Dysfunctional uterine bleeding differential diagnosis

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

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	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 extrogen Excess of endogenous estrogen DUB (dysfunctional uterine bleeding) is a diagnosis of exclusion	Endometrial hyperplasia realted 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)	Risk factors include: Type 1 diabetes Type 2 diabetes Obesity Hereditary facotors	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

• Endometrioma
• Hyperprolactinemia
• Hypo- or Hyperthyroidism
• Hypothalamic lesion
• Medications (e.g., Norepinephrine)
• Nonuterine bleeding

  • Rectal
  • Urinary
  • Vaginal
  • Cervical

• Other malignancy
• Pelvic infection
• Polycystic Ovarian Syndrome (Stein Leventhal Syndrome)
• Systemic disease
• Anorexia Nervosa
• Immature hypothalamic-pituitary-ovarian axis
• Intense exercise
• Nutritional status (Very low calorie diets)
• Peri-menopause
• Psychologic stress