Endometriosis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Differential Diagnosis
Endometriosis is a cause of abnormal uterine bleeding and can result in infertility. There are several diseases which can result in excessive uterine bleeding and the following table is a description of various causes of excessive uterine bleeding.
Clinical Features | Physical Examination | Diagnostic Findings | |
---|---|---|---|
Endometriosis | dysmenorrhea and dyspareunia infertility,
Peak age 25 to 35 years bowel and bladder dysfunction, abnormal uterine bleeding, low back pain |
nodules in the posterior fornix, adnexal masses, and immobility or lateral placement of the cervix or uterus | Serum cancer antigen (CA) 125
Nodules of the rectovaginal septum Hypoechoic, vascular mass on MRI Laproscopic visualization |
Adenomyosis[1] | Abnormal uterine bleeding and dysmenorrhea
40 and 50 |
Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of gestation | Asymmetric thickening of the myometrium on MRI |
Submucous uterine leiomyomas[2] | 25 to 44 years of age
Menorrhagia Pelvic pressure and pain Infertility |
mobile uterus with an irregular contour | Transvaginal ultrasound will demonstrate the presence of myomas |
Pelvic Inflammatory disease[3] | prevalence in patients with sexually transmitted disease
multiple sexual partners age younger than 25 |
abdominal tenderness
Acute cervical motion, uterine, and adnexal tenderness Purulent endocervical discharge |
Positive Nucleic acid amplification tests for C. trachomatis and N. gonorrhoeae |
Pelvic congestion Syndrome[4] | shifting location of pain, deep dyspareunia, post-coital pain, and exacerbation of pain after prolonged standing | Bimanual tenderness
Cervical motion tenderness |
pelvic varicosities on ultrasound with reduced blood flow |
References
- ↑ Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P (2006). "Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis". Fertil Steril. 86 (3): 711–5. doi:10.1016/j.fertnstert.2006.01.030. PMID 16782099.
- ↑ Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J; et al. (2016). "Long-term medical management of uterine fibroids with ulipristal acetate". Fertil Steril. 105 (1): 165–173.e4. doi:10.1016/j.fertnstert.2015.09.032. PMID 26477496.
- ↑ Ross J, Judlin P, Jensen J, International Union against sexually transmitted infections (2014). "2012 European guideline for the management of pelvic inflammatory disease". Int J STD AIDS. 25 (1): 1–7. doi:10.1177/0956462413498714. PMID 24216035.
- ↑ Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES (2001). "Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women". AJR Am J Roentgenol. 176 (1): 119–22. doi:10.2214/ajr.176.1.1760119. PMID 11133549.