menstruation | * Painful menstruation | ||
Line 551: | Line 543: | ||
* Infertility | * Infertility | ||
* Watery vaginal discharge | * Watery vaginal discharge | ||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Pelvic pain | |||
* Back pain | |||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Tender uterosacral nodularity | * Tender uterosacral nodularity | ||
Line 575: | Line 570: | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Heavy bleeidng | * Heavy bleeidng | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Painful menstruation ±Vaginal discharge | ||
| 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;" |− | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |− | | style="background: #F5F5F5; padding: 5px;" |− | ||
Line 596: | Line 589: | ||
* Intermenstrual bleeding | * Intermenstrual bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Fever | * Fever | ||
Line 608: | Line 598: | ||
* Dysuria | * Dysuria | ||
* Dyscchezia | * Dyscchezia | ||
* Smelly grey/white vaginal discharge | * Smelly 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* − | * − | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Vaginal/vulvar tender lesion depending on microbial cause | * Vaginal/vulvar tender lesion depending on microbial cause | ||
Line 628: | Line 620: | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Abnormal uterine bleeding | * Abnormal uterine bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Painful menstruation | * Painful menstruation | ||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Polypoid mass protruding into the endocervical canal. | * Polypoid mass protruding into the endocervical canal. | ||
Line 649: | Line 640: | ||
* Bleeding after pelvic exam | * Bleeding after pelvic exam | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Pelvic pain | * Pelvic pain | ||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Soft and disporportionally enlarged uterus. | * Soft and disporportionally enlarged uterus. | ||
Line 677: | Line 667: | ||
* Postcoital bleeding | * Postcoital bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Vaginal discharge | |||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
Line 695: | Line 684: | ||
* Bleeding from lesion | * Bleeding from lesion | ||
* Oozing | * Oozing | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * ±Vaginal discharge | ||
* Pain in vulva | * Pain in vulva | ||
| style="background: #F5F5F5; padding: 5px;" | | |||
* 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;" |− | ||
* | * | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Scaly eczematoid lesion in vulva. | * Scaly eczematoid lesion in vulva. | ||
Line 720: | Line 711: | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Postcoital bleeding | * Postcoital bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Tenesmus | * Tenesmus | ||
Line 729: | Line 718: | ||
* Pelvic pain | * Pelvic pain | ||
* Vaginal discharge | * Vaginal discharge | ||
| 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 745: | Line 735: | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Postcoital bleeding | * Postcoital bleeding | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Pain during sex | * Pain during sex | ||
* Vaginal discharge | * Vaginal discharge | ||
| 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Cystic mass on exam | * Cystic mass on exam |
Revision as of 15:35, 1 February 2019
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
Treatment
Contraindicated medications
Template:Abnormal uterine bleeding Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[4]
Overview
Abnormal uterine bleeding differential diagnosis
- Abnormal uterine bleeding differential diagnosis include:
- 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 Genitourinary/ Gastrointestinal symptoms | Abdominal pain | Pelvic
pain |
B symptoms | Gynecological examinations | Abdominal
mass |
HPV
Pap smear STI panel |
Other labs | Ultrasound | Other
imagings | |||||||
Cervical cancer[1][2][3][4][5][6] |
|
|
+ |
+ | + |
|
+ | ± HPV
|
|
T2-weighted MRI :
|
|
| |||||
Cervical polyp[7] |
|
|
− | − | − |
|
− | − |
|
|
|
||||||
Cervical leiomyoma[8][9][10][11][12][13][14][15] |
|
|
+ | + | − |
|
±
|
− |
|
T2-weighted MRI:
