eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology
Dysfunctional Uterine Bleeding: Differential Diagnoses & Workup
Updated: Feb 1, 2010
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
| Abortion, Complete | Fibroids (leiomyomata) |
| Abortion, Incomplete | Foreign body |
| Abortion, Inevitable | Hydatidiform Mole |
| Abortion, Missed | Hyperthyroidism |
| Abortion, Threatened | Hypothyroidism |
| Abruptio Placentae | Intrauterine devices |
| Adenomyosis | Liver disease |
| Anovulation | Mullerian Duct Anomalies |
| Anticoagulants | Oral contraceptives |
| Antipsychotics | Ovarian Cysts |
| Arteriovenous Malformations | Pelvic Inflammatory Disease |
| Cervical Cancer | Placenta Previa |
| Cervicitis | Platelet Disorders |
| Coagulopathies | Polycystic Ovarian Syndrome |
| Cushing Syndrome | Pregnancy, Ectopic |
| Endocervical Polyp | Prolactinoma |
| Endometrial Carcinoma | Renal disease |
| Endometrial Polyp | Trauma |
| Endometriosis | von Willebrand Disease |
| Estrogen Therapy | Vulvovaginitis |
Workup
Laboratory Studies
- When evaluating a woman of reproductive age with vaginal bleeding, pregnancy must always be ruled out by urine or serum human chorionic gonadotropin.
- In a patient with any hemodynamic instability, excessive bleeding, or clinical evidence of anemia, a complete blood count is essential.
- Coagulation studies should be considered when indicated by the history or physical examination findings and in patients with underlying liver disease or other coagulopathies.
- In patients with suspected endocrine disorders, other laboratory studies such as thyroid function tests and prolactin levels may be helpful, although these results may not be available from the ED.
Imaging Studies
- Pelvic ultrasonography is an important imaging modality for nonpregnant patients with abnormal vaginal bleeding. It may determine the etiology of the bleeding such as a fibroid uterus, endometrial thickening, or a focal mass.
- Thickened endometrium may indicate an underlying lesion or excess estrogen and may be suggestive of malignancy.
- An endometrial stripe measuring less than 4 mm thick is unlikely to have endometrial hyperplasia or cancer, and biopsy is often considered unnecessary before treatment.
- Women with a normal endometrial stripe (5–12 mm) may require biopsy, particularly if they have risk factors for endometrial cancer.
- When the endometrial stripe is larger than 12 mm, a biopsy should be performed.6
- Depending on the urgency to determine the etiology of bleeding and on the reliability of outpatient follow-up, ultrasonography may be deferred for outpatient evaluations because for the majority of nonpregnant patients, ultrasonographic findings do not immediately affect ED decision-making.3
- Thickened endometrium may indicate an underlying lesion or excess estrogen and may be suggestive of malignancy.
- Transvaginal ultrasonography may be particularly helpful in further delineating ovarian cysts and fluid in the cul-de-sac.
- Computed tomography is used primarily for evaluation of other causes of acute abdominal or pelvic pain.
- Magnetic resonance imaging is used primarily for cancer staging.
Procedures
- Before instituting therapy, many consulting gynecologists perform endometrial sampling or biopsy to diagnose intrauterine pathology and to exclude endometrial malignancy.
- Endometrial biopsy is indicated for the following patients with abnormal uterine bleeding6 :
- Women older than 35 years
- Obese patients
- Women who have prolonged periods of unopposed estrogen stimulation
- Women with chronic anovulation
- Hysteroscopy is the definitive way to detect intrauterine lesions. It offers a more complete examination of the surface of the endometrium. However, it is usually reserved for treating lesions that were detected by other less invasive means.
More on Dysfunctional Uterine Bleeding |
| Overview: Dysfunctional Uterine Bleeding |
 Differential Diagnoses & Workup: Dysfunctional Uterine Bleeding |
| Treatment & Medication: Dysfunctional Uterine Bleeding |
| Follow-up: Dysfunctional Uterine Bleeding |
| References |
| « Previous Page | Next Page » |
References
Frick KD, Clark MA, Steinwachs DM, et al. Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment. Womens Health Issues. Jan-Feb 2009;19(1):70-8. [Medline].
Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG. Abnormal uterine bleeding. In: Williams Gynecology. McGraw-Hill; 2008:Chap 8.
Tibbles CD. Selected gynecologic disorders. In: Marx JA, Hockberger RS, Walls RM, Adams JG. Rosen's Emergency Medicine: Concepts and Clinical Practice. Vol 1. 7th ed. Mosby (Elsevier); 2009:Chap 98.
Pitkin J. Dysfunctional uterine bleeding. BMJ. May 26 2007;334(7603):1110-1. [Medline].
[Guideline] James AH, Kouides PA, Abdul-Kadir R, et al. Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel. Am J Obstet Gynecol. Jul 2009;201(1):12.e1-8. [Medline].
Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. Jun 2008;35(2):219-34, viii. [Medline].
[Best Evidence] Hickey M, Higham J, Fraser IS. Progestogens versus oestrogens and progestogens for irregular uterine bleeding associated with anovulation. Cochrane Database Syst Rev. Oct 17 2007;CD001895. [Medline].
Dickersin K, Munro MG, Clark M, et al. Hysterectomy compared with endometrial ablation for dysfunctional uterine bleeding: a randomized controlled trial. Obstet Gynecol. Dec 2007;110(6):1279-89. [Medline].
Further Reading
Keywords
dysfunctional uterine bleeding, DUB, dysfunctional uterine bleeding symptoms, dysfunctional uterine bleeding causes, abnormal uterine bleeding, abnormal vaginal bleeding, menorrhagia, metrorrhagia, menometrorrhagia, amenorrhea, oligomenorrhea, vaginal carcinoma, cervical cancer, uterine cancer, ovarian cancer, functional ovarian cysts, cervicitis, endometritis, salpingitis, vaginal infection
