Differential diagnosis of abnormal uterine bleeding,☆☆,

https://doi.org/10.1016/S0002-9378(96)80082-2Get rights and content

Abstract

The causes of abnormal uterine bleeding include a wide spectrum of diseases of the reproductive system and nongynecologic causes as well. The differential diagnosis of abnormal excessive uterine bleeding includes organic causes that may be subdivided into reproductive tract disease, iatrogenic causes, and systemic disease. Reproductive tract disease that may result in abnormal uterine bleeding comprises the complications of pregnancy (threatened, incomplete, or missed abortion, ectopic pregnancy, trophoblastic disease, placental polyp, and subinvolution of the placental site), malignant tumors (endometrial, cervical, vaginal, vulvar, and oviduct malignancies and granulosa theca cell ovarian tumors), infection (endometritis, salpingitis), and other benign pelvic disorders (traumatic lesions of the vagina, severe vaginal infections, foreign bodies, cervical polyps, cervical erosion, cervicitis, submucous uterine leiomyomas, adenomyosis, endometriosis, and endometrial polyps). Iatrogenic causes of abnormal uterine bleeding include sex steroids, hypothalamic depressants, digitalis, phenytoin, anticoagulants, and intrauterine contraceptive devices. Systemic diseases that may cause abnormal uterine bleeding include hypothyroidism, cirrhosis, and coagulation disorders. Abnormal uterine bleeding that occurs in a woman of reproductive age should be considered the result of a complication of pregnancy until proved otherwise. Abnormal uterine bleeding occurring in a woman of perimenopausal or postmenopausal age should be considered the result of a malignancy until proved otherwise. Menorrhagia occurring in an adolescent should be attributed to a coagulopathy until proved otherwise. When an organic cause of abnormal uterine bleeding cannot be found, then by exclusion the diagnosis of dysfunctional uterine bleeding is assumed. Coagulation disorders, particularly von Willebrand disease, are more common than many physicians realize. Women with a history of high-risk factors, all adolescents with menorrhagia, women with anovulatory dysfunctional uterine bleeding who fail medical or surgical therapy, and women with ovulatory dysfunctional uterine bleeding without an anatomic uterine lesion should be screened for a coagulopathy. (Am J Obstet Gynecol 1996;175:766-9.)

Section snippets

PRESENTATIONS OF ABNORMAL UTERINE BLEEDING

Abnormal uterine bleeding includes a decrease (hypomenorrhea) or increase (menorrhagia) in blood loss during menses (volume), a decrease (oligomenorrhea) or an increase (polymenorrhea) in the number of bleeding episodes (number of menses), a decrease or an increase (menorrhagia) in the length of menses (number of days), and irregular bleeding episodes that occur at frequent intervals between menses (metrorrhagia). Abnormal uterine bleeding may also occur as prolonged bleeding at irregular

DIFFERENTIAL DIAGNOSIS OF ABNORMAL UTERINE BLEEDING

The differential diagnosis of abnormal excessive uterine bleeding includes organic causes, which may be subdivided into reproductive tract disease, iatrogenic causes, and systemic disease and, in the absence of an organic cause, dysfunctional uterine bleeding (Table I). The diagnosis of dysfunctional uterine bleeding is made by excluding all organic causes.

References (23)

  • DA Grimes

    Estimating vaginal blood loss

    J Reprod Med

    (1979)
  • Cited by (0)

    From the Department of Obstetrics and Gynecology, University of Southern California School of Medicine.

    ☆☆

    Reprint requests: Paul F. Brenner, MD, Women's and Children's Hospital, Room L1009, 1240 N. Mission Road, Los Angeles, CA 90033.

    0002-9378/96 $5.00 + 0 6/0/72477

    View full text