enhancement
|
|
| |||||
Cervical lymphoma[16][17] |
|
|
+ | + | + |
|
+ | − |
|
|
| ||||||
Cervical sarcoma[18] |
|
|
+ | + | ± |
|
+ | − |
| ||||||||
Cervical erosion(Ectropion)[19][20][21] |
|
|
+ | + | − |
|
− | − | |||||||||
Cervicitis[22][23][24] |
|
|
+ | + |
|
|
− | STI panel:
|
|
||||||||
Endometrial carcinoma[25] |
bleeding |
|
+ | + | |||||||||||||
Endometrial hyperplasia[26] |
|
|
|
|
|||||||||||||
Endometriosis[27][28][29][30] |
|
|
+ |
|
− |
|
− |
|
|
||||||||
IUD use[31] |
|
|
+ | − | − | − | |||||||||||
Pelvic inflammatory diseases[32] |
|
|
± | + |
|
|
− | STI panel:
|
|
||||||||
Adnemyosis[33] |
|
|
+ | − |
|
− | |||||||||||
Cervical ectopic pregnancy[34] |
|
|
+ | − | − |
|
− |
|
T2-weighted MRI:
T1-weighted MRI:
|
|
| ||||||
DES exposure (Clear cell adenocarcinoma)[35] |
|
|
− | ||||||||||||||
Paget's disease of vulva to cervix[36][37][38] |
|
|
− | − | −
|
|
− | − |
|
| |||||||
Vaginal cancer[39] |
|
|
|
− | |||||||||||||
Nabothian cyst[40][41][42] |
|
|
− | − |
|
− | − | T1-weighted
|
Pregnancy and pregnancy related conditions | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Physical examination | |||||||||
Lab Findings | Imaging | Histopathology | ||||||||
Abnormal uterine bleeding | Other symptoms | |||||||||
Miscarriage | + |
|
|
|||||||
Abruptio placenta | + |
|
|
|||||||
Placenta previa | + |
|
||||||||
Ectopic pregnancy | + |
|
||||||||
Molar pregnancy[43] | + |
|
Ultrasound:
|
|
||||||
Hematologic conditions | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | ||||||
Symptoms | Physical examination | |||||||||
Lab findings | Imaging | Histopathology | ||||||||
Abnormal uterine
bleeding |
Other symptoms | |||||||||
Von willebrand disease[44] | + |
|
|
N/A | ||||||
Factors deficiencies | + |
|
N/A | |||||||
Platelet dysfunction | ± |
|
N/A | |||||||
Metabolic conditions | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | ||||||
Symptoms | Physical examination | |||||||||
Lab findings | Imaging | Histopathology | ||||||||
Abnormal uterine bleeding | Other symptoms | |||||||||
Hyperthyroidism[45][46] | + |
|
|
|
Ultrasound:
|
Thyroid follicles |
For Grave's disease:
|
|||
Hypothyroidism[47][48] | + |
|
|
|
Ultrasound:
|
Thyroid follicles |
|
|||
Adrenal hyperplasia[49][50] | + |
|
Depending upon deficient enzyme:
|
Depending upon enzyme deficiencies may include the following:
|
||||||
Cushing's disease[51] | + |
|
|
|
T1-weighted MRI:
|
|||||
Polycystic ovarian syndrome[52] | + |
|
|
|||||||
Hepatic disease | + | |||||||||
Medication side effects/ Iatrogenic | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | ||||||
Symptoms | Physical examination | |||||||||
Lab Findings | Imaging | Histopathology | ||||||||
Abnormal uterine bleeding | Other symptoms | |||||||||
Anticoagulants | + | |||||||||
Antipsychotics | + | |||||||||
Corticosteroids | + | |||||||||
Oral contraceptive pills | Break through bleeding | |||||||||
Herbal supplements | ||||||||||
References
- ↑ Hippisley-Cox J, Coupland C (January 2013). "Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm". Br J Gen Pract. 63 (606): e11–21. doi:10.3399/bjgp13X660733. PMC 3529288. PMID 23336450.
- ↑ Dunyo, Priscilla; Effah, Kofi; Udofia, Emilia Asuquo (2018). "Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study". BMC Public Health. 18 (1). doi:10.1186/s12889-018-6065-6. ISSN 1471-2458.
- ↑ Khalife D, El Housheimi A, Khalil A, Saba C S, Seoud M, Rammal R, Abdallah IE, Abdallah R (February 2019). "Treatment of cervical cancer metastatic to the abdominal wall with reconstruction using a composite myocutaneous flap: A case report". Gynecol Oncol Rep. 27: 38–41. doi:10.1016/j.gore.2018.12.006. PMC 6302027. PMID 30603660. Vancouver style error: name (help)
- ↑ . doi:10.1097/PAS.0000000000000498. Check
|doi=
value (help). Missing or empty|title=
(help) - ↑ Brenner PF (September 1996). "Differential diagnosis of abnormal uterine bleeding". Am. J. Obstet. Gynecol. 175 (3 Pt 2): 766–9. PMID 8828559.
- ↑ Alcázar, Juan Luis; Arribas, Sara; Mínguez, José Angel; Jurado, Matías (2014). "The Role of Ultrasound in the Assessment of Uterine Cervical Cancer". The Journal of Obstetrics and Gynecology of India. 64 (5): 311–316. doi:10.1007/s13224-014-0622-4. ISSN 0971-9202.
- ↑ Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.
- ↑ Al-Habib A, Elgamal EA, Aldhahri S, Alokaili R, AlShamrani R, Abobotain A, AlRaddadi K, Alkhalidi H (November 2016). "Large primary leiomyoma causing progressive cervical deformity". J Surg Case Rep. 2016 (11). doi:10.1093/jscr/rjw190. PMC 5159177. PMID 27887011.
- ↑ Adaikkalam J (April 2016). "Lipoleiomyoma of Cervix". J Clin Diagn Res. 10 (4): EJ01–2. doi:10.7860/JCDR/2016/16505.7531. PMID 27190823.
- ↑ Houser, L. Murray; Carrasco, C. H.; Sheehan, C. R. (1979). "Lipomatous tumour of the uterus: radiographic and ultrasonic appearance". The British Journal of Radiology. 52 (624): 992–993. doi:10.1259/0007-1285-52-624-992. ISSN 0007-1285.
- ↑ Keriakos, Remon; Maher, Mark (2013). "Management of Cervical Fibroid during the Reproductive Period". Case Reports in Obstetrics and Gynecology. 2013: 1–3. doi:10.1155/2013/984030. ISSN 2090-6684.
- ↑ Coronado GD, Marshall LM, Schwartz SM (May 2000). "Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study". Obstet Gynecol. 95 (5): 764–9. PMID 10775744.
- ↑ Kamra, Hemlata T (2013). "Myxoid Leiomyoma of Cervix". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2013/6171.3805. ISSN 2249-782X.
- ↑ El-agwany, Ahmed Samy (2015). "Lipoleiomyoma of the uterine cervix: An unusual variant of uterine leiomyoma". The Egyptian Journal of Radiology and Nuclear Medicine. 46 (1): 211–213. doi:10.1016/j.ejrnm.2014.10.001. ISSN 0378-603X.
- ↑ Chaparala RP, Fawole AS, Ambrose NS, Chapman AH (March 2004). "Large bowel obstruction due to a benign uterine leiomyoma". Gut. 53 (3): 386, 430. PMC 1773948. PMID 14960521.
- ↑ Grace A, O'Connell N, Byrne P, Prendiville W, O'Donnell R, Royston D, Walsh CB, Leader M, Kay E (1999). "Malignant lymphoma of the cervix. An unusual presentation and a rare disease". Eur. J. Gynaecol. Oncol. 20 (1): 26–8. PMID 10422676.
- ↑ Kanaan, Daniel; Parente, Daniella Braz; Constantino, Carolina Pesce Lamas; Souza, Rodrigo Canellas de (2012). "Linfoma de colo de útero: achados na ressonância magnética". Radiologia Brasileira. 45 (3): 167–169. doi:10.1590/S0100-39842012000300009. ISSN 0100-3984.
- ↑ Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK (November 2005). "Cervical sarcomas: an analysis of incidence and outcome". Gynecol. Oncol. 99 (2): 348–51. doi:10.1016/j.ygyno.2005.06.021. PMID 16051326.
- ↑ Mitchell L, King M, Brillhart H, Goldstein A (September 2017). "Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis". Sex Med. 5 (3): e212–e214. doi:10.1016/j.esxm.2017.03.001. PMC 5562466. PMID 28460993.
- ↑ Mitchell H (May 2004). "Vaginal discharge--causes, diagnosis, and treatment". BMJ. 328 (7451): 1306–8. doi:10.1136/bmj.328.7451.1306. PMC 420177. PMID 15166070.
- ↑ Sharma, Abhishek; Ojha, Ranapratap; Sengupta, Parama; Chattopadhyay, Sarbani; Mondal, Soumit (2013). "Cervical intramural pregnancy: Report of a rare case". Nigerian Medical Journal. 54 (4): 271. doi:10.4103/0300-1652.119670. ISSN 0300-1652.
- ↑ Mattson SK, Polk JP, Nyirjesy P (July 2016). "Chronic Cervicitis: Presenting Features and Response to Therapy". J Low Genit Tract Dis. 20 (3): e30–3. doi:10.1097/LGT.0000000000000225. PMID 27243142.
- ↑ Rosenfeld WD, Clark J (June 1989). "Vulvovaginitis and cervicitis". Pediatr. Clin. North Am. 36 (3): 489–511. PMID 2660084.
- ↑ Woods, Jennifer L.; Bailey, Sarabeth L.; Hensel, Devon J.; Scurlock, Amy M. (2011). "Cervicitis in Adolescents: Do Clinicians Understand Diagnosis and Treatment?". Journal of Pediatric and Adolescent Gynecology. 24 (6): 359–364. doi:10.1016/j.jpag.2011.06.006. ISSN 1083-3188.
- ↑ Beddy, Peter; O'Neill, Ailbhe C.; Yamamoto, Adam K.; Addley, Helen C.; Reinhold, Caroline; Sala, Evis (2012). "FIGO Staging System for Endometrial Cancer: Added Benefits of MR Imaging". RadioGraphics. 32 (1): 241–254. doi:10.1148/rg.321115045. ISSN 0271-5333.
- ↑ Palmer, Julia E; Perunovic, Branko; Tidy, John A (2008). "Endometrial hyperplasia". The Obstetrician & Gynaecologist. 10 (4): 211–216. doi:10.1576/toag.10.4.211.27436. ISSN 1467-2561.
- ↑ Hsu AL, Khachikyan I, Stratton P (June 2010). "Invasive and noninvasive methods for the diagnosis of endometriosis". Clin Obstet Gynecol. 53 (2): 413–9. doi:10.1097/GRF.0b013e3181db7ce8. PMC 2880548. PMID 20436318.
- ↑ Chamié, Luciana Pardini; Blasbalg, Roberto; Pereira, Ricardo Mendes Alves; Warmbrand, Gisele; Serafini, Paulo Cesar (2011). "Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy". RadioGraphics. 31 (4): E77–E100. doi:10.1148/rg.314105193. ISSN 0271-5333.
- ↑ Datta S, Kunde K (July 2008). "From vaginal discharge to endometriosis: an unusual case of endometriosis in pregnancy". J Obstet Gynaecol. 28 (5): 552–3. doi:10.1080/01443610802247352. PMID 18850447.
- ↑ Chamié, Luciana Pardini; Blasbalg, Roberto; Pereira, Ricardo Mendes Alves; Warmbrand, Gisele; Serafini, Paulo Cesar (2011). "Findings of Pelvic Endometriosis at Transvaginal US, MR Imaging, and Laparoscopy". RadioGraphics. 31 (4): E77–E100. doi:10.1148/rg.314105193. ISSN 0271-5333.
- ↑ Trobough GE (March 1978). "Pelvic pain and the IUD". J Reprod Med. 20 (3): 167–74. PMID 347074.
- ↑ Hoenderboom BM, van Benthem B, van Bergen J, Dukers-Muijrers N, Götz HM, Hoebe C, Hogewoning AA, Land JA, van der Sande M, Morré SA, van den Broek I (January 2019). "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". Sex Transm Infect. doi:10.1136/sextrans-2018-053778. PMID 30606817. Vancouver style error: initials (help)
- ↑ Filip G, Balzano A, Cagnacci A (November 2018). "Histological evaluation of the prevalence of adenomyosis, myomas and of their concomitance". Minerva Ginecol. doi:10.23736/S0026-4784.18.04291-0. PMID 30486633.
- ↑ Mouhajer M, Obed S, Okpala AM (June 2017). "Cervical Ectopic Pregnancy in Resource Deprived Areas: A Rare and Difficult Diagnosis". Ghana Med J. 51 (2): 94–97. PMC 5611908. PMID 28955106.
- ↑ Tantitamit T, Hamontri S, Rangsiratanakul L (May 2017). "Clear cell adenocarcinoma of the cervix in second generation young women who are without maternal exposure to diethylstilbestrol: A case report". Gynecol Oncol Rep. 20: 34–36. doi:10.1016/j.gore.2017.02.008. PMC 5328756. PMID 28275694.
- ↑ van der Linden, M.; Meeuwis, K.A.P.; Bulten, J.; Bosse, T.; van Poelgeest, M.I.E.; de Hullu, J.A. (2016). "Paget disease of the vulva". Critical Reviews in Oncology/Hematology. 101: 60–74. doi:10.1016/j.critrevonc.2016.03.008. ISSN 1040-8428.
- ↑ Lloyd J, Evans DJ, Flanagan AM (July 1999). "Extension of extramammary Paget disease of the vulva to the cervix". J. Clin. Pathol. 52 (7): 538–40. PMC 501500. PMID 10605411.
- ↑ Shaco-Levy R, Bean SM, Vollmer RT, Papalas JA, Bentley RC, Selim MA, Robboy SJ (January 2010). "Paget disease of the vulva: a histologic study of 56 cases correlating pathologic features and disease course". Int. J. Gynecol. Pathol. 29 (1): 69–78. doi:10.1097/PGP.0b013e3181b1cc5e. PMID 19952933.
- ↑ Tarney CM, Han J (2014). "Postcoital bleeding: a review on etiology, diagnosis, and management". Obstet Gynecol Int. 2014: 192087. doi:10.1155/2014/192087. PMC 4086375. PMID 25045355.
- ↑ Casey PM, Long ME, Marnach ML (February 2011). "Abnormal cervical appearance: what to do, when to worry?". Mayo Clin. Proc. 86 (2): 147–50, quiz 151. doi:10.4065/mcp.2010.0512. PMC 3031439. PMID 21270291.
- ↑ Bin Park, Sung; Lee, Jong Hwa; Lee, Young Ho; Song, Mi Jin; Choi, Hye Jeong (2010). "Multilocular Cystic Lesions in the Uterine Cervix: Broad Spectrum of Imaging Features and Pathologic Correlation". American Journal of Roentgenology. 195 (2): 517–523. doi:10.2214/AJR.09.3619. ISSN 0361-803X.
- ↑ Okamoto, Yoshikazu; Tanaka, Yumiko O.; Nishida, Masato; Tsunoda, Hajime; Yoshikawa, Hiroyuki; Itai, Yuji (2003). "MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation". RadioGraphics. 23 (2): 425–445. doi:10.1148/rg.232025065. ISSN 0271-5333.
- ↑ Jeffers MD, O'Dwyer P, Curran B, Leader M, Gillan JE (October 1993). "Partial hydatidiform mole: a common but underdiagnosed condition. A 3-year retrospective clinicopathological and DNA flow cytometric analysis". Int. J. Gynecol. Pathol. 12 (4): 315–23. PMID 8253548.
- ↑ Castaman, Giancarlo; Linari, Silvia (2017). "Diagnosis and Treatment of von Willebrand Disease and Rare Bleeding Disorders". Journal of Clinical Medicine. 6 (4): 45. doi:10.3390/jcm6040045. ISSN 2077-0383.
- ↑ Deshmukh, Prasad; Boricha, B.; Pandey, Ankita (2015). "The association of thyroid disorders with abnormal uterine bleeding". International Journal of Reproduction, Contraception, Obstetrics and Gynecology: 701–708. doi:10.18203/2320-1770.ijrcog20150077. ISSN 2320-1770.
- ↑ Pishdad P, Pishdad GR, Tavanaa S, Pishdad R, Jalli R (March 2017). "Thyroid Ultrasonography in Differentiation between Graves' Disease and Hashimoto's Thyroiditis". J Biomed Phys Eng. 7 (1): 21–26. PMC 5401130. PMID 28451576.
- ↑ Deshmukh, Prasad; Boricha, B.; Pandey, Ankita (2015). "The association of thyroid disorders with abnormal uterine bleeding". International Journal of Reproduction, Contraception, Obstetrics and Gynecology: 701–708. doi:10.18203/2320-1770.ijrcog20150077. ISSN 2320-1770.
- ↑ Pishdad P, Pishdad GR, Tavanaa S, Pishdad R, Jalli R (March 2017). "Thyroid Ultrasonography in Differentiation between Graves' Disease and Hashimoto's Thyroiditis". J Biomed Phys Eng. 7 (1): 21–26. PMC 5401130. PMID 28451576.
- ↑ Vigliani MB, Buster JE (April 2012). "Nonclassic 21-hydroxylase deficiency presenting as endometrial hyperplasia with uterine bleeding in a 67-year-old woman". Fertil. Steril. 97 (4): 950–2. doi:10.1016/j.fertnstert.2012.01.089. PMID 22270556.
- ↑ . doi:10.1515/jpem-2017-0235. Check
|doi=
value (help). Missing or empty|title=
(help) - ↑ Zada, Gabriel (2013). "Diagnosis and Multimodality Management of Cushing's Disease: A Practical Review". International Journal of Endocrinology. 2013: 1–7. doi:10.1155/2013/893781. ISSN 1687-8337.
- ↑ Lie Fong, S.; Laven, J.S.E.; Duhamel, A.; Dewailly, D. (2017). "Polycystic ovarian morphology and the diagnosis of polycystic ovary syndrome: redefining threshold levels for follicle count and serum anti-Müllerian hormone using cluster analysis". Human Reproduction. 32 (8): 1723–1731. doi:10.1093/humrep/dex226. ISSN 0268-1161